"Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions.

OBJECTIVE: The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children. METHOD: This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children. RESULTS: 64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information. CONCLUSION: Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.

Poly-l-lactic acid for HIV-1 facial lipoatrophy: 48-week follow-up.

OBJECTIVES: Poly-l-lactic acid (PLA) injections modestly increase objectively assessed facial thickness but not facial soft tissue volume (FSTV) over 24 weeks. The durability of this response has not been well defined objectively. METHODS: HIV-infected lipoatrophic adults were randomized to four open-label PLA treatments administered every 2 weeks from week 0 (immediate group, n=50) or from week 24 (deferred group, n=50). Endpoints included FSTV assessed by computed tomography, facial lipoatrophy severity, quality of life (QoL) and safety. Analyses were by intention to treat. RESULTS: Between weeks 24 and 48, soft tissue thickness increased modestly in injection planes, at the maxillary [mean 0.9 mm; 95% confidence interval (CI) 0.3-1.5 mm; P=0.007] and base of nasal septum levels (mean 0.4 mm; 95% CI 0.1-0.8; P=0.021), but not in untreated areas (P=0.79 and P=0.24). PLA durability assessed at week 48 in immediate group participants showed a mean change in FSTV of 14 cm(3) (95% CI-1 to 29 cm(3); P=0.060) and increased tissue depth at the maxillary (P<0.0001), base of nasal septum (P<0.0001) and mandibular (P=0.0035) levels. At week 48, clinicians and patients subjectively assessed facial lipoatrophy severity as reduced in immediate participants (83 and 91%, respectively), and the Mental Health scale score of the Short Form-36 Health Survey improved significantly in immediate participants relative to deferred participants (P=0.027). Subcutaneous injection-site nodule incidence at 48 weeks was 10%. CONCLUSIONS: PLA treatment benefits were durable, with objectively assessed modest increases in facial volume and tissue thickness sustained over 48 weeks in injection planes but not in other facial areas. Improvements in some QoL domains were maintained.

Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture.

The value of routine aspiration of the hip joint before revision of a hip arthroplasty remains controversial. We reviewed the results of such aspirations in an attempt to determine clinical or laboratory factors that could help the surgeon to identify hips that are infected and that should be aspirated preoperatively. One hundred and fifty consecutive revision total hip arthroplasties were performed by one of us. Preoperative aspiration was not performed or data were excluded for eight hips; no fluid was obtained from one of these hips (0.7 percent of the 150). Of the remaining 142 hips, 128 had preoperative aspiration once and fourteen, twice. Twenty-one (15 percent) of the 142 hips were infected, as demonstrated by the intraoperative culture. The intraoperative culture for two of these hips, however, was considered to be false-positive. The initial aspiration was considered to be positive only if an organism grew on the solid medium or if grossly purulent fluid was obtained. The initial aspiration was positive for nineteen hips; on culture of specimens from one hip, Bacteroides thetaiotaomicron grew in the liquid medium only; and purulent fluid was obtained from one hip but no organisms grew on culture. Fourteen aspirations were repeated for various reasons, most commonly to confirm the presence of an unusual organism. The repeat aspiration did not change the diagnosis for these hips. When the two hips with a false-positive intraoperative culture were excluded, preoperative aspiration had a sensitivity of 92 percent, a specificity of 97 percent, and an accuracy of 96 percent. Seventeen of the nineteen truly infected hips were associated with an abnormally elevated erythrocyte-sedimentation rate (mean, 80.8 millimeters per hour). However, fifty-eight (50 percent) of the 116 hips that were not infected, and for which the results were available, also had an abnormally elevated erythrocyte-sedimentation rate (mean, 32.0 millimeters per hour). This difference was significant (p = 0.001, Fischer exact test). The peripheral leukocyte count was not helpful in predicting infection. Hips in which the implants had been in situ for more than five years were less likely to be infected (p = 0.008, Fisher exact test) than those in which the implants had been in situ for five years or less. None of the infected hips in which the implants had been in situ for more than five years were associated with a normal erythrocyte-sedimentation rate. In this study, preoperative aspiration of the hip joint had an excellent sensitivity and specificity with regard to the prediction of infection, On the basis of our findings, we now favor a selective approach to aspiration, as determined by the erythrocyte sedimentation rate and the amount of time that the implant has been in situ.

HIV type 1 in Fiji is caused by subtypes C and B.

The HIV epidemic in Fiji remains largely uncharacterized. By February 2009, there were 294 confirmed cases; the majority occurred among the 20- to 39-year old age group and resulted from heterosexual contact. There are currently no published data concerning HIV subtypes in Fiji. In this study, venous blood samples were collected as dried blood spots from 35 HIV-positive individuals in Fiji. HIV-1 subtype was determined for 27 (77%) samples and the presence of four different subtypes, with multiple introductions of two, was demonstrated. Subtype distribution was as follows: 16 (59%) were subtype C, 9 (33%) were subtype B, 1 (4%) was subtype A, and 1 (4%) was subtype G. Phylogenetic analysis showed a clear segregation of the Fijian subtype C isolates and previously published Papua New Guinea subtype C isolates as well as multiple introductions of subtype B. These findings represent the first HIV-1 subtype data from the Fiji Islands.

Peyronie's disease in men with HIV responding to highly active antiretroviral therapy.

The pathogenesis of Peyronie's disease (induratio penis plastica) is unclear, but immune phenomena appear likely to be involved. Two cases are presented where the condition developed in temporal association with a virological response to highly active antiretroviral therapy (HAART) in men with HIV infection. It is suggested that this may represent another manifestation of immune restoration disease.

Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist.

Simultaneous laceration of both major nerves with flexor tendons at the wrist is a combination injury familiar to any hand surgeon, which has received scant attention in the English-language literature. The causes and pattern of injury in twenty-six patients treated for this condition over a 10-year period were reviewed. Intensive reassessment of eight of these patients revealed good restoration of hand mobility and strength from the repair of tendons, but the results of nerve repair were less reliable. Tests of hand function indicated that the majority had compensated well for their impairments and seven of the eight had returned to full employment.