Adolescent and parental decision-making for the MenACWY vaccination: influential predictors and parental-adolescent differences among households in the Netherlands.

BACKGROUND: Between 2015 and 2018 The Netherlands experienced increases of invasive meningococcal disease (IMD) serogroup W (MenW). Therefore in 2018 the MenACWY vaccination was introduced in the National Immunisation Programme (NIP) and a catch-up campaign was initiated targeting adolescents. This study aimed to gain insight into what factors played a role in the decision-making process regarding the MenACWY vaccination. The focus was on the differences in the decision-making of parents and adolescents in order to assess what factors influence the decisions made. METHODS: An online questionnaire was offered to adolescents and one of their parents. We used random forest analyses to determine which factors best predict the outcome of the MenACWY vaccination decision. We carried out ROC (receiver-operator characteristics) analyses to confirm the predictive value of the variables. RESULTS: Among parents several factors stand out, centring on the process of the decision, their attitude about the MenACWY vaccination, trust in the vaccination, and ideas of important people around them. Among adolescents the three stand-out predictors are the ideas of important people around them, the process of the decision and trust in the vaccination. Parents have prominent influence in the decision-making, while the adolescent's influence in the household decision-making is more limited. Adolescents tend to be less engaged and spend less time thinking about the decision compared to parents. Opinions of parents and adolescents from the same households concerning the factors that are influential do not differ a lot in the final decision-making. CONCLUSIONS: Information about MenACWY vaccination might be mainly addressed to the parents of the adolescents and whereby the dialogue about MenACWY vaccination between parents and adolescents will be stimulated. With regard to the predictor trust in vaccination, raising the frequency of use of certain sources, especially those deemed very reliable among households such as conversations with a GP or the provider of the vaccination (GGD/JGZ), might prove a useful strategy to solidify vaccination uptake numbers.

Household decision-making for the MenACWY vaccination: How parents and adolescents deal with an adolescent vaccination decision.

OBJECTIVE: Between 2015 and 2018 The Netherlands experienced increases of invasive meningococcal disease (IMD) serogroup W (MenW), from 0.02 cases/100,000 people between 2010 and 2014 up to 0.5 cases/100,000 in 2017. Therefore in 2018 the MenACWY vaccination was introduced in the National Immunisation Programme (NIP) and a catch-up campaign was initiated among adolescents. This study aimed to gain insight into the decision-making process within households regarding the MenACWY vaccination. The focus was on the differences in the decision-making process of parents and adolescents and of those that had accepted the MenACWY vaccination and those that had not, in order to assess how these types of decisions are made within households. METHOD: We conducted a total of 38 semi-structured interviews in 20 households (7 not vaccinated) with 20 parents and 18 adolescents (18 dyads) across The Netherlands concerning their decision-making process. Interview guides were constructed based on the Precaution Adaption Process (PAP) model. We performed thematic analysis using qualitative data analysis software (MAXQDA). RESULTS: Parents are the main actors in the household decision-making process regarding the MenACWY vaccination. Parents start their decision-making process before adolescents are even aware of the issue. Households in the study took different approaches in involving the adolescent in the decision-making, resulting in three styles of household decision-making: parents decide without the adolescent, parents involve the adolescent, or parents leave it up to the adolescent to decide. CONCLUSION: Parents influence adolescent reasoning, engagement and involvement during the MenACWY vaccination decision-making. And this is the case both among those that have accepted and rejected the MenACWY vaccination. Adolescent engagement with the MenACWY vaccination decision-making is either short-lived or non-existent. However, the moment offers opportunities to engage adolescents on vaccinations and decision-making, with parents as key figures to promote this.

Diurnal changes in serum triglycerides as related to changes in lipolytic enzymes, lipoproteins and hormones in patients with primary endogenous hypertriglyceridaemia on a carbohydrate-rich diet.

Parameters of diurnal triglyceride (TG) metabolism were investigated in 5 subjects with primary endogenous hypertriglyceridaemia and compared with those of normal subjects studied previously. The patients were in a steady state on a carbohydrate-rich diet (meals at 9.00, 13.00 and 17.00 h). Serum TG showed a wavelike pattern with a maximum at around 17.00 h. Post-heparin lipoprotein lipase (LPL) activity in the fasting state was not different from that in normals, but failed to show the normal increase in the fed state (16.30 h). This was due to the inability of patients to increase their adipose tissue (AT)-LPL activity in the course of the day. AT-LPL activity was throughout the day lower than in normal subjects. Skeletal muscle LPL activity was low and showed no diurnal change, equalling our findings in normal subjects. Low density lipoprotein cholesterol and high density lipoprotein (HDL) cholesterol concentrations showed no diurnal change. However, HDL phospholipids increased significantly in the course of the day.

Diurnal course of the suitability of serum samples obtained from normal subjects and from patients with primary endogenous hypertriglyceridaemia to serve as substrate for milk lipoprotein lipase.

Serum samples, obtained at various times of the day from four normal subjects and five patients with primary endogenous hypertriglyceridaemia on a carbohydrate-rich diet (meals at 09.00, 13.00 and 17.00 h), were incubated with cows' milk lipoprotein lipase (LPL) to investigate the susceptibility of the triglyceride(TG)-rich lipoprotein fraction to hydrolysis. Mean KM and vmax of this reaction increased in patients between 09.00 and 13.00 h (p = 0.016 and 0.015, respectively) and decreased again thereafter, whereas no diurnal change was observed in normal subjects (p = 0.31 and 0.27, respectively). At 13.00 and 23.00 h patients showed a higher mean KM (p less than 0.02) at 23.00 h a higher mean vmax (p less than 0.03) than normal subjects. When the data were expressed as reaction rates (FFA formation rates) at TG-concentrations in the in vivo range, neither group showed a diurnal difference. Patients showed a significantly lower reaction rate than normal subjects only at 13.00 h at TG concentrations below 3 mmol X 1-1. This suggests that a defect in the suitability of TG-rich particles to serve as a substrate for LPL is not likely to play a role in the development of hypertriglyceridaemia.

Diurnal changes in serum triglycerides as related to changes in lipolytic enzymes, (apo) lipoproteins and hormones in normal subjects on a carbohydrate-rich diet.

Normal subjects in steady state on a carbohydrate-rich diet (three equivalent meals a day at 9.00, 13.00 and 17.00 h), show a wave-like serum triglyceride (TG) pattern with a peak at 14.00 h. Post-heparin lipoprotein lipase (LPL) activity increased from a mean value of 49 mU/ml +/- 13 (SD) in the fasting state to 127 mU/ml +/- 18 in the fed state (P less than 0.005). This was due to an increase in adipose tissue LPL activity which, at 16.30 and 21.30 h, was significantly higher than basal levels (128.3 +/- 81.5 and 87.7 +/- 23.2 v. 43.3 +/- 9.3 mU/g, P less than 0.05 and P less than 0.01, respectively). Skeletal muscle LPL activity was low (5.8 mU/g +/- 2.3, mean +/- SD) and showed no diurnal change. The observed changes in TG-hydrolysing capacity in the course of the day might explain the TG-pattern. High density lipoprotein (HDL) subfractions HDL2 and HDL3 were separated by density gradient ultracentrifugation and had mean hydrated densities of 1.088 and 1.135 g/ml, respectively. While HDL2 showed no diurnal change, HDL3-cholesterol and-phospholipid significantly increased during the day (P less than 0.005 and P less than 0.001 respectively), reaching their highest levels in the evening. Since te rise in HDL3-lipids follows the fall in serum TG, this provides further indication that the metabolism of these fractions in mutually related.

Diurnal levels of lipids, glucose and insulin in type IV hyperlipidemic patients on high carbohydrate and high fat diet: comparison with normals.

Diurnal levels of serum triglyceride (TG), cholesterol, free fatty acids (FFA), glucose and insulin were measured in three type IV hyperlipidemic patients on a fixed solid 65% carbohydrate and a 65% fat diet when in steady state conditions in a metabolic unit. The carbohydrate-rich food was divided into either three or eight equivalent portions, differently spaced over the day and night. The fat-rich food was given in three equivalent portions only. The diurnal TG profiles on these diets showed the same characteristics as those found in normals, but increments and mean levels were considerably higher. On the carbohydrate-rich diet, mean TG levels decreased during the study. This was not seen either on the fat-rich diet or in normals. In contrast to our findings in normals, chylomicrons formed the major contribution to the serum TG pattern. FFA levels were markedly higher on the high-fat than on the carbohydrate-rich diet, but not different from those in normals. Postprandial glucose responses did not differ significantly between the diets. Insulin responses were markedly higher on the carbohydrate-rich than on the fat-rich food. Glucose levels did not differ from those in normals. Insulin levels were significantly higher in the patients. Cholesterol showed minimal fluctuations, parallel to the TG pattern, which could be attributed to chylomicron cholesterol.

Influence of meal frequency on diurnal lipid, glucose and insulin levels in normal subjects on a high fat diet; comparison with data obtained on a high carbohydrate diet.

Diurnal levels of serum triglyceride (TG) were measured in six normal persons consuming a fixed solid 65% fat diet under steady state conditions in a metabolic unit. The food was divided into either three or eight similar portions, differently spaced over the day and night. The diurnal TG-profiles on this diet were practically identical to those found under comparable conditions on a 65% carbohydrate diet [1]. Mean diurnal TG values did not significantly differ with varying meal frequency. Free fatty acid levels, however, were significantly higher on a high fat diet. Post-prandial glucose and insulin reponses did not significantly differ whether a high fat diet or a high carbohydrate diet was consumed. We conclude that the composition of the diet is of little importance in determining diurnal TG patterns when the diet consists of normal food stuffs, but that these patterns are dependent on meal frequency and distribution.