A multinational study on the factors influencing university students' attitudes and usage of ChatGPT.

Artificial intelligence models, like ChatGPT, have the potential to revolutionize higher education when implemented properly. This study aimed to investigate the factors influencing university students' attitudes and usage of ChatGPT in Arab countries. The survey instrument "TAME-ChatGPT" was administered to 2240 participants from Iraq, Kuwait, Egypt, Lebanon, and Jordan. Of those, 46.8% heard of ChatGPT, and 52.6% used it before the study. The results indicated that a positive attitude and usage of ChatGPT were determined by factors like ease of use, positive attitude towards technology, social influence, perceived usefulness, behavioral/cognitive influences, low perceived risks, and low anxiety. Confirmatory factor analysis indicated the adequacy of the "TAME-ChatGPT" constructs. Multivariate analysis demonstrated that the attitude towards ChatGPT usage was significantly influenced by country of residence, age, university type, and recent academic performance. This study validated "TAME-ChatGPT" as a useful tool for assessing ChatGPT adoption among university students. The successful integration of ChatGPT in higher education relies on the perceived ease of use, perceived usefulness, positive attitude towards technology, social influence, behavioral/cognitive elements, low anxiety, and minimal perceived risks. Policies for ChatGPT adoption in higher education should be tailored to individual contexts, considering the variations in student attitudes observed in this study.

A Preliminary Checklist (METRICS) to Standardize the Design and Reporting of Studies on Generative Artificial Intelligence-Based Models in Health Care Education and Practice: Development Study Involving a Literature Review.

BACKGROUND: Adherence to evidence-based practice is indispensable in health care. Recently, the utility of generative artificial intelligence (AI) models in health care has been evaluated extensively. However, the lack of consensus guidelines on the design and reporting of findings of these studies poses a challenge for the interpretation and synthesis of evidence. OBJECTIVE: This study aimed to develop a preliminary checklist to standardize the reporting of generative AI-based studies in health care education and practice. METHODS: A literature review was conducted in Scopus, PubMed, and Google Scholar. Published records with "ChatGPT," "Bing," or "Bard" in the title were retrieved. Careful examination of the methodologies employed in the included records was conducted to identify the common pertinent themes and the possible gaps in reporting. A panel discussion was held to establish a unified and thorough checklist for the reporting of AI studies in health care. The finalized checklist was used to evaluate the included records by 2 independent raters. Cohen κ was used as the method to evaluate the interrater reliability. RESULTS: The final data set that formed the basis for pertinent theme identification and analysis comprised a total of 34 records. The finalized checklist included 9 pertinent themes collectively referred to as METRICS (Model, Evaluation, Timing, Range/Randomization, Individual factors, Count, and Specificity of prompts and language). Their details are as follows: (1) Model used and its exact settings; (2) Evaluation approach for the generated content; (3) Timing of testing the model; (4) Transparency of the data source; (5) Range of tested topics; (6) Randomization of selecting the queries; (7) Individual factors in selecting the queries and interrater reliability; (8) Count of queries executed to test the model; and (9) Specificity of the prompts and language used. The overall mean METRICS score was 3.0 (SD 0.58). The tested METRICS score was acceptable, with the range of Cohen κ of 0.558 to 0.962 (P<.001 for the 9 tested items). With classification per item, the highest average METRICS score was recorded for the "Model" item, followed by the "Specificity" item, while the lowest scores were recorded for the "Randomization" item (classified as suboptimal) and "Individual factors" item (classified as satisfactory). CONCLUSIONS: The METRICS checklist can facilitate the design of studies guiding researchers toward best practices in reporting results. The findings highlight the need for standardized reporting algorithms for generative AI-based studies in health care, considering the variability observed in methodologies and reporting. The proposed METRICS checklist could be a preliminary helpful base to establish a universally accepted approach to standardize the design and reporting of generative AI-based studies in health care, which is a swiftly evolving research topic.

Compulsory Vaccination Coverage in 12 Sub-Saharan African Countries Two Years Following the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a global threat, challenging health services' provision and utilization. This study aimed to assess compulsory vaccination coverage in 12 Sub-Saharan African countries two years following the COVID-19 pandemic using the Health Belief Model. A cross-sectional survey was conducted from November 1 to December 15, 2022. Multivariate logistic regression was conducted to identify the determinants of vaccination coverage. Among the 5032 respondents, 73.1% reported that their children received compulsory vaccination. The lowest coverage was observed in Ghana (36.5%), while the highest was in Burkina Faso and Congo (92.0%). Factors associated with non-vaccination included older mothers (adjusted odds ratio (AOR) = 1.04, 95%CI: 1.03-1.05), lower mothers' education, older children (AOR = 0.76, 95%CI: 0.60-0.96), children with chronic illnesses (AOR = 0.55, 95%CI: 0.45-0.66), and difficult accessibility to healthcare facilities (AOR = 11.27, 95%CI: 9.48-13.44). Low perceived risk, in which non-vaccinated children were believed to be at no higher risk for infectious diseases and the disease severity would not worsen among non-vaccinated children, increased the likelihood of non-vaccination (AOR = 2.29, 95%CI: 1.75-2.99 and AOR = 2.12, 95%CI: 1.64-2.73, respectively). Perceiving vaccines as unnecessary, and needless for breastfed babies increased the probability of non-vaccination (AOR = 1.38, 95%CI: 1.10-1.73 and AOR = 1.69, 95%CI: 1.31-2.19, respectively). Higher odds of non-vaccination were found when the provision of vaccine information did not motivate parents to vaccinate their children (AOR = 4.29, 95%CI: 3.15-5.85). Conversely, believing that vaccines were safe for children decreased the odds of non-vaccination (AOR = 0.72, 95%CI: 0.58-0.88). Parental perceptions and concerns should be considered in interventions aiming to increase compulsory vaccine acceptance and coverage.

Rating communication skills in dental practice: the impact of different sociodemographic factors.

BACKGROUND: Communication abilities are essential for the successful operation of a dental business and significantly influence outcomes, compliance, and patient satisfaction. AIMS AND METHODS: The aim of our study was to evaluate the knowledge and practice of doctor-patient communication among Jordanian dentists. This evaluation was conducted through a survey based on the key components of the Calgary Cambridge Observation Guides. Additionally, the impact of several sociodemographic characteristics on communication abilities was investigated. This cross-sectional study was conducted from January to June 2022. The data collection tool was an online questionnaire developed by the researchers, consisting of three sections: self-reported demographic and professional data, the practice of doctor-patient communication, and knowledge of doctor-patient communication. RESULTS: The study included 305 dentists, comprising 106 males and 199 females, with a mean age of 32.9 ± 9.0 years. The mean score for communication skills knowledge was 41.5, indicating a moderate level of communication skills knowledge. Female dentists demonstrated significantly higher communication scores compared to their male counterparts, and those working in the private sector scored significantly higher than those in the governmental sector or in both sectors (P ≤ 0.05). In general, older and more experienced dentists exhibited better communication skills. Educational level had a positive impact on certain communication skills items. 58.4% believed that communication skills can always be developed and improved through training sessions, while 48.9% reported never having attended such courses. 95.1% believed that training courses on communication skills are always necessary as part of the educational curriculum. The main obstacles that may deter dentists from considering communication skills courses were limited time (62.3%), course availability (37.7%), cost (28.2%), and perceived lack of importance (8.2%). CONCLUSION: Among a sample of Jordanian dentists, there appears to be a discrepancy between knowledge and self-reported practices regarding communication abilities. In certain crucial, evidence-based areas of doctor-patient communication, there are fundamental deficiencies. Considering the significant role dentists play in oral health and prevention, communication skills should be a top educational priority for them.

ChatGPT Performance in Diagnostic Clinical Microbiology Laboratory-Oriented Case Scenarios.

BACKGROUND: Artificial intelligence (AI)-based tools can reshape healthcare practice. This includes ChatGPT which is considered among the most popular AI-based conversational models. Nevertheless, the performance of different versions of ChatGPT needs further evaluation in different settings to assess its reliability and credibility in various healthcare-related tasks. Therefore, the current study aimed to assess the performance of the freely available ChatGPT-3.5 and the paid version ChatGPT-4 in 10 different diagnostic clinical microbiology case scenarios. METHODS: The current study followed the METRICS (Model, Evaluation, Timing/Transparency, Range/Randomization, Individual factors, Count, Specificity of the prompts/language) checklist for standardization of the design and reporting of AI-based studies in healthcare. The models tested on December 3, 2023 included ChatGPT-3.5 and ChatGPT-4 and the evaluation of the ChatGPT-generated content was based on the CLEAR tool (Completeness, Lack of false information, Evidence support, Appropriateness, and Relevance) assessed on a 5-point Likert scale with a range of the CLEAR scores of 1-5. ChatGPT output was evaluated by two raters independently and the inter-rater agreement was based on the Cohen's κ statistic. Ten diagnostic clinical microbiology laboratory case scenarios were created in the English language by three microbiologists at diverse levels of expertise following an internal discussion of common cases observed in Jordan. The range of topics included bacteriology, mycology, parasitology, and virology cases. Specific prompts were tailored based on the CLEAR tool and a new session was selected following prompting each case scenario. RESULTS: The Cohen's κ values for the five CLEAR items were 0.351-0.737 for ChatGPT-3.5 and 0.294-0.701 for ChatGPT-4 indicating fair to good agreement and suitability for analysis. Based on the average CLEAR scores, ChatGPT-4 outperformed ChatGPT-3.5 (mean: 2.64±1.06 vs. 3.21±1.05, P=.012, t-test). The performance of each model varied based on the CLEAR items, with the lowest performance for the "Relevance" item (2.15±0.71 for ChatGPT-3.5 and 2.65±1.16 for ChatGPT-4). A statistically significant difference upon assessing the performance per each CLEAR item was only seen in ChatGPT-4 with the best performance in "Completeness", "Lack of false information", and "Evidence support" (P=0.043). The lowest level of performance for both models was observed with antimicrobial susceptibility testing (AST) queries while the highest level of performance was seen in bacterial and mycologic identification. CONCLUSIONS: Assessment of ChatGPT performance across different diagnostic clinical microbiology case scenarios showed that ChatGPT-4 outperformed ChatGPT-3.5. The performance of ChatGPT demonstrated noticeable variability depending on the specific topic evaluated. A primary shortcoming of both ChatGPT models was the tendency to generate irrelevant content lacking the needed focus. Although the overall ChatGPT performance in these diagnostic microbiology case scenarios might be described as "above average" at best, there remains a significant potential for improvement, considering the identified limitations and unsatisfactory results in a few cases.

Pilot Testing of a Tool to Standardize the Assessment of the Quality of Health Information Generated by Artificial Intelligence-Based Models.

Background Artificial intelligence (AI)-based conversational models, such as Chat Generative Pre-trained Transformer (ChatGPT), Microsoft Bing, and Google Bard, have emerged as valuable sources of health information for lay individuals. However, the accuracy of the information provided by these AI models remains a significant concern. This pilot study aimed to test a new tool with key themes for inclusion as follows: Completeness of content, Lack of false information in the content, Evidence supporting the content, Appropriateness of the content, and Relevance, referred to as "CLEAR", designed to assess the quality of health information delivered by AI-based models. Methods Tool development involved a literature review on health information quality, followed by the initial establishment of the CLEAR tool, which comprised five items that aimed to assess the following: completeness, lack of false information, evidence support, appropriateness, and relevance. Each item was scored on a five-point Likert scale from excellent to poor. Content validity was checked by expert review. Pilot testing involved 32 healthcare professionals using the CLEAR tool to assess content on eight different health topics deliberately designed with varying qualities. The internal consistency was checked with Cronbach's alpha (α). Feedback from the pilot test resulted in language modifications to improve the clarity of the items. The final CLEAR tool was used to assess the quality of health information generated by four distinct AI models on five health topics. The AI models were ChatGPT 3.5, ChatGPT 4, Microsoft Bing, and Google Bard, and the content generated was scored by two independent raters with Cohen's kappa (κ) for inter-rater agreement. Results The final five CLEAR items were: (1) Is the content sufficient?; (2) Is the content accurate?; (3) Is the content evidence-based?; (4) Is the content clear, concise, and easy to understand?; and (5) Is the content free from irrelevant information? Pilot testing on the eight health topics revealed acceptable internal consistency with a Cronbach's α range of 0.669-0.981. The use of the final CLEAR tool yielded the following average scores: Microsoft Bing (mean=24.4±0.42), ChatGPT-4 (mean=23.6±0.96), Google Bard (mean=21.2±1.79), and ChatGPT-3.5 (mean=20.6±5.20). The inter-rater agreement revealed the following Cohen κ values: for ChatGPT-3.5 (κ=0.875, P<.001), ChatGPT-4 (κ=0.780, P<.001), Microsoft Bing (κ=0.348, P=.037), and Google Bard (κ=.749, P<.001). Conclusions The CLEAR tool is a brief yet helpful tool that can aid in standardizing testing of the quality of health information generated by AI-based models. Future studies are recommended to validate the utility of the CLEAR tool in the quality assessment of AI-generated health-related content using a larger sample across various complex health topics.

Vaccine conspiracy association with higher COVID-19 vaccination side effects and negative attitude towards booster COVID-19, influenza and monkeypox vaccines: A pilot study in Saudi Universities.

Conspiracies regarding vaccines are widely prevalent, with negative consequences on health-seeking behaviors. The current study aimed to investigate the possible association between the embrace of vaccine conspiracies and the attitude to booster COVID-19, seasonal influenza, and monkeypox (mpox) vaccinations as well as the perceived side effects following COVID-19 vaccination. The target population involved academic staff and university students in health colleges in the Kingdom of Saudi Arabia. A self-administered questionnaire was distributed in January 2023 to collect data on participants' demographics, self-reported side effects following each dose, willingness to get booster COVID-19, seasonal influenza, and mpox vaccinations, as well as an evaluation of vaccine conspiracies and attitude to mandatory vaccination. Among the 273 participants, the willingness to receive yearly booster COVID-19 vaccination was observed among 26.0% of the participants, while it was 46.9% and 34.1% for seasonal influenza and mpox vaccinations, respectively. Multinomial logistic regression analyses demonstrated a significant correlation between endorsing vaccine conspiracies and higher frequency of self-reported side effects following uptake of the second and third doses of COVID-19 vaccines. Vaccine conspiracies were also correlated with attitude toward booster COVID-19, influenza, mpox, and mandatory vaccination. The findings of this pilot study highlighted the potential adverse impact of the preexisting notions and negative attitudes toward vaccines, which could have contributed to heightened perceived side effects following COVID-19 vaccination. The study also highlighted the ongoing divisions concerning mandatory vaccination policies, emphasizing the need for cautious implementation of this strategy as a last resort for public health benefit.

Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan.

Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.

Reply to Moreno et al. Comment on "Sallam, M. ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns. Healthcare 2023, 11, 887".

I would like to thank the authors for their commentary on the publication "ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns" [...].

Evaluation of knowledge, experiences, and fear toward prescribing and dispensing corticosteroids among Egyptian healthcare professionals: A cross-sectional study.

Background: Corticosteroids (CS) are essential drugs in the treatment of several medical conditions. Assuming different roles, physicians and pharmacists play a primary role in prescribing and dispensing these medications to optimize patients' clinical management. The data on assessing knowledge and experience of healthcare professionals toward CS is scarce. Therefore, this study aimed to assess and compare knowledge, experience, and fears towards CS among Egyptian physicians and pharmacists. Methods: A cross-sectional, self-administrated, validated online questionnaire was used to collect the data from Egyptian healthcare professionals. The questionnaire consisted of four sections with multiple choice questions: sociodemographic (7 questions), knowledge about CS (13 questions), experience with CS prescription/dispensing (5 questions), and fears and preferences toward CS prescription/dispensing (13 questions). Descriptive and inferential statistics were used to analyze the data. Results: A total of 600 responses were analyzed in this study. The study sample was almost two-half of healthcare providers: 303 (50.5%) pharmacists and 297 (49.5%) physicians. Pharmacists had marginally higher knowledge scores as compared to those recorded for physicians (11.29 versus 10.16, respectively; P = 0.047). Physicians had more experience choosing corticosteroids in treatment plans based on their experience (51.8% vs 38.5%) and guideline recommendations (72.8% vs 50.9%) than pharmacists. However, pharmacists had more experience dealing with corticosteroid use based on patients' preferences (19.5% vs 4.9%) and showed a broader scope of experiencing side effects of corticosteroids with their patients. The two professions demonstrated high levels of fear, with pharmacists acknowledging significantly lower concerns about CS than physicians (3.72 versus 4.0, respectively; P = 0.003). Conclusion: Discrepancies exist among healthcare professionals in knowledge and experience, favoring better scientific knowledge of pharmacists related to corticosteroids. Based on these findings, the interprofessional collaborative efforts would provide comprehensive, patient-centered care that maximizes the benefits of CS while minimizing their risks.

Assessing disparities in medical students' knowledge and attitude about monkeypox: a cross-sectional study of 27 countries across three continents.

Background and aims: The recent monkeypox (Mpox) outbreak confirmed by the World Health Organization (WHO) underscores the importance of evaluating the knowledge and attitude of medical students toward emerging diseases, given their potential roles as healthcare professionals and sources of public information during outbreaks. This study aimed to assess medical students' knowledge and attitude about Mpox and to identify factors affecting their level of knowledge and attitude in low-income and high-income countries. Methods: A cross-sectional study was conducted on 11,919 medical students from 27 countries. A newly-developed validated questionnaire was used to collect data on knowledge (14 items), attitude (12 items), and baseline criteria. The relationship between a range of factors with knowledge and attitude was studied using univariate and multivariate analyses. Results: 46% of the study participants were males; 10.7% were in their sixth year; 54.6% knew about smallpox; 84% received the coronavirus disease 2019 (COVID-19) vaccine; and 12.5% had training on Mpox. 55.3% had good knowledge of Mpox and 51.7% had a positive attitude towards it. Medical students in their third, fifth, or sixth year high- income countries who obtained information on Mpox from friends, research articles, social media and scientific websites were positive predictors for good knowledge. Conversely, being male or coming from high-income countries showed a negative relation with good knowledge about Mpox. Additionally, a positive attitude was directly influenced by residing in urban areas, being in the fifth year of medical education, having knowledge about smallpox and a history of receiving the coronavirus disease 2019 (COVID-19) vaccine. Receiving information about Mpox from social media or scientific websites and possessing good knowledge about Mpox were also predictors of a positive attitude. On the other hand, being male, employed, or receiving a training program about Mpox were inversely predicting positive attitude about Mpox. Conclusion: There were differences in knowledge and attitude towards Mpox between medical students in low and high-income countries, emphasizing the need for incorporating epidemiology of re-emerging diseases like Mpox into the medical curriculum to improve disease prevention and control.

Prospective Attitudes towards Respiratory Syncytial Virus (RSV) Vaccination: Validation of a Survey Instrument among Young Females in Jordan Pending Vaccine Authorization.

In May 2023, the U.S. FDA advisors endorsed Pfizer's pregnancy-administered vaccine (branded ABRYSVO) to protect infants from respiratory syncytial virus (RSV) infection. Vaccination can reduce the burden of RSV-related respiratory disease, with previous studies showing its substantial medical and financial burden in Jordan. However, pregnant women may exhibit hesitancy to get vaccinated due to concerns about potential risks to themselves or their fetuses. This study aimed to assess the acceptance of the RSV vaccine among young females and identify the determinants influencing their decision using a newly constructed instrument. A survey instrument was developed and validated, comprising 26 items to measure RSV vaccine acceptance. A cross-sectional study design was employed, with data collection from a sample of females aged 18 to 45 residing in Jordan during 5-6 July 2023, using a convenient approach via an online distributed questionnaire. The final study sample comprised 315 respondents, with 67.6% who have heard of RSV before the study. If the vaccine was safe, effective, and provided freely, 70.2% showed willingness to get the RSV vaccine, 15.2% resisted, and 14.6% were hesitant. Principal component analysis identified six internally consistent sub-scales with the following suggested themes: Advice, Burden, Conspiracy, Dangers, Efficiency, and Fear, comprising 21 items collectively as assigned as the "ABCDEF" scale for RSV vaccine acceptance. RSV vaccine acceptance in this study was associated with the advice and fear constructs. The validated survey instrument successfully captured important determinants of RSV vaccine acceptance among young females. RSV vaccine promotion efforts should focus on the following: enhancing vaccine education, improving trust in healthcare institutions and providers, reducing burdens through resolving cost issues and focusing on the role of social support, addressing safety concerns, and tailoring communication strategies to effectively promote the benefits of the vaccine. These insights can inform public health policies and interventions aiming to promote RSV vaccination and mitigate the burden of RSV-related diseases among infants. Follow-up studies are recommended with pregnant women as the target group to assess their attitude towards RSV vaccination and to confirm the validity of the conceived ABCDEF survey instrument.

Assessing Health Students' Attitudes and Usage of ChatGPT in Jordan: Validation Study.

BACKGROUND: ChatGPT is a conversational large language model that has the potential to revolutionize knowledge acquisition. However, the impact of this technology on the quality of education is still unknown considering the risks and concerns surrounding ChatGPT use. Therefore, it is necessary to assess the usability and acceptability of this promising tool. As an innovative technology, the intention to use ChatGPT can be studied in the context of the technology acceptance model (TAM). OBJECTIVE: This study aimed to develop and validate a TAM-based survey instrument called TAME-ChatGPT (Technology Acceptance Model Edited to Assess ChatGPT Adoption) that could be employed to examine the successful integration and use of ChatGPT in health care education. METHODS: The survey tool was created based on the TAM framework. It comprised 13 items for participants who heard of ChatGPT but did not use it and 23 items for participants who used ChatGPT. Using a convenient sampling approach, the survey link was circulated electronically among university students between February and March 2023. Exploratory factor analysis (EFA) was used to assess the construct validity of the survey instrument. RESULTS: The final sample comprised 458 respondents, the majority among them undergraduate students (n=442, 96.5%). Only 109 (23.8%) respondents had heard of ChatGPT prior to participation and only 55 (11.3%) self-reported ChatGPT use before the study. EFA analysis on the attitude and usage scales showed significant Bartlett tests of sphericity scores (P<.001) and adequate Kaiser-Meyer-Olkin measures (0.823 for the attitude scale and 0.702 for the usage scale), confirming the factorability of the correlation matrices. The EFA showed that 3 constructs explained a cumulative total of 69.3% variance in the attitude scale, and these subscales represented perceived risks, attitude to technology/social influence, and anxiety. For the ChatGPT usage scale, EFA showed that 4 constructs explained a cumulative total of 72% variance in the data and comprised the perceived usefulness, perceived risks, perceived ease of use, and behavior/cognitive factors. All the ChatGPT attitude and usage subscales showed good reliability with Cronbach α values >.78 for all the deduced subscales. CONCLUSIONS: The TAME-ChatGPT demonstrated good reliability, validity, and usefulness in assessing health care students' attitudes toward ChatGPT. The findings highlighted the importance of considering risk perceptions, usefulness, ease of use, attitudes toward technology, and behavioral factors when adopting ChatGPT as a tool in health care education. This information can aid the stakeholders in creating strategies to support the optimal and ethical use of ChatGPT and to identify the potential challenges hindering its successful implementation. Future research is recommended to guide the effective adoption of ChatGPT in health care education.

From Conspiracy to Hesitancy: The Longitudinal Impact of COVID-19 Vaccine Conspiracy Theories on Perceived Vaccine Effectiveness.

The embrace of coronavirus disease 2019 (COVID-19) vaccine conspiracies has been linked to vaccine hesitancy. This study aimed to investigate the relationship between COVID-19 vaccine conspiracy theories and perceived vaccine effectiveness. The study utilized a longitudinal follow-up study in which adults in Chile completed surveys in December 2020 (T1) and May 2021 (T2). The psychometric properties of the five-item instrument on conspiracy theories for the COVID-19 vaccine were evaluated using data from T1 (n = 578). A confirmatory one-factor structure with suitable indicators of reliability was found. The longitudinal analysis (n = 292) revealed that conspiracy theories about the COVID-19 vaccine in T1 were associated with lower beliefs in its effectiveness in T2. However, no significant association was found between beliefs in effectiveness in T1 and conspiracy theories in T2. The study suggests that beliefs in conspiracy theories may temporally precede beliefs in vaccine effectiveness for COVID-19. The results have implications for strategies to address vaccine conspiracy beliefs and their implementation at the public policy level.

The impact of surgical guide design and bone quality on heat generation during pilot implant site preparation: an in vitro study.

BACKGROUND: Surgical guides restrict the flow of cooling agent to osteotomy site, which will lead to a temperature rise that provokes tissue injury. Few studies compared differences in the temperature changes between non-limiting 'conventional' and limiting 'guided' surgical guides during implant site preparation. The objective of this study was to investigate the difference in temperature changes during bone drilling for implant placement using non-limiting and limiting surgical guides at cortical and cancellous bone levels. METHODS: Forty-four bovine rib samples were used for implant bed preparation in this study with a minimum thickness of 11 mm was chosen for the ribs. The bone was stored in a freezer at 10 °C until it was used. On the day of the study, the bone was defrosted and soaked in water at 21 °C for three hours before embarking on drilling to make sure each sample was at the same temperature when tested. Forty-four bone specimens were prepared and randomly allocated to receive either a limiting or a non-limiting surgical guides (22 for each group). The osteotomy site was prepared by one operator following the manufacturer's instructions, using limiting and non-limiting surgical guides. Temperature changes were recorded during implant bed preparation using thermocouples that fit into 7 mm-horizontal channels at two different depths (Coronally) and (Apically) at 1 mm distance from the osteotomy site. The data were tested for homogeneity of variances using Levene's test, then data were analyzed using an Independent sample t-test and the significance level was set at P ≤ 0.05. RESULTS: The mean temperature rise for all samples was 0.55 °C. The mean temperature rises for the limiting and non-limiting surgical guides were 0.80 °C and 0.33 °C respectively. There was a statistically significant difference in temperature rise between the limiting and non-limiting surgical guides (P = 0.008). In relation to position of temperature recording (coronal vs. apical), there was no significant difference (P > 0.05). No significant difference was noted between the two groups at cancellous bone level (P = 0.68), but the difference was significant at cortical bone level (P = 0.036). CONCLUSION: Limiting surgical guides showed higher readings than non-limiting. However, for both techniques, temperature rise was not significant clinically and within a safe range.

The Effect of Combining the COVID-19 Vaccine with the Seasonal Influenza Vaccine on Reducing COVID-19 Vaccine Rejection Among Libyans.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccine coverage remains low in Libya compared to other countries in the Eastern Mediterranean Region. This study aimed to evaluate the willingness of the general public in Libya to receive COVID-19 and seasonal influenza vaccines. Additionally, the study aimed to investigate the potential effect of combining the two vaccines to reduce COVID-19 vaccine rejection. METHODS: An anonymous nationwide online cross-sectional survey was carried out from 1st September to 16th October 2022. Libyans aged 18 years or older were recruited using convenience and snowball sampling approaches. The participants were surveyed for sociodemographic information, health status, and vaccination attitude towards COVID-19 and seasonal influenza vaccines. RESULTS: A total of 2484 participants formed the final study sample: 68.7% were females, 39.4% were aged 18-25 years, 50.4% were single, 32.5% had previous COVID-19 infection, and 47.2% experienced COVID-19 death among relatives. Three-fourths of the respondents showed COVID-19 vaccine rejection: 57.3% did not receive COVID-19 vaccination, 10.1% would not complete the primary vaccination series, and 7.8% refused booster doses. About 55.0% rejected seasonal influenza vaccination, while 1.9% reported influenza vaccine uptake and 21.2% were willing to get the influenza vaccine for the first time. Additionally, 18.8% had already received influenza vaccination in the last year and intended to get the vaccine this season, while 3.3% were unwilling to get influenza vaccination this year despite receiving it in the last influenza season. Age, sex, and occupation were significantly associated with COVID-19 and influenza vaccine rejection. Rejection of COVID-19 vaccination decreased if its combination with influenza vaccine as a single dose was suggested, with 28.2% of the COVID-19 vaccine rejector group accepting the combined vaccine as it would be safer (50.9%), needing fewer injections (24.0%), would be more effective (19.1%), and would be less expensive (3%). Approximately 73.0% of the COVID-19 vaccine rejector group refused this combination due to fear of side effects (48.7%), absence of published studies on this combination (29.8%), and considering this combination as useless (11.2%). CONCLUSION: In Libya, the prevalence of COVID-19 vaccine rejection was high, while the rejection of seasonal influenza vaccination was relatively lower. If influenza and COVID-19 vaccines are administered simultaneously as a single injection, this may reduce the rejection of the COVID-19 vaccine due to better-perceived vaccine safety and efficacy besides being more convenient in terms of the number of injections and cost.

Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination.

During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.

Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis.

Objectives: Understanding COVID-19 vaccine hesitancy among migrant and refugee groups is critical for achieving vaccine equity. Therefore, we aimed to estimate the prevalence of COVID-19 vaccine acceptance among migrant and refugee populations. Methods: A systematic review (PROSPERO: CRD42022333337) was conducted (December 2019-July 2022) using PubMed, Scopus, Web of Science, ProQuest and Google Scholar. Results: Nineteen studies from 12 countries were included. The pooled estimated prevalence of COVID-19 vaccine willingness among migrant and refugee groups was 70% (19 studies, 95% CI: 62.3-77.4%, I2: 99.19%, τ2: 0.03). Female and male participants did not differ significantly with each other (p = 0.64). Although no individual variable contributed statistically significantly in multivariable meta-regression analysis, the multivariable model that considered methodological quality, mean age of participants, participant group and country of origin explained 67% of variance. Discussion: Proportions of migrant/refugee groups receiving COVID-19 vaccinations approximated those observed among general populations. Additional studies are needed to examine factors relating to vaccine willingness to identify the most significant factors that may be targeted in interventions.

Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs.

A substantial burden of high-risk human papillomavirus (HPV) infections and HPV-related cancers can be mitigated by vaccination. The current study aimed to investigate the willingness of female students at the University of Kuwait to get HPV vaccination and its possible association with general vaccine conspiracy beliefs (VCBs). This cross-sectional survey study was conducted during September-November 2022 using a validated VCB scale as the survey instrument. The final sample comprised 611 respondents with a median age of 22 y and a majority of Arab ethnicity (n = 600, 98.2%). Only 360 respondents (56.9%) heard of HPV before participation and these students showed an above-average level of HPV knowledge (mean knowledge score of 12.7 ± 2.6 out of 16 as the maximum score), of whom only 33 self-reported HPV vaccine uptake (9.2%). The willingness to accept free-of-charge HPV vaccination was seen among 69.8% of the participants, with 20.1% who were hesitant and 10.1% who were resistant. The acceptance of HPV vaccination if payment is required was 23.1%. Reasons for HPV vaccine hesitancy/resistance included complacency to the HPV disease risks, lack of confidence in HPV vaccination, and inconvenience. The embrace of VCBs was associated with significantly higher odds of HPV vaccine hesitancy/resistance. The current study showed the detrimental impact of endorsing vaccine conspiracy beliefs manifested in lower intention to get HPV vaccination among female university students in Kuwait. This should be considered in vaccine promotion efforts aiming to reduce the burden of HPV cancers.