A mixed methods study exploring early career doctors’ and medical students’ seasonal influenza vaccination

Seasonal influenza is an acute, contagious respiratory infection that causes considerable morbidity and mortality each year. The Chief Medical Officer for England recommends that healthcare workers have a seasonal influenza vaccination in an attempt to protect both patients and NHS staff. Despite current recommendations and campaigns targeted at improving vaccination uptake, many healthcare workers do not have a seasonal influenza vaccination. It is clear that more research is necessary to fully understand the vaccination decision of healthcare workers. This mixed methods thesis employed a range of novel methodological approaches to understanding the influences on the seasonal influenza vaccination decision by medical students and junior doctors. Social network analysis is a well-established research approach that looks at individuals in the context of their social connections. I used an outbreak simulation model to investigate to assess whether an individual’s risk of infection could be linked with their position in the social network. Expanding further on this, the auto-logistic regression model was applied to social network data to predict an individual’s likelihood of vaccinating given the behaviour of their peers. Finally, a qualitative approach was used to explore the factors informing vaccination decisions. Findings gathered throughout this programme of work were synthesised together to produce a more detailed evaluation of seasonal influenza vaccination amongst medical students and junior doctors. These have been disseminated widely, particularly to occupational health practitioners and the wider academic community – demonstrating that this public health research has impact in practice. By gaining a better understanding of the social effects on influenza vaccination it will be possible to improve seasonal influenza vaccination uptake by healthcare workers, in turn better protecting patients and staff

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people. A scoping review protocol

Objective: The objective of this review is to identify and collate the available evidence, and to produce an overview of interventions delivered in secondary and tertiary healthcare settings with the aim of improving vaccination uptake in children and young people. Introduction: Vaccine hesitancy appears in the World Health Organization's Ten Threats to Global Health in 2019.1 Time spent in secondary or tertiary healthcare settings with a child or young person may present an opportunity to deliver vaccination-focused interventions. National Institute for Health and Care Excellence guidance highlights a gap in the evidence of the effectiveness of different interventions aimed at increasing immunization uptake among children and young people.2 Inclusion criteria: Quantitative studies that describe interventions delivered in secondary and tertiary care settings will be included. Participants will include children and young people aged less than 16 years and/or their parents/carers (potentially interventions could be delivered to the child-parent/carer dyad) present in a secondary or tertiary care setting as either a patient or relative. Methods: This scoping review will be conducted using MEDLINE, CINAHL, Cochrane Library, Embase, Web of Science, as well as gray literature. The scoping review will exclude publications not available in English and any publication older than 30 years. Two reviewers will independently select articles using the inclusion criteria, based on their title and abstract. Data will be extracted from selected full text articles using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular form detailing the interventions identified in the literature

COVID-19:Transatlantic Declines in Pediatric Emergency Admissions

INTRODUCTION: This cross-sectional study looked at the impact of the SARS-CoV-2/COVID-19 pandemic on pediatric emergency department (PED) attendances and admissions (as a proxy for severity of illness) in the United States and United Kingdom. METHODS: Data were extracted for children and adolescents, younger than 16 years, attending Royal Manchester Children's Hospital (RMCH, United Kingdom), and Yale New Haven Children's Hospital (YNHCH, United States). Attendances for weeks 1 to 20 of 2020 and 2019 were compared, and likelihood of admission was assessed via calculation of odds ratios, using week 13 (lockdown) as a cutoff. RESULTS: Attendance numbers for each PED decreased in 2020 compared with 2019 (RMCH, 29.2%; YNHCH, 24.8%). Odds of admission were significantly higher after lockdown than in 2019-RMCH (odds ratio, 1.26; 95% confidence interval, 1.08-1.46) and YNHCH (odds ratio, 1.60; 95% confidence interval, 1.31-1.98). CONCLUSIONS: Although the absolute numbers of children and adolescents attending the PED and being admitted decreased after lockdown, the acuity of illness of those attending appears to be higher

The potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: Analysis of the ONS COVID-19 Infection Survey

Objectives To assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection. Design We analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from 1 December 2020 to 11 May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups. Results Estimated rates of triple vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%) and retail (85%). High rates were observed for individuals working in health (95% for office based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios across all occupational groups reduced from 1.37 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. Conclusions Variation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence

Correction to: Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature.

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper

Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature (vol 267, pg 607, 2020)

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper

Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper

Feasbility and acceptability pilot of a public health intervention delivered in the paediatric emergency department

Aim Paediatric Emergency Departments (PEDs) are well-placed to deliver public health interventions. Whilst numerous studies describe the effectiveness of a range of ED-based interventions for adults, less has been done to assess interventions for Children and Young People (CYP). Every year in England, millions of CYP attend hospital, often with relatively minor illnesses/injuries, which sometimes result in long waits – time that could be used to improve wider health and wellbeing. This pilot study assessed the acceptability and feasibility of delivering a public health intervention in the PED of a busy district general hospital. Methods Full prospective ethical approval was obtained. Participants were CYP and their carers attending a PED in England. An opportunistic sampling strategy was used, with a focus on recruiting those who had a wait whilst in the department. The intervention was a consultation delivered by a public health specialist, based around the “Screening, Brief Intervention, and Referral for Treatment” (SBIRT) model and focussed on: household smoking, vaccination status, dental health, and frequent attendance. Quantitative outcome data (e.g. registering with dentist) were collected by phone at one week and then one, three, and six months post-enrolment (where indicated). Qualitative data came from engaging with participants and completion of a field diary by the public health specialist (primary researcher). Results Thirty participants were recruited over the two-week pilot, with 50% of CYP participating in the consent process. Twenty participants (67%) triggered at least one screening question, with dental health and (household) smoking being the most common triggers. Four participants were lost to phone follow-up at one week and a further five were “thanked and discharged” as they had not triggered any of the categories during screening. Of the remaining participants, five had taken action as a result of the study and others had plans, all relating to dental appointments. Conclusion The PED offers an under-utilised opportunity to deliver public health interventions. Findings from this study will be used to refine the intervention before an assessment of its effectiveness is made, using an appropriate study design. Acknowledgements This study was funded by a grant from the Sir Halley Stewart Trust

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people. A scoping review protocol

Objective: The objective of this review is to identify and collate the available evidence, and to produce an overview of interventions delivered in secondary and tertiary healthcare settings with the aim of improving vaccination uptake in children and young people. Introduction: Vaccine hesitancy appears in the World Health Organization's Ten Threats to Global Health in 2019.1 Time spent in secondary or tertiary healthcare settings with a child or young person may present an opportunity to deliver vaccination-focused interventions. National Institute for Health and Care Excellence guidance highlights a gap in the evidence of the effectiveness of different interventions aimed at increasing immunization uptake among children and young people.2 Inclusion criteria: Quantitative studies that describe interventions delivered in secondary and tertiary care settings will be included. Participants will include children and young people aged less than 16 years and/or their parents/carers (potentially interventions could be delivered to the child-parent/carer dyad) present in a secondary or tertiary care setting as either a patient or relative. Methods: This scoping review will be conducted using MEDLINE, CINAHL, Cochrane Library, Embase, Web of Science, as well as gray literature. The scoping review will exclude publications not available in English and any publication older than 30 years. Two reviewers will independently select articles using the inclusion criteria, based on their title and abstract. Data will be extracted from selected full text articles using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular form detailing the interventions identified in the literature