Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

Objective To assess the acceptability of pre-pandemic influenza vaccination among healthcare workers in public hospitals in Hong Kong and the effect of escalation in the World Health Organization’s alert level for an influenza pandemic

Knowledge, attitude, practice and barriers on vaccination against human papillomavirus infection: a cross-sectional study among primary care physicians in Hong Kong.

This study explored the knowledge, attitude, practice and barriers to prescribe human papillomavirus (HPV) vaccines among private primary care physicians in Hong Kong. A self-administered questionnaire survey was conducted by sending letters to doctors who had joined a vaccination program for school girls. From 720 surveys sent, 444 (61.7%) completed questionnaires were returned and analyzed. For knowledge, few responded to questions accurately on the prevalence of cervical HPV (27.9%) and genital wart infection (13.1%) among sexually active young women in Hong Kong, and only 44.4% correctly answered the percentage of cervical cancers caused by HPV. For attitude, most agreed that HPV vaccination should be fully paid by the Government (68.3%) as an important public health strategy. Vaccination against HPV was perceived as more important than those for genital herpes (52.2%) and Chlamydia (50.1%) for adolescent health, and the majority selected adolescents aged 12-14 years as the ideal group for vaccination. Gardasil(®) (30.9%) and Cervarix(®) (28.0%) were almost equally preferred. For practice, the factors influencing the choice of vaccine included strength of vaccine protection (61.1%), long-lasting immunity (56.8%) and good antibody response (55.6%). The most significant barriers to prescribe HPV vaccines consisted of parental refusal due to safety concerns (48.2%), and their practice of advising vaccination was mostly affected by local Governmental recommendations (78.7%). A substantial proportion of physicians had recommended HPV vaccines for their female clients/patients aged 18-26 years for protection of cervical cancer (83.8%) or both cervical cancer and genital warts (85.5%). The knowledge on HPV infection was low among physicians in Hong Kong. Prescription of HPV vaccine was hindered by the perceived parental concerns and was mostly relied on Governmental recommendations. Educational initiatives should be targeted towards both physicians and parents, and the Government should consider full subsidy to enhance vaccine uptake rate

Effect of facemasks on empathy and relational continuity: A randomised controlled trial in primary care

Background: There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor's facemask wearing were explored. Method. A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients' perception of doctors' empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients' views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling. Results: 1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients' perception of the doctors' empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors' mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03). Conclusion: This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient's perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level. Clinical trial registration. This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/ en/proj/show.aspx?proj=3486. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012. © 2013 Wong et al.; licensee BioMed Central Ltd.link_to_subscribed_fulltex

Meta-analysis on prevalence and attribution of human papillomavirus types 52 and 58 in cervical neoplasia worldwide.

To estimate the prevalence and attribution of two non-vaccine-covered HPV types (HPV52 and HPV58) across the world.Meta-analysis on studies reported in English and Chinese between 1994 and 2012.The pooled prevalence and attribution rates of HPV52 and HPV58 in invasive cervical cancers were significantly higher in Eastern Asia compared to other regions (HPV52 prevalence: 5.7% vs. 1.8-3.6%, P<0.001; HPV52 attribution: 3.7% vs. 0.2-2.0%; HPV58 prevalence: 9.8% vs. 1.1-2.5%, P<0.001; HPV58 attribution: 6.4% vs. 0.7-2.2%, P<0.001). Oceania has an insufficient number of studies to ascertain the prevalence of HPV52. Within Eastern Asia, the attribution of HPV58 to invasive cervical cancer was 1.8-fold higher than that of HPV52. Similarly, HPV52 and HPV58 shared a higher prevalence and attribution among cervical intraepithelial neoplasia in Eastern Asia. In contrast to the classical high-risk type, HPV16, the prevalence and attribution of HPV52 and HPV58 decreased with increasing lesion severity. Thus, HPV52 and HPV58 behave as an "intermediate-risk" type.The attribution of HPV52 and HPV58 to cervical intraepithelial neoplasia and invasive cancer in Eastern Asia were respectively 2.5-2.8 and 3.7-4.9 folds higher than elsewhere. Changes in the attributed disease fraction can serve as a surrogate marker for cross-protection or type replacement following widespread use of HPV16/18-based vaccines. This unique epidemiology should be considered when designing HPV screening assays and vaccines for Eastern Asia

Practice of human papillomavirus (HPV) vaccination according to recommendations, age groups and sex.

<p>Practice of human papillomavirus (HPV) vaccination according to recommendations, age groups and sex.</p

Preference and reasons to choose human papillomavirus (HPV) vaccines (bivalent vs. quadrivalent) in practice for adolescent girls aged 10–17 years.

a<p>Percentages in brackets were valid % which excluded missing variables.</p

Knowledge on human papillomavirus (HPV) infection (N = 444).

<p>Knowledge on human papillomavirus (HPV) infection (N = 444).</p

The assoication between preferred vaccine (Cervarix® vs. Gardasil® vs. no preference) and the reasons to choose vaccines (A to N).

<p>(A: Stronger protection; B: Safety; C: Lower price; D: More HPV types; E: Protect against genital warts; F: Better antibody response; G: Long-lasting immunity; H: Cross-protection for other cancer-associated HPV types; I: Better adjuvant; J: Patients think it’s better; K: Practice management; L: Selected by the Government; M: Credibility of manufacturer; N: Comprehensive service of manufacturer). All comparisons among vaccine preference groups across reasons to choose vaccine categories (A to N) were statistically significant (p<0.05).</p

Participant Characteristics (N = 444).

<p>HPV: Human Papillomavirus.</p

Attitude towards the importance of public health strategies to promote human papillomavirus vaccination.

<p>(A: Partial (∼30%) subsidy by the Government; B: Fully paid by the Government; C: Price offered at 50% discount; D: School immunization program with market price; E: Immunization program jointly organized by school and community doctors with market price).</p