Examining age, period and cohort effects in attitude change to childhood vaccinations in a representative New Zealand survey: a multiyear cohort-sequential growth modelling study.

OBJECTIVES: Vaccinations are an important preventative measure in reducing the spread of infectious diseases worldwide. However, concerns of undervaccination during childhood have become increasingly common. The current study aims to investigate changes in attitudes towards childhood vaccinations prior to the COVID-19 pandemic using a national sample from New Zealand. DESIGN: Age-based, period-based, and cohort-based changes were assessed using cohort-sequential latent growth modelling in 11 overlapping birth cohorts, which spanned the ages of 23-79 years. SETTING AND PARTICIPANTS: Data were taken from the New Zealand Attitudes and Values Study where 58 654 adults completed at least one wave across a 7-year period (2013 and 2015-2019). RESULTS: The period-based and cohort-based models fit the data equally well (χ2(282)=8547.93, p<0.001, comparative fit index, CFI=0.894, root mean square error of approximation, (RMSEA)=0.074, standardised root mean square residual, SRMR=0.105; χ2(273)=8514.87, p<0.001, CFI=0.894, RMSEA=0.075, SRMR=0.105, respectively) suggesting societal factors contribute to childhood vaccination attitudes. Additionally, the findings suggest attitudes towards childhood vaccinations were becoming increasingly more positive in all birth cohorts (ps<0.001), with younger and older birth cohorts exhibiting even positive attitudes compared with middle-aged cohorts. CONCLUSION: Overall, both the cohort-based and period-based models reveal changes in vaccination attitudes suggesting that even prior to the COVID-19 pandemic, societal influences had an impact on attitudes towards childhood vaccination.

Ethnic group differences in patient satisfaction with GP services: findings from the New Zealand Attitudes and Values Study.

AIM: To identify key predictors of general practitioner (GP) satisfaction and increase insight into the mechanisms behind ethnic health inequities in New Zealand. METHOD: Regression analyses were conducted using data from the 2019 New Zealand Attitudes and Values Study (n=38,465). RESULTS: Initially, Maori and Asian peoples showed lower, and Pasifika peoples showed no significant difference in GP satisfaction level relative to New Zealand (NZ) Europeans. However, after accounting for differences in patient-perceived GP cultural respect and GP ethnic similarity, Maori and Pasifika peoples showed higher and Asian peoples showed no difference in GP satisfaction level relative to NZ Europeans. These effects continued to hold when adjusting for a range of demographic factors. Subsequent regression analyses were conducted to investigate the impact of GP perceptions, GP satisfaction and demographic factors on healthcare access satisfaction and health status across ethnic groups. For all ethnic groups, GP satisfaction was the strongest predictor of satisfaction with access to healthcare. Higher GP satisfaction was also a significant predictor of higher self-rated health and lower psychological distress. CONCLUSION: Lack of GP cultural respect is a key contributor to lower GP satisfaction among ethnic minorities, which can further exacerbate inequities in healthcare access and health outcomes. Interventions to enhance GPs' provision of culturally respectful and safe healthcare services may help reduce ethnic health inequities and improve population health.

The sanctity of life: The role of purity in attitudes towards abortion and euthanasia.

Although abortion and euthanasia are highly contested issues at the heart of the culture war, the moral foundations underlying ideological differences on these issues are mostly unknown. Given that much of the extant debate is framed around the sanctity of life, we argued that the moral foundation of purity/sanctity-a core moral belief that emphasises adherence to the "natural order"-would mediate the negative relationship between conservatism and support for abortion and euthanasia. As hypothesised, results from a nation-wide random sample of adults in New Zealand (N = 3360) revealed that purity/sanctity mediated the relationship between conservatism and opposition to both policies. These results demonstrate that, rather than being motivated by a desire to reduce harm, conservative opposition to pro-choice and end-of-life decisions is (partly) based on the view that ending a life, even if it is one's own, violates God's natural design and, thus, stains one's spiritual purity.

Increased sleep predicts annual decreases in psychological distress: Results from a 6-year longitudinal panel sample.

OBJECTIVE: To investigate the annual temporal ordering of sleep quantity and psychological distress, separating between-person stability from within-person change. DESIGN: Random-intercepts cross-lagged panel model using 6 annual waves of longitudinal data from the New Zealand Attitudes Values Study postal questionnaire. PARTICIPANTS: New Zealand Attitudes Values Study respondents in 2013, 2014, 2015, 2016, 2017, and 2018 (Ns = 17,890; 15,757; 13,904; 21,849; 17,031; and 47,462). MEASUREMENTS: Participants were asked, "During the past month, on average, how many hours of actual sleep did you get per night?" and responded to the K6 psychological distress scale each year. They also reported their demographic characteristics. RESULTS: Identified longitudinal associations between sleep duration and psychological distress in a traditional cross-lagged panel model were mostly attributable to the stability of the between-person differences in sleep duration and psychological distress. We provide evidence to suggest that increased sleep duration as indicated over a short period of time (ie, 1 month) predicted lower within-person levels of psychological distress the following year. Psychological distress did not predict sleep duration, in contrast. CONCLUSIONS: Our analyses suggest that sleep duration in this sample of New Zealanders precedes psychological distress. This is significant given the propensity for short sleep in this sample and issues of poor mental health and short sleep among low SES indigenous members of this community. The promotion of adequate sleep duration may yield positive gains in psychological well-being.

Ethnic disparities in vaccine safety attitudes and perceptions of family doctors/general practitioners.

Ethnic groups have disparate perceptions of and experiences with family doctors/General Practitioners (GP), yet little is known about differences in GP influence on vaccine safety perceptions across ethnic groups in New Zealand. Using data from the 2017 New Zealand Attitudes and Values Study survey (N = 17,072), the current study investigates the correlation between vaccine safety agreement and GP satisfaction, perceived GP cultural similarity, GP cultural respect, healthcare access and diverse demographic factors among Maori, Pacific, Asian and European New Zealanders. Europeans expressed greater positive perceptions of GPs and high vaccine safety agreement (74.7%) relative to other ethnic groups (Asian: 72.3%; Pacific: 65.8%; Maori: 59.4%). Increased GP satisfaction, healthcare access and education were key correlates of higher vaccine safety agreement among Europeans. Increased GP satisfaction, healthcare access and being non-religious were key correlates among Maori. Higher vaccine safety agreement was significantly and strongly associated with being non-religious, born overseas and having a partner among Pacific peoples. Among Asian peoples, men, younger, more educated individuals, and those with greater perceived GP cultural respect showed higher agreement. Our findings highlight important ethnic differences in the shaping of vaccine attitudes and inform the development of tailored interventions for specific ethnic groups.

Maternal and paternal confidence in vaccine safety: Whose attitudes are predictive of children's vaccination?

Relatively little is known about the differential impact of maternal and paternal perceptions of vaccine safety on children's vaccination status in New Zealand. Using a sample of 68 couples from the New Zealand Attitudes and Values Study (NZAVS), the present study investigated the distinct influence of mothers' and fathers' confidence in the safety of childhood vaccinations following the national immunisation schedule on their reports of children's vaccination status. Actor-Partner Interdependence Modelling revealed that mothers', but not fathers', vaccine confidence predicted children's vaccination status, regardless of who reported their children's vaccination status. Higher maternal vaccine confidence increased the likelihood of child full vaccination status, but paternal vaccine confidence showed no unique significant effects. As women tend to express lower vaccine confidence than men, it is imperative to further investigate the key drivers of their low confidence and develop target interventions accordingly. Encouraging fathers' involvement in the vaccination decision-making process may also be beneficial in increasing the likelihood of childhood vaccination uptake.

Attitudes toward vaccinations are becoming more polarized in New Zealand: Findings from a longitudinal survey.

BACKGROUND: Despite continuing vaccine controversies, little is known about the trajectory of change in vaccine confidence over time. The current study examined whether there are subpopulations among the New Zealand public with diverging trajectories of confidence in the safety of childhood vaccinations from 2013 to 2017. METHODS: Using longitudinal survey data from the New Zealand Attitudes and Values Study, latent class growth models identified subpopulations with distinct rates and directions of change in vaccine confidence from 2013 to 2017 (N= 12,423; 11,912; 12,009; 10,254). The demographic profiles of these subpopulations were examined. FINDINGS: Most New Zealanders' (60%) maintained strong vaccine confidence throughout the years (i.e. vaccine believers), but 30% expressed decreasing confidence over time (i.e. vaccine skeptics). Around 10% were former skeptics who had low vaccine confidence in 2013 but showed increasing confidence thereafter. Men, Europeans/Others, those more educated and living in more affluent regions were more likely to be vaccine believers. Relative to former skeptics, women, older individuals and those with lower education were more likely to be vaccine skeptics. INTERPRETATION: Attitudes toward the safety of childhood vaccinations are becoming increasingly polarized in New Zealand. Roughly 30% of the population are becoming more concerned about vaccine safety over time, 10% are becoming more confident, whereas 60% show consistent high vaccine confidence. It is vital to further investigate the key contributors to decreasing confidence among vaccine skeptics and implement target interventions. FUNDING: Templeton Religion Trust Grant (TRT0196) for data collection; Corresponding author supported by University of Auckland Doctoral Scholarship.

Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being.

The contagiousness and deadliness of COVID-19 have necessitated drastic social management to halt transmission. The immediate effects of a nationwide lockdown were investigated by comparing matched samples of New Zealanders assessed before (Nprelockdown = 1,003) and during the first 18 days of lockdown (Nlockdown = 1,003). Two categories of outcomes were examined: (a) institutional trust and attitudes toward the nation and government and (b) health and well-being. Applying propensity score matching to approximate the conditions of a randomized controlled experiment, the study found that people in the pandemic/lockdown group reported higher trust in science, politicians, and police, higher levels of patriotism, and higher rates of mental distress compared to people in the prelockdown prepandemic group. Results were confirmed in within-subjects analyses. The study highlights social connectedness, resilience, and vulnerability in the face of adversity and has applied implications for how countries face this global challenge. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Outcome of Screening MRI in Premenopausal Women as a Function of the Week of the Menstrual Cycle.

OBJECTIVE. The objective of our study was to determine whether there are differences in outcome of screening MRI examinations in premenopausal women as a function of the week of the menstrual cycle in which the study was performed. MATERIALS AND METHODS. The reports of consecutive screening MRI examinations performed from January 1, 2011, through December 31, 2012, of premenopausal women were reviewed. Only cases for which the 1st day of the last menstrual cycle was documented were included. Associations between the week of the menstrual cycle, degree of background parenchymal enhancement (BPE), final BI-RADS assessment, positive predictive values (PPVs), cancer detection rate (CDR), sensitivity, and specificity were noted. RESULTS. A total of 1536 MRI examinations of 1239 women were performed. Distribution of MRI examinations by menstrual cycle week was as follows: 21.8% (n = 335) in week 1, 35.4% (n = 544) in week 2, 23.4% (n = 360) in week 3, and 19.3% (n = 297) in week 4. In the overall comparison, there was no significant difference in BPE, BI-RADS assessment, PPV1, PPV2, PPV3, CDR, sensitivity, or specificity by the week of the menstrual cycle. When outcomes for cases with MRI performed in week 2 were compared with those of cases with MRI performed in weeks 1, 3, and 4 combined, there was no significant difference in the same outcome measures. CONCLUSION. There was no evidence of a difference in outcomes of screening MRI examinations as a function of the week of menstrual cycle in which the study is performed. The results of our study do not support the need for screening MRI to be performed in week 2 of the menstrual cycle.

Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer.

BackgroundContrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than two-dimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting.PurposeTo evaluate the performance of CEDM for breast cancer screening.Materials and MethodsThis retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value were determined.ResultsIn the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%).ConclusionContrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer.© RSNA, 2019.

Demographic and Psychological Factors Associated with Feelings of Antibiotic Entitlement in New Zealand.

Patients' expectations of being prescribed antibiotics can have an important influence on inappropriate prescribing. Therefore, it is important to understand the drivers of patients' antibiotic expectations. The 2015/16 New Zealand Attitudes and Values Study measured sense of entitlement to antibiotics in a nationally representative sample of New Zealanders (n = 13,484). Participants were asked to rate their agreement with the statement "If I go to my doctor/GP with a minor illness (e.g., sore throat, cough, runny nose, etc.), I think that I should be prescribed antibiotics by default." Eighty percent of participants showed low feelings of antibiotic entitlement, while 18.5% exhibited moderate and 3.7% high feelings of entitlement. People of ethnic minority, lower socio-economic status, and with diabetes expressed higher expectations of being prescribed antibiotics. This may be partially based on a higher risk of rheumatic fever or other complications. Men, religious people, those with lower educational attainment and self-rated health, but greater psychological distress and feelings of control over their health exhibited higher feelings of antibiotic entitlement. Those high on Extraversion, Conscientiousness, and Narcissism, but low on Agreeableness and Openness, also showed greater feelings of entitlement. Our findings help identify key characteristics of those more likely to express inappropriate expectations of antibiotic prescription.

Personality and demographic correlates of New Zealanders' confidence in the safety of childhood vaccinations.

Despite extensive scientific evidence on the safety of standard vaccinations, some parents express skeptical attitudes towards the safety of childhood immunisations. This paper uses data from the 2013/14 New Zealand Attitudes and Values Study (NZAVS) survey (N=16,642) to explore the distribution, and demographic and personality correlates of New Zealanders' attitudes towards the safety of childhood vaccinations. Around two thirds (68.5%) of New Zealanders strongly agreed/were confident that "it is safe to vaccinate children following the standard New Zealand immunisation schedule," 26% were skeptical and 5.5% were strongly opposed. Multiple regression analysis indicated that people lower on Conscientiousness and Agreeableness but higher on Openness to Experience expressed lower confidence about vaccine safety. Having higher subjective health satisfaction, living rurally, being Maori, single, employed and not a parent were all associated with lower confidence, while a higher income and educational attainment were associated with greater confidence. Our findings suggest that the majority of New Zealand adults trust in the safety of scheduled childhood vaccinations, but about one third do express some degree of concern. This finding highlights the importance of improving public education about the safety and necessity of vaccinations.

The Diversity and Prevalence of Sexual Orientation Self-Labels in a New Zealand National Sample.

In this study, we asked participants to "describe their sexual orientation" in an open-ended measure of self-generated sexual orientation. The question was included as part of the New Zealand Attitudes and Values Study (N = 18,261) 2013/2014 wave, a national probability survey conducted shortly after the first legal same-sex marriages in New Zealand. We present a two-level classification scheme to address questions about the prevalence of, and demographic differences between, sexual orientations. At the most detailed level of the coding scheme, 49 unique categories were generated by participant responses. Of those who responded with the following, significantly more were women: bisexual (2.1 % of women, compared to 1.5 % of men), bicurious (0.7 % of women, 0.4 % of men), and asexual (0.4 % of women and less than 0.1 % of men). However, significantly fewer women than men reported being lesbian or gay (1.8 % of women, compared to 3.5 % of men). Those openly identifying as bicurious, bisexual, or lesbian/gay were significantly younger than those with a heterosexual orientation. This study shows diversity in the terms used in self-generated sexual orientations, and provides up-to-date gender, age, and prevalence estimates for the New Zealand population. Finally, results reveal that a substantial minority of participants may not have understood the question about sexual orientation.

Breast Cancers Detected at Screening MR Imaging and Mammography in Patients at High Risk: Method of Detection Reflects Tumor Histopathologic Results.

Purpose To compare the clinical, imaging, and histopathologic features of breast cancers detected at screening magnetic resonance (MR) imaging, screening mammography, and those detected between screening examinations (interval cancers) in women at high risk. Materials and Methods This retrospective institutional review board-approved, HIPAA-compliant review of 7519 women at high risk for breast cancer who underwent screening with MR imaging and mammography between January 2005 and December 2010 was performed to determine the number of screening-detected and interval cancers diagnosed. The need for informed consent was waived. Medical records were reviewed for age, risk factors (family or personal history of breast cancer, BRCA mutation status, history of high-risk lesion or mantle radiation), tumor histopathologic results, and time between diagnosis of interval cancer and most recent screening examination. The χ(2) test and logistic regression methods were used to compare the features of screening MR imaging, screening mammography, and interval cancers. The Wilcoxon signed-rank test was used to calculate P values. Results A total of 18 064 screening MR imaging examinations and 26 866 screening mammographic examinations were performed. Two hundred twenty-two cancers were diagnosed in 219 women, 167 (75%) at MR imaging, 43 (19%) at mammography, and 12 (5%) interval cancers. Median age at diagnosis was 52 years. No risk factors were associated with screening MR imaging, screening mammography, or interval cancer (P > .06). Cancers found at screening MR imaging were more likely to be invasive cancer (118 of 167 [71%]; P < .0001). Of the 43 cancers found at screening mammography, 38 (88%) manifested as calcifications and 28 (65%) were ductal carcinoma in situ. Interval cancers were associated with nodal involvement (P = .005) and the triple-negative subtype (P = .03). Conclusion In women at high risk for breast cancer who underwent screening with mammography and MR imaging, invasive cancers were more likely to be detected at MR imaging, whereas most cancers detected at screening mammography were ductal carcinoma in situ. Interval cancers were found infrequently and were more likely to be node positive and of the triple-negative subtype. (©) RSNA, 2016.

Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging.

The objective of this study was to evaluate the impact of tamoxifen treatment on amount of fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and cysts on breast MRI. Retrospective search identified 96 women with breast cancer who had a breast MRI both before and during adjuvant tamoxifen therapy between 2002 and 2008. After exclusion of all irradiated breasts, 88 women were eligible. Two readers blinded to tamoxifen treatment status independently rated level of BPE, amount of FGT, and cysts using a 4-point categorical scale: BPE--Minimal, Mild, Moderate, Marked; FGT--Fatty, Scattered, Heterogeneously Dense (HD), Dense; Cysts--Minimal, Mild, Moderate, Marked. A consensus interpretation was reached in cases of disagreement. During tamoxifen, there was a significant shift from higher to lower degree BPE, cysts, and FGT compared with before tamoxifen. BPE, cysts and FGT decreased in 68% (60/88), 38% (33/88), and 40% (35/88) of women during tamoxifen (p<0.001 for all measures). After the exclusion of all cases with minimal BPE, cysts, or FGT on the pre-tamoxifen MRI, the percentage of women demonstrating a decrease in these factors increased to 81% (60/74), 77% (33/43), and 41% (35/86), respectively. Exclusion of patients treated with chemotherapy did not substantially change these results. The percentage of women with decreases in FGT and cysts increased with greater duration on tamoxifen, whereas decreases in BPE were detected early in treatment (<90 days) and did not change substantially with longer duration on tamoxifen. A significant association exists between treatment with tamoxifen and decreases in BPE, cysts, and FGT on breast MRI.

Patient follow-up after concordant histologically benign imaging-guided biopsy of MRI-detected lesions.

OBJECTIVE: The purpose of this study was to review the reported experience and suggest follow-up after biopsy for MRI-detected lesions. CONCLUSION: Imaging-guided biopsy, using MRI or sonographic guidance, of MRI-detected lesions may result in false-negative results that are not appreciated at the time of the biopsy. A 6-month follow-up MRI is suggested as the most appropriate interval to identify lesions that were missed at biopsy without clinically significant delay in diagnosis of those lesions that are malignant.

Vascular wall engineering via femtosecond laser ablation: scaffolds with self-containing smooth muscle cell populations.

For tissue-engineered vascular grafts to reach their full potential, three-dimensional (3D) cellular micro-integration will be necessary. In this study, we utilize femtosecond laser ablation to produce microchannels inside electrospun polycaprolactone (PCL) scaffolds. These microchannels potentially provide spatially controlled cell distributions approaching those observed in vivo. The ability of such laser-ablated microchannels to direct cell seeding was evaluated. The dimensions chosen were 100 µm wide, 100 µm deep and 10 mm long. Femtosecond laser ablation successfully produced these microchannels in the scaffolds without substantially altering the ~900 nm diameter fibers. Flow within these microchannels was studied by injecting fluorescent polystyrene bead solutions. Direct measurement of bead motion yielded an inlet velocity of 2.78 cm s(-1). This was used for modeling two-dimensional (2D) flow using computational fluid dynamics to estimate flow profiles within the microchannel. Successful demonstrations of bead flow were followed by seeding of 500,000 human coronary artery smooth muscle cells (HCASMCs) in proliferative medium at a rate of ~500 µL min(-1). Confocal microscopy and scanning electron microscopy confirmed that the HCASMCs were seeded down the full 10-mm length of the microchannel and stayed within its boundaries. Both nuclei and F-actin were observed within the seeded cells. The presence of F-actin filaments shows that the cells were adhered strongly to the scaffold and remained viable throughout the culture. The concept of "vascular wall engineering" producing intricate cell seeding through microchannels produced via femtosecond laser ablation was validated.

Screening breast MR imaging in women with a history of chest irradiation.

PURPOSE: To assess the utility of screening magnetic resonance (MR) imaging in detecting otherwise occult breast cancers in women with a history of radiation therapy to the chest. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the authors' institutional review board. The need for informed consent was waived. Retrospective review of the radiology department database identified 247 screening breast MR imaging examinations performed between January 1999 and December 2008 in 91 women with a history of chest irradiation. Findings and recommendations for each breast MR study and on the most recent mammogram were reviewed. The number of cancers diagnosed, their method of detection, and tumor characteristics were examined. The exact 95% binomial proportion confidence intervals were calculated by using methods described by Clopper and Pearson. RESULTS: Biopsy was recommended for 32 suspicious lesions on 27 (11%) of 247 MR imaging studies in 21 women. Seven cancers were identified in 30 lesions sampled (23%). Biopsy was recommended in five additional patients on the basis of mammographic findings, and malignancy was detected in three. Ten cancers were detected during the study period: four detected with MR imaging alone, three with MR imaging and mammography, and three with mammography alone. The four cancers detected with MR imaging alone were invasive carcinomas. Two of three cancers detected with mammography alone were ductal carcinoma in situ (DCIS), and the third was DCIS with microinvasion. CONCLUSION: MR imaging is a useful adjunct modality to screen high-risk women with a history of chest irradiation, resulting in a 4.4% (95% confidence interval: 1.2%, 10.9%) incremental cancer detection rate; the sensitivity for detecting breast cancers by using a combination of MR imaging and mammography was higher than that for either modality alone.