Mapping the Cognitive Biases Related to Vaccination: A Scoping Review of the Literature.

INTRODUCTION: Human behavior and understanding of the vaccine ecosystem play a critical role in the vaccination decision-making process. The objective of this study was to understand different cognitive biases that may lead to vaccine acceptance or hesitancy. METHODS: The eligibility criteria for this scoping review was vaccination-related cognitive bias studies published in the English language from inception to April 2022 and available on PubMed, Embase, and Google Scholar. It included all geographical locations and individuals of all age groups and excluded studies focusing on (i) clinical trials of vaccines, (ii) vaccine research conduct bias, (iii) cognitive delay, or (iv) statistical biases. The search method also included reviewing references in the retrieved articles. RESULTS: Overall, 58 articles were identified, and after screening, 19 were included in this study. Twenty-one cognitive biases with the potential to affect vaccination decision-making were observed. These biases were further grouped into three broad categories: cognitive biases seen while processing vaccine-related information, during vaccination-related decision-making, and due to prior beliefs regarding vaccination. CONCLUSIONS: This review identified critical cognitive biases affecting the entire process of vaccination that can influence research and public health efforts both positively and negatively. Recognizing and mitigating these cognitive biases is crucial for maintaining the population's level of trust in vaccination programs around the world.

Development of a Choice-framework for Covid vaccines in India using a multi-criteria decision analysis approach.

BACKGROUND: Vaccines were crucial in controlling the Covid-19 pandemic. As more vaccines receive regulatory approval, stakeholders will be faced with several options and must make an appropriate choice for themselves. We proposed a multi-criteria decision analysis (MCDA) framework to guide decision-makers in comparing vaccines for the Indian context. METHODS: We adhered to the ISPOR guidance for the MCDA process. Seven vaccine options were compared under ten criteria. Through three virtual workshops, we obtained opinions and weights from citizens, private-sector hospitals, and public health organisations. Available evidence was rescaled and incorporated into the performance matrix. The final score for each vaccine was calculated for the different groups. We performed different sensitivity analyses to assess the consistency of the rank list. RESULTS: The cost, efficacy and operational score of the vaccines had the highest weights among the stakeholders. From the six scenario groups, Janssen had the highest score in four. This was driven by the advantage of having a single dose of vaccination. In the probabilistic sensitivity analysis for the overall group, Covaxin, Janssen, and Sputnik were the first three options. The participants expressed that availability, WHO approvals and safety, among others, would be crucial when considering vaccines. CONCLUSIONS: The MCDA process has not been capitalised on in healthcare decision-making in India and LMICs. Considering the available data and stakeholder preference at the time of the study, Covaxin, Janssen, and Sputnik were preferred options. The choice framework with the dynamic performance matrix is a valuable tool that could be adapted to different population groups and extended based on increasing vaccine options and emerging evidence. *ISPOR - The Professional Society for Health Economics and Outcomes Research.

Application of the revised WHO causality assessment protocol for adverse events following immunization in India.

BACKGROUND: In 2013, the World Health Organization (WHO) and CIOMS introduced a revised Causality Assessment Protocol (CAP) for Adverse Events following Immunization (AEFI). India is one of the first countries to adopt the revised CAP. This study describes the application of the revised CAP in India. METHODS: We describe use of CAP by India's AEFI surveillance program to assess reported AEFIs. Using publicly available results of causality assessment for reported AEFIs, we describe the results by demographic characteristics and review the trends for the results of the causality assessment. RESULTS: A total of 771 reports of AEFI between January 2012 and January 2015, completed causality review by August 2016. The cases were reported as belonging to a cluster (54%; n=302), hospitalized or requiring hospitalization (41%; n=270), death (25%; n=195), or resulting in disability (0.4%; n=3). The most common combinations of vaccines leading to report of an AEFI were DTwP, Hepatitis B, and OPV (14%; n=106), followed by Pentavalent and OPV (13%; n=103), and JE vaccine (13%; n=101). Using the WHO Algorithm, most AEFI reports (89%, n=683) were classifiable. Classifiable AEFI reports included those with a consistent causal association (53%; n=407), an inconsistent causal association (29%; n=226) or were indeterminate causal association with implicated vaccine(s) or vaccination process (6.5%; n=50) (Fig. 1); 88 reports remained unclassifiable. CONCLUSIONS: The revised CAP was informative and useful in classifying most of the reviewed AEFIs in India. Unclassifiable reports could be minimized with more complete information from health records. Improvements in causality assessment, and standardization in reporting between countries, can improve public confidence in vaccine system performance and identify important vaccine safety signals.

Severity and clustering of menopausal symptoms among obese and nonobese postmenopausal women in India.

BACKGROUND: The symptoms of menopause have a negative impact on quality of life, especially in women transitioning to menopause and earlier transitions. This study was conducted with the objective of assessing the effect of obesity on the severity of menopausal symptoms and the clustering of symptoms in postmenopausal women in India. METHODOLOGY: The Menopausal Rating Scale (MRS) was used to assess the severity of menopausal symptoms of postmenopausal women of Chennai, visiting Saveetha Medical College, Chennai, India. This cross-sectional study was conducted from August to November 2013 in Chennai, India. Sociodemographic characteristics, anthropometric measurements, blood pressure level, menopausal history, personal health history, and hormonal disorder issues were investigated. RESULTS: The results have shown that 24% of the participants had complaint of mild to severe hot flushes, half of them had reported heart ailments (49%; n = 74), and disturbed sleep (48%; n = 72). The proportion of overweight/obese participants was higher in married (64%) than widows (41%), and this difference was found statistically significant (P = 0.005). There were no significant differences in MRS scores of obese and nonobese postmenopausal participants. CONCLUSION: There is a need of developing interactive, user friendly, technology based education module for addressing the chronic ailments of postmenopausal women.

Multiple Risk Factors of Alcoholic and Non-Alcoholic Myocardial Infarction Patients.

BACKGROUND: Myocardial infarction (MI) is one of the most critical medical emergency and contributor to morbidity and mortality worldwide. Myocardial infarction is the most common form of coronary heart disease and leading cause of premature death. Past century has seen substantial advancement in the field of medical sciences but still mortality trends due to myocardial infarction is increasing in developing countries including India. We have conducted this study to compare the Sociodemographic characteristics of alcoholic and non alcoholic MI patients admitted in coronary care unit of Saveetha Medical College, Chennai, India. METHODS: An exploratory cross sectional study was performed by enrolling a convenient sample of 100 Myocardial Infarction patients. Information about Sociodemographic characteristics, past medical history, alcohol and tobacco intake, physical activity, psychological stress and biochemical measurements was gathered. RESULTS: The mean age of the respondents was 46 (SD=6) years and majority of them were male i.e. 82%. 100% married and 89% literate, there were 24% past and 22% present alcoholics. Consumption of alcohol on a monthly, weekly and daily basis was 8%, 11% and 5% respectively. Preference to brandy was 67%, rum was 21% and that the beer was 12%. Current smoker were 20% and former were 11%. 93% and 52% respondents were under medication of beta blocker and angiotensin-converting-enzyme (ACE) inhibitors respectively. CONCLUSION: Worldwide, MI is the most common cause of mortality and morbidity and hence early diagnosis and management is most essential. Results from our study revealed that, participants had sedentary lifestyles where risk factors of MI such as alcohol consumption, and smoking does existed.

Water and sanitation hygiene knowledge, attitude, and practices among household members living in rural setting of India.

BACKGROUND: Rural population in developing countries face water, sanitation, and hygiene-related health issues. To objectively highlight these issues, we studied the knowledge, attitude, and practices-related to drinking water and sanitation facilities among the rural population of Chennai, India. MATERIALS AND METHODS: A cross-sectional study was designed involving individuals over 18 years of age living in Thandalam village, Chennai, India. Basic information about sociodemographic profile and existing drinking water and sanitation related knowledge, attitude, and practices was collected using a modified version of previously validated questionnaire and analyzed. RESULTS: Forty-five percent of the participants were not following any methods of water treatment and among them half of the participants felt that water available to them was clean and did not require any additional treatment. Twenty-five percent of the participants surveyed did not have access to toilets inside their household. CONCLUSION: There is a need for intervention to educate individuals about drinking water treatment methods, sanitation, and hand washing practices.

Exploring Factors that Influence Smoking Initiation and Cessation among Current Smokers.

INTRODUCTION: Worldwide, cigarette smoking kills 5 million people annually, and leads to illness, disability and death. This study aimed to assess the factors influencing smoking initiation and cessation among current smokers in Chennai, India. MATERIALS AND METHODS: This cross-sectional study was conducted in September 2013 in Chennai, India. A convenient sample of 100 current smokers aged >15 years was enrolled. A modified version of Alcohol, Smoking and Substance Involvement Screen Test (ASSIST) questionnaire was used to gather information on socio-demographics, smoking initiation and cessation, expenditure on smoking products and perceptions on incentives for smoking cessation. RESULTS: Surrounding influence (44%), stress (42%) and fun (40%) were major reasons for smoking initiation. Majority of participants (68%) attempted to quit smoking within past 6 months but failed. Health promotion programs (61%) and financial incentives (20%) were perceived to be helpful in smoking cessation. CONCLUSION: Smoking cessation strategies, especially at workplaces, should target the multi-factorial nature of smoking initiation and cessation. There is a need to review national guidelines to evaluate the accessibility and availability of smoking products in and around the workplace.