Strengthening COVID-19 vaccine confidence & demand during the US COVID-19 emergency response.

In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses.

Mental Health Indices of Intensive Care Unit and Emergency Room Frontliners during the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic in India.

BACKGROUND: The contagious coronavirus disease-2019 (COVID-19) pandemic has had a significant psychological impact on healthcare workers. Intensive care unit (ICU) and emergency room (ER) providers have functioned in an environment of fear for their health as well as their family well-being. AIM AND OBJECTIVE: The aim and objective of the article was to study mental health disorders (anxiety, depression, stress, post-traumatic stress disorder (PTSD), and sleep quality) in frontliners and to identify factors affecting mental health indices. MATERIALS AND METHODS: A survey of 153 doctors and nurses working in ICU and ER was conducted from December 2020 to January 2021 using questionnaire with clinically validated scales: Acute Stress Disorder Scale, Perceived Stress Scale, Beck's Depression Inventory (BDI), Zung Self-rating Anxiety Scale (SAS), Global Pittsburgh Sleep Quality Index (PSQI), Multidimensional Scale of Perceived Social Support (MSPS), and New General Self-efficacy (NGSE) Scale. Analysis was performed to identify of gender, age, place of work, self-efficacy, and social support using logistic regression. RESULTS: Of the 153 participants, 21.6% had PTSD, 88.6% had moderate to high stress, 16.3% had anxiety, and 59.5% had poor sleep. Of these, the majority were females and those aged ≤30 years. Males had lesser depression, anxiety, and poor sleep compared to females (p <0.05). Participants working in ER reported higher stress as compared to those working in ICU (p <0.05). PTSD, perceived stress, depression, anxiety, and poor sleep were higher in participants with low-to-moderate perceived self-efficacy as compared to participants with high self-efficacy (p <0.05). CONCLUSION: This study reveals significant psychological distress among ER and ICU frontliners during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a typical high-acuity environment during the nonpandemic times. HOW TO CITE THIS ARTICLE: Vadi S, Shah S, Bajpe S, George N, Santhosh A, Sanwalka N, et al. Mental Health Indices of Intensive Care Unit and Emergency Room Frontliners during the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic in India. Indian J Crit Care Med 2022;26(1):100-107.

Digital health developments and drawbacks: a review and analysis of top-returned apps for bipolar disorder.

BACKGROUND: Although a growing body of literature highlights the potential benefit of smartphone-based mobile apps to aid in self-management and treatment of bipolar disorder, it is unclear whether such evidence-based apps are readily available and accessible to a user of the app store. RESULTS: Using our systematic framework for the evaluation of mental health apps, we analyzed the accessibility, privacy, clinical foundation, features, and interoperability of the top-returned 100 apps for bipolar disorder. Only 56% of the apps mentioned bipolar disorder specifically in their title, description, or content. Only one app's efficacy was supported in a peer-reviewed study, and 32 apps lacked privacy policies. The most common features provided were mood tracking, journaling, and psychoeducation. CONCLUSIONS: Our analysis reveals substantial limitations in the current digital environment for individuals seeking an evidence-based, clinically usable app for bipolar disorder. Although there have been academic advances in development of digital interventions for bipolar disorder, this work has yet to be translated to the publicly available app marketplace. This unmet need of digital mood management underscores the need for a comprehensive evaluation system of mental health apps, which we have endeavored to provide through our framework and accompanying database (apps.digitalpsych.org).

Use of a choice survey to identify adult, adolescent and parent preferences for vaccination in the United States.

BACKGROUND: Adult and adolescent vaccination rates are far below coverage targets in the United States. Our objective was to identify the most influential factors related to vaccine uptake among adults, adolescents, and parents of adolescents (parents) in the United States. METHODS: We used a fractional factorial design to create a binary choice survey to evaluate preferences for vaccination. The national survey was fielded to a sample of adults, adolescents ages 13-17 years, and parents, using a national probability-based online research panel in November 2015. Respondents were presented with 5 profiles of a hypothetical vaccine and asked in a series of questions whether they would accept each vaccine. We analyzed the binary choice data using logistic regression in STATA v13 (College Station, TX) to calculate the odds that a participant would choose to accept the vaccine. RESULTS: We received completed responses from 334 (51%) of 652 adults, 316 (21%) of 1516 adolescents, and 339 (33%) of 1030 parents. Respondents were generally representative of the U.S. POPULATION: Vaccine effectiveness was the most influential factor in the choice to vaccinate for all groups. Other most influential factors were primary care provider (PCP) recommendation and the out-of-pocket cost of the vaccine. Other factors such as risk of illness, risk of vaccine side effects, vaccination location, and time for vaccination were not important in the decision to get vaccinated. CONCLUSIONS: Adults, adolescents, and parents are most sensitive to vaccine effectiveness, PCP recommendation, and out-of-pocket cost for vaccination in their decision to get vaccinated. Strong PCP recommendations that focus on vaccine effectiveness and health care policies that minimize out-of-pocket costs for vaccinations may increase vaccine uptake by adults and adolescents.

Perceptions and acceptability of an experimental Ebola vaccine among health care workers, frontline staff, and the general public during the 2014-2015 Ebola outbreak in Sierra Leone.

INTRODUCTION: Experimental Ebola vaccines were introduced during the 2014-2015 Ebola outbreak in West Africa. Planning for the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) was underway in late 2014. We examined hypothetical acceptability and perceptions of experimental Ebola vaccines among health care workers (HCWs), frontline workers, and the general public to guide ethical communication of risks and benefits of any experimental Ebola vaccine. METHODS: Between December 2014 and January 2015, we conducted in-depth interviews with public health leaders (N = 31), focus groups with HCWs and frontline workers (N = 20), and focus groups with members of the general public (N = 15) in Western Area Urban, Western Area Rural, Port Loko, Bombali, and Tonkolili districts. Themes were identified using qualitative content analysis. RESULTS: Across all participant groups, not knowing the immediate and long-term effects of an experimental Ebola vaccine was the most serious concern. Some respondents feared that experimental vaccines may cause Ebola, lead to death, or result in other adverse events. Among HCWs, not knowing the level of protection provided by experimental Ebola vaccines was another concern. HCWs and frontline workers were motivated to help find a vaccine for Ebola to help end the outbreak. General public participants cited positive experiences with routine childhood immunization in Sierra Leone. DISCUSSION: Our formative assessment prior to STRIVE's implementation in Sierra Leone helped identify concerns, motivations, and information gaps among potential participants of an experimental Ebola vaccine trial, at the time when an unprecedented outbreak was occurring in the country. The findings from this assessment were incorporated early in the process to guide ethical communication of risks and benefits when discussing informed consent for possible participation in the vaccine trial that was launched later in 2015.

Lessons Learned in Clinical Trial Communication During an Ebola Outbreak: The Implementation of STRIVE.

Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

Meeting the Challenges of Immunizing Adults.

The overall burden of illness from diseases for which vaccines are available disproportionately falls on adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccine recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Vaccine use among U.S. adults is low. Although receipt of a provider (physician or other vaccinating healthcare provider) recommendation is a key predictor of vaccination, more often consumers report not receiving vaccine recommendations at healthcare provider visits. Although providers support the benefits of vaccination, they also report several barriers to vaccinating adults, including the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.

Meeting the Challenges of Immunizing Adults.

The overall burden of illness from diseases for which vaccines are available disproportionately falls on adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccine recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Vaccine use among U.S. adults is low. Although receipt of a provider (physician or other vaccinating healthcare provider) recommendation is a key predictor of vaccination, more often consumers report not receiving vaccine recommendations at healthcare provider visits. Although providers support the benefits of vaccination, they also report several barriers to vaccinating adults, including the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.

Theoretical and practical issues related to the management of severe and refractory psychotic illness complicated by pulmonary embolism.

Pulmonary embolism (PE) is a potentially fatal condition. We describe the educative case of a young adult male, with a longstanding history of schizophrenia, who was receiving anticoagulant treatment because of repeated episodes of PE in the past. He presented with severe exacerbation of psychosis and did not respond to oral and parenteral antipsychotic medication during inpatient treatment. He was taken up for electroconvulsive therapy (ECT) and received a single ECT uneventfully. The ECT course had to be interrupted because of the unexpected development of a 4-day febrile illness, after which he experienced sudden onset breathlessness, which was diagnosed as acute-on-chronic PE. After the crisis resolved with 4 days of intensive care, he was managed with clozapine. We discuss concerns associated with the psychiatric management of patients with PE; special issues include the use of restraints, parenteral antipsychotic medications, anticoagulants, and ECT.

Intimate partner violence prevention program in an Asian immigrant community: integrating theories, data, and community.

To fill an existing gap in research and practice on intimate partner violence (IPV) in immigrant communities, the authors developed an IPV prevention program, called the Shanti Project, in an Asian Indian community in the Midwest. Building on the notion of shanti (harmony/peace), a cherished value and strength of the community, we created a communications campaign that combined social marketing and community-based participatory approaches. Recognizing the interactive influences of multiple levels of social ecology, campaign activities were designed to bring about changes at the individual, relationship/family, organization, and community levels. This article presents the development of this theoretically, empirically, and community-based IPV prevention program.