Beyond the "information deficit model" - understanding vaccine-hesitant attitudes of midwives in Austria: a qualitative study.

BACKGROUND: Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives' influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives' attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives' vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. METHODS: We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. RESULTS: Healthcare workers' stewardship to address vaccine hesitancy is commonly framed in terms of the "information deficit model": disseminate the right information and remedy publics' information deficits. Our findings suggest that this approach is too simplistic: Midwives' professional self-understanding, their notions of "good care" and "good parenthood" inflect how they engage with vaccine information and how they address it to their clients. Midwives' model of care prioritized good counseling rather than sharing scientific information in a "right the wrong"-manner. They saw themselves as critical consumers of that information and as promoting "empowered patients" who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. CONCLUSIONS: Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals' means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals' views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.

Neurophysiological evidence for evaluative feedback processing depending on goal relevance.

Feedback signaling the success or failure of actions is readily exploited to implement goal-directed behavior. Two event-related brain potentials (ERPs) have been identified as reliable markers of evaluative feedback processing: the Feedback-Related Negativity (FRN) and the P3. Recent ERP studies have shown a substantial reduction of these components when the feedback's goal relevance (in terms of goal informativeness) was decreased. However, it remains unclear whether this lowering of evaluative feedback processing at the FRN and P3 levels (i) reflects a common regulation process operating across them or (ii) indirectly and mostly depends on valence processing. To address these questions, 44 participants performed a time estimation task wherein the perceived goal relevance of the feedback following each decision was manipulated via instructions in different blocks. We recorded 64-channel EEG and collected subjective ratings of feedback valence and relevance, separately for goal-relevant and irrelevant conditions. ERP results showed a substantial reduction of the FRN and P3 components for irrelevant than relevant feedback, despite the balanced task relevance between them. Moreover, a Principal Component Analysis (PCA) showed that these two successive ERP effects had dissociable spatiotemporal properties. Crucially, a multivariate multiple regression analysis revealed that goal relevance per se, but not valence, was the unique significant predictor of the amplitude reduction of the FRN and P3 when the feedback was goal irrelevant. Our results suggest that although these ERP components exhibit non-overlapping spatiotemporal properties and performance monitoring effects, they can both be modulated by a common, valence-unspecific process related to goal relevance.

The pulvinar nucleus and antidepressant treatment: dynamic modeling of antidepressant response and remission with ultra-high field functional MRI.

Functional magnetic resonance imaging (fMRI) successfully disentangled neuronal pathophysiology of major depression (MD), but only a few fMRI studies have investigated correlates and predictors of remission. Moreover, most studies have used clinical outcome parameters from two time points, which do not optimally depict differential response times. Therefore, we aimed to detect neuronal correlates of response and remission in an antidepressant treatment study with 7 T fMRI, potentially harnessing advances in detection power and spatial specificity. Moreover, we modeled outcome parameters from multiple study visits during a 12-week antidepressant fMRI study in 26 acute (aMD) patients compared to 36 stable remitted (rMD) patients and 33 healthy control subjects (HC). During an electrical painful stimulation task, significantly higher baseline activity in aMD compared to HC and rMD in the medial thalamic nuclei of the pulvinar was detected (p = 0.004, FWE-corrected), which was reduced by treatment. Moreover, clinical response followed a sigmoid function with a plateau phase in the beginning, a rapid decline and a further plateau at treatment end. By modeling the dynamic speed of response with fMRI-data, perigenual anterior cingulate activity after treatment was significantly associated with antidepressant response (p < 0.001, FWE-corrected). Temporoparietal junction (TPJ) baseline activity significantly predicted non-remission after 2 antidepressant trials (p = 0.005, FWE-corrected). The results underline the importance of the medial thalamus, attention networks in MD and antidepressant treatment. Moreover, by using a sigmoid model, this study provides a novel method to analyze the dynamic nature of response and remission for future trials.

Mood congruent tuning of reward expectation in positive mood: evidence from FRN and theta modulations.

Positive mood broadens attention and builds additional mental resources. However, its effect on performance monitoring and reward prediction errors remain unclear. To examine this issue, we used a standard mood induction procedure (based on guided imagery) and asked 45 participants to complete a gambling task suited to study reward prediction errors by means of the feedback-related negativity (FRN) and mid-frontal theta band power. Results showed a larger FRN for negative feedback as well as a lack of reward expectation modulation for positive feedback at the theta level with positive mood, relative to a neutral mood condition. A control analysis showed that this latter result could not be explained by the mere superposition of the event-related brain potential component on the theta oscillations. Moreover, these neurophysiological effects were evidenced in the absence of impairments at the behavioral level or increase in autonomic arousal with positive mood, suggesting that this mood state reliably altered brain mechanisms of reward prediction errors during performance monitoring. We interpret these new results as reflecting a genuine mood congruency effect, whereby reward is anticipated as the default outcome with positive mood and therefore processed as unsurprising (even when it is unlikely), while negative feedback is perceived as unexpected.

Modulatory effects of happy mood on performance monitoring: Insights from error-related brain potentials.

Goal-adaptive behavior requires the rapid detection of conflicts between actions and intentions or goals. Although many studies have focused in the past on the influence of negative affect on this cognitive control process (and more specifically, on error monitoring), little is known about the possible modulatory effects of positive affect on it. To address this question, we used a standard (positive) mood induction procedure (based on guided imagery) and asked participants to carry out a speeded go/no-go task while high-density electroencephalography was recorded concurrently. As a control condition, we used a group with neutral mood. Event-related potential results showed that the error-related negativity (ERN) component, reflecting early error detection within the dorsal anterior cingulate cortex, was not influenced by happy mood. In contrast, the subsequent error positivity (Pe) component, related to the appraisal of the motivational significance of errors, was reliably smaller in the happy than in the neutral mood group. Complementing source localization analyses showed that this effect was explained by decreased activation within the posterior cingulate and insular cortices. These results were obtained in the absence of group differences regarding behavioral performance and tonic arousal. These findings suggest that happy mood likely decreases and changes the motivational significance of worse-than-expected events (Pe), while leaving their earlier automatic detection (ERN) unaltered. We discuss these new results in terms of dynamic changes in the complex interplay of performance monitoring with motivation.

Magnetic resonance thermometry: Methodology, pitfalls and practical solutions.

Clinically established thermal therapies such as thermoablative approaches or adjuvant hyperthermia treatment rely on accurate thermal dose information for the evaluation and adaptation of the thermal therapy. Intratumoural temperature measurements have been correlated successfully with clinical end points. Magnetic resonance imaging is the most suitable technique for non-invasive thermometry avoiding complications related to invasive temperature measurements. Since the advent of MR thermometry two decades ago, numerous MR thermometry techniques have been developed, continuously increasing accuracy and robustness for in vivo applications. While this progress was primarily focused on relative temperature mapping, current and future efforts will likely close the gap towards quantitative temperature readings. These efforts are essential to benchmark thermal therapy efficiency, to understand temperature-related biophysical and physiological processes and to use these insights to set new landmarks for diagnostic and therapeutic applications. With that in mind, this review summarises and discusses advances in MR thermometry, providing practical considerations, pitfalls and technical obstacles constraining temperature measurement accuracy, spatial and temporal resolution in vivo. Established approaches and current trends in thermal therapy hardware are surveyed with respect to potential benefits for MR thermometry.