Helping people see their place in community immunity : a dynamic web-based visualization

L'immunité collective - parfois appelée immunité de groupe - est un concept important et complexe de la santé publique qui n'est pas toujours bien compris par le grand public. Cette incompréhension est particulièrement prononcée chez les personnes qui hésitent à se faire vacciner. Des recherches antérieures ont suggéré que la décision d'obtenir un vaccin pour soi ou son enfant est principalement motivée par les avantages et les risques individuels, plutôt que par les avantages pour la communauté. Cependant, peu de recherches ont identifié des moyens d'aider les gens à comprendre le fonctionnement de l'immunité collective. Il y a également eu relativement peu de recherches sur le rôle des émotions sur la perception du risque et sur les connaissances et les comportements relatifs à l'immunité collective. La visualisation d'informations est un mécanisme de communication puissant pour transmettre des informations et des données sur les risques, car elle permet de présenter rapidement des concepts complexes de manière claire et attrayante. La visualisation d'informations pourrait également permettre d'influencer les émotions. La première partie de ce travail visait à examiner systématiquement les interventions conçues pour communiquer au grand public ce qu'est l'immunité collective et comment elle fonctionne. Cet examen systématique a montré qu'il existe relativement peu de preuves scientifiques des effets de stratégies de communication sur l'immunité collective. Il existe un certain nombre d'interventions disponibles en ligne pour transmettre le concept d'immunité collective, mais leurs effets ont rarement été évalués et aucune étude n'a évalué les effets des interventions sur les émotions. La deuxième partie de ce travail visait à concevoir une application Web au sujet de l'immunité collective et à optimiser cette application en fonction des réponses cognitives et émotionnelles des utilisateurs. Dans notre application, les utilisateurs sont invités à construire leur communauté en créant un personnage qui les représente (leur avatar) et huit autres personnages qui représentent des personnes de leur entourage, par exemple leur famille ou leurs collègues de travail. L'application intègre ces personnages dans une visualisation animée de deux minutes montrant comment différents paramètres (par exemple, la couverture vaccinale et les contacts au sein des communautés) influencent l'immunité collective. Cette étude a montré que notre animation avec des avatars personnalisés peut aider les gens à comprendre leur rôle dans la santé de la population. Notre application s'est révélée être une méthode de communication prometteuse pour expliquer la relation entre les comportements individuels et la santé de la communauté. Elle offre une stratégie potentielle pour concevoir du matériel de communication sur des sujets complexes tels que la santé ou l'immunité collective. La troisième et dernière partie de ce travail visait à évaluer les effets de notre application Web montrant le fonctionnement de l'immunité collective sur la perception des risques, sur les émotions, sur la confiance dans les informations, sur les connaissances et sur les intentions en matière de vaccination. Dans le cadre d'un vaste essai contrôlé randomisé en ligne et factoriel, notre application a influencé tous les résultats dans le sens souhaité, en particulier chez les personnes ayant une vision du monde plus collectiviste. Cette étude est encore plus pertinente aujourd'hui, alors que les pays du monde entier mènent des campagnes de vaccination contre la COVID-19. Notre application est d'ailleurs présentement utilisée dans un outil d'aide à la décision en ligne, permettant aux gens de prendre une décision éclairée par rapport aux vaccins contre la COVID-19 pour eux-mêmes ou leurs enfants.Community immunity--sometimes referred to as herd immunity--is an important and complex concept in public health that is not always well-understood by members of the general public. This lack of understanding is particularly pronounced among people who are vaccine hesitant. Previous research has suggested that decisions about whether or not to vaccinate oneself or one's child are primarily driven by benefits and risks to the individual, with community-level benefits being less compelling. However, little research has identified ways to help people understand how community immunity works, and there has also been relatively little research investigating the role of emotion in risk perceptions, knowledge, and behavior relevant to community immunity. Visualization is a powerful communication mechanism for communicating information and data, including information and data about risk, because it enables rapid presentation of complex concepts in understandable, compelling ways. Visualization may also influence emotions. The first part of this work was aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. This systematic review demonstrates that there is relatively little evidence about the effects of communicating about community immunity. There are a number of interventions available online for conveying the concept of community immunity, but very few interventions were evaluated for its effects and no studies evaluated the effects of interventions on emotions. The second part aimed to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. This study found out that applications with personalized avatars may help people understand their individual role in population health. Our application showed promise as a method of communicating the relationship between individual behaviour and community health. It offers a potential roadmap for designing health communication materials for complex topics such as community immunity. The third and last part of this work aimed to evaluate the effects of our online application showing how community immunity (herd immunity) works on risk perception, emotions, trust in information, knowledge and intentions regarding vaccination. In a large, factorial, online randomized controlled trial, our application influenced all outcomes in the desired directions, particularly among people who have more collectivist worldviews. This work is increasingly relevant as countries around the world carry out COVID-19 vaccination campaigns. Accordingly, our application is currently being used in an online decision aid to support people making evidence-informed decisions about COVID-19 vaccines for themselves or their children

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Analysis of the Relevance of the Advocacy Coalition Framework to Analyze Public Policies in Non-Pluralist Countries

The Advocacy Coalition Framework (ACF) is a theoretical approach developed for the study of the emergence of public policies in pluralist countries. Little is known about the relevance of the framework for the study of policies in non-pluralist countries (NPCs). A review of the literature was conducted on the use of ACF in studies performed in NPCs. Nineteen documents were identified. They were based on studies conducted in China, Laos, and Vietnam. The results show that the ACF is a powerful theoretical approach for highlighting the dynamics of interactions between coalitions that exist in NPCs, as in pluralist countries, and for highlighting their specificity. ACF is a relevant tool for the study of the determinants of the emergence of public policies in NPCs

Effect of cholecalciferol recommended daily allowances on vitamin d status and fabroblast growth factor- 23, in Acute burn patients

People who have had burns may get vitamin D insufficiency. Vitamin D intakes are not recommended in the dietary guidelines for burn victims, and the majority of studies solely include ergocalciferol as a source of vitamin D. (VD2). Providing children with burns with nutritional support. The objectives of this study were to: (1) describe the VD status of adult burns; (2) examine the impact of (VD3) supplementation on VD metabolism during acute burn treatment; and (3) look into the relationship between FGF23 and (CRP). Epidemiology study was created. Methods: Adults (18 years and older) who were hospitalized within 24 hours of a burn incident and had a burn surface area participated between March 2012 and January 2013. (BSA). Along with VD3 (400-600 IU) either orally or intravenously each day, patients also received a multivitamin complex (200–220 IU). After admission (Day 0), calcium, phosphate, albumin, and CRP levels were checked once a week for four weeks. Third-generation (PTH), 25(OH)-D, and 1-25(OH)2-D blood concentrations, as well as (FGF23) and PTH, were also measured. You may get the data as a ratio or as the midpoint value (min–max).&nbsp

Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey

Abstract Background In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). Method The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents’ Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. Results Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2–2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4–3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3–0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3–12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1–22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. Conclusion Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs

A Personalized Avatar-Based Web Application to Help People Understand How Social Distancing Can Reduce the Spread of COVID-19: Cross-sectional, Observational, Pre-Post Study

BackgroundTo reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. ObjectiveThis study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the health care system, and society. MethodsUsing Scrum, which is an agile framework; JavaScript (Vue.js framework); and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces the transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8, 2020, and April 9, 2020. ResultsAfter 26 days, the application received 3588 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly (170/177, 96%) already practicing distancing and indicated that they intended to practice distancing in the coming week (172/177, 97.2%). Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. ConclusionsWe developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The nonrandomized design of this rapid study prevents us from concluding the application’s effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission

An Online Application to Explain Community Immunity with Personalized Avatars: A Randomized Controlled Trial

Abstract accepted for presentation at the Society for Medical Decision Making Annual Meeting 2022, presentation date October 25, 2022 (awarded Lee B. Lusted Trainee Award on October 26, 2022) Purpose: To evaluate the effects of an intervention conveying the concept of community immunity (herd immunity) on risk perception, emotions, knowledge and vaccination intentions. Methods: We previously developed an online application showing how community immunity works through a user-centered design process with 110 participants across 4 cycles. In our application, people personalize a virtual community by making avatars (themselves, 2 vulnerable people in their community, and 6 others.) The application integrates these avatars in a 2-minute narrated animation. The present study evaluated this intervention in a randomized controlled trial among adults in Canada. We collected participants’ sociodemographic details and a validated measure of individualism and collectivism. We analyzed the application’s effects on primary outcome risk perception, divided into comprehension (accuracy) and feelings (subjective sense of risk) and secondary outcomes emotions (worry, anticipated guilt), knowledge and vaccination intentions, using analyses of variance for continuous outcomes and logistic regressions for dichotomous outcomes. We pre-registered our trial, depositing all study materials (including pre-scripted analysis code) on Open Science Framework, then ran the trial March 1-July 1, 2021. Results: Study participants (N=5516) approximately reflected Canadian adult population statistics, with median age 42 years (interquartile range 32-58), 50% women, 49% men (1% other answers), 79% white, 16% born outside Canada, 20% French-speaking, and 59% with college/higher education. The application had positive effects on all outcomes. People assigned to the application were more likely to score high on risk perception as comprehension (Chi-squared(1)=134.54, p<0.001) and risk perception as feelings (F(1,3875)=28.79, p<0.001) compared to those assigned to a control condition. The application also increased emotions (F(1,3875)=13.13, p<0.001), knowledge (F(1,3875)=36.37, p<0.001), and vaccination intentions (Chi-squared(1)=9.4136, p=0.002). Overall, participants with more collectivist orientations demonstrated more responsiveness to arguments about the collective benefits of widespread vaccination. Comparing our application to others available online, other interventions had weaker effects for named diseases (measles, flu) but stronger effects in the context of an unnamed, ‘vaccine- preventable disease.’ Conclusions: An online application about community immunity can contribute to higher- quality decision making (i.e., more accurate risk perception, greater knowledge, more concern for others, higher vaccination intentions) about recommended vaccines

Understanding the Influence of Web-Based Information, Misinformation, Disinformation, and Reinformation on COVID-19 Vaccine Acceptance: Protocol for a Multicomponent Study

BackgroundThe COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children. ObjectiveThe overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. MethodsBased on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. ResultsAs of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. ConclusionsThe findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. International Registered Report Identifier (IRRID)DERR1-10.2196/4101