Deepening Our Understanding of COVID-19 Vaccine Decision-Making amongst Healthcare Workers in Southwest Virginia, USA Using Exploratory and Confirmatory Factor Analysis.

Vaccine hesitancy amongst healthcare workers (HCWs) has been a major challenge throughout the COVID-19 pandemic. While many studies have identified HCW characteristics and specific attitudes associated with COVID-19 vaccine hesitancy, researchers are still working towards developing a holistic understanding of the psychological constructs that influence COVID-19 vaccine decision-making in this population. Between 15 March and 29 March 2021, we distributed an online survey assessing individual characteristics and vaccine-related perceptions to employees of a not-for-profit healthcare system in Southwest Virginia (N = 2459). We then performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to describe patterns of vaccine-related thought amongst HCWs and identify latent psychometric constructs involved in vaccine decision-making. The goodness of model fit was assessed using the Tucker-Lewis Index (TLI), the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RMSEA). Internal consistency and reliability of each factor were assessed using Cronbach's alpha. EFA identified four latent psychometric constructs: Lack of trust in the COVID-19 vaccine; Anti-science sentiment; Adverse side-effects; and Situational risk assessment. The goodness of EFA model fit was adequate (TLI > 0.90, RMSEA ≤ 0.08) with acceptable internal consistency and reliability for three of four factors (Cronbach's alpha > 0.70). The CFA model also had adequate goodness of fit (CFI > 0.90, RMSEA ≤ 0.08). We believe the psychometric constructs identified in this study can provide a useful framework for interventions to improve vaccine uptake amongst this critical population.

Examining drivers of coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare workers.

OBJECTIVE: To assess characteristics and perceptions associated with vaccine hesitancy among healthcare workers to increase coronavirus disease 2019 (COVID-19) vaccine uptake in this population. DESIGN: Cross-sectional quantitative survey. SETTING: A not-for-profit healthcare system in southwestern Virginia. PARTICIPANTS: A convenience sample of 2,720 employees of a not-for-profit healthcare system. METHODS: Between March 15 and 29, 2021, we conducted an Internet-based survey. Our questionnaire assessed sociodemographic and work-related characteristics, vaccine experience and intentions, agreement with vaccine-related perceptions, the most important reasons for getting or not getting vaccinated, and trusted sources of information about COVID-19. We used χ2 analyses to assess the relationship between vaccine hesitancy and both HCW characteristics and vaccine-related perceptions. RESULTS: Overall, 18% of respondents were classified as vaccine hesitant. Characteristics significantly associated with hesitancy included Black race, younger age, not having a high-risk household member, and prior personal experience with COVID-19 illness. Vaccine hesitancy was also significantly associated with many vaccine-related perceptions, including concerns about short-term and long-term side effects and a belief that the vaccines are not effective. Among vaccine-acceptant participants, wanting to protect others and wanting to help end the pandemic were the most common reasons for getting vaccinated. Personal physicians were cited most frequently as trusted sources of information about COVID-19 among both vaccine-hesitant and vaccine-acceptant respondents. CONCLUSIONS: Educational interventions to decrease vaccine hesitancy among healthcare workers should focus on alleviating safety concerns, emphasizing vaccine efficacy, and appealing to a sense of duty. Such interventions should target younger adult audiences. Personal physicians may also be an effective avenue for reducing hesitancy among their patients through patient-centered discussions.

Early clinical observations in prospectively followed patients with fungal meningitis related to contaminated epidural steroid injections.

UNLABELLED: Chinese translation BACKGROUND: Administration of epidural steroid injections (ESIs) with contaminated methylprednisolone resulted in an outbreak of fungal meningitis in many locations in the United States. OBJECTIVE: To characterize early clinical findings and initial response to treatment. DESIGN: Case series with standardized observation studied from 4 October to 31 October 2012. SETTING: An 800-bed hospital in Virginia. PATIENTS: 172 patients who presented to the hospital with exposure to contaminated ESI. INTERVENTION: Standardized approach to screening, case definition, treatment, and data collection. MEASUREMENTS: Clinical findings, cerebrospinal fluid (CSF) values, magnetic resonance imaging (MRI), serum and CSF voriconazole concentrations, and clinician assessment of response to therapy. RESULTS: Of 172 patients presenting to the hospital who had had ESI, 131 had lumbar puncture because of symptoms or signs consistent with central nervous system disease. Twenty-five (19%) had neutrophilic meningitis. All were started on voriconazole therapy alone. Three patients developed stroke during treatment. Ten patients had arachnoiditis, another had an epidural abscess, and 9 had urine retention. Fifteen continued to receive voriconazole, and 10 were switched to amphotericin B. Cerebrospinal fluid leukocyte counts began to decrease by day 13 of treatment. Findings on MRI included ventriculitis, leptomeningeal enhancement, infarction, hemorrhage, and arachnoiditis. Serum voriconazole levels varied, and CSF concentrations of voriconazole were approximately 50% those of serum. Exserohilum rostratum and Cladosporium species have been cultured. LIMITATIONS: This is an observational study of an evolving outbreak. Not all exposed patients presented for evaluation. Follow-up is too short to determine final outcomes. CONCLUSION: Meningitis after receipt of contaminated ESI has been diagnosed in many exposed patients presenting to 1 hospital. Most patients have improved on receipt of empirical voriconazole therapy. The full natural history and long-term sequelae of this infection are currently unknown. PRIMARY FUNDING SOURCE: None.

Estudo comparativo cego com cefuroxima e cefaclor no tratamento das infecçöes das vias respiratórias inferiores / Blind comparative study with cefuroxime and ceflacor in the treatment of the inferior duct respiratory infections

A acetil cefuroxima foi comparada ao cefaclor no tratamento de infecçöes das vias respiratórias inferiores. Sessenta e um paciente foram distribuídos aleatoriamente em três grupos e se submeteram aos seguintes esquemas pososlógicos: (1) axetil cefuroxima, 250 mg por via oral cada 12 horas (21 pacientes); (2) axetil cefuroxima, 500 mg por via oral cada 12 horas (21 pacientes); 3 (3) cefaclor, 500 mg por via oral cada oito horas (19 pacientes). Desses 61 pacientes, 80 por cento eram homens, com idade média de 59,5 anos; 56 por cento apresentavam pneumonia aguda enquanto o restante tinha bronquite aguda. Os patógenos causais incluíram patógenos típicos do trato respiratório. Em suma 23 de 27 pacientes com bronquite estavam clinicamente curados ao se concluído o tratamento. Trinta e um dos 34 casos de pneumonia foram clinicamente curados ou melhoraram ao término da terapia; as três falhas terapêuticas em pacientes com pneumonia ocorreram nos grupos tratados com a menor dose cefuroxima (n=2) e de cefaclor (n=1). De modo geral, houve cura bacteriológica em 86 por cento dos pacientes tratados com 500mg de axetil cefuroxima em comparaçäo com 60 por cento dos pacientes que receberam tratamento com cefaclor. Os efeitos adversos foram raros. Baseando-se neste estudo, concluiu-se que a axetil cefuroxima, administrada cada 12 horas, é pelo menos, täo eficaz quanto o cefaclor em termos clínicos; trata-se de uma nova cefalosporina oral que, em comparaçäo com muitos outros agentes mais antigos, apresenta vantagens farmacológicas e de espectro antibacteriano