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Behavioral Fatigue: Real Phenomenon, Naïve Construct, or Policy Contrivance?
Nov. 5, 2020 · · Original resource · article

In some countries, government policies to combat Covid-19 have been based on the notion that behavioral fatigue prevents people maintaining self-isolation and other restrictions to their life styles for more than a short time. By 16 March 2020, 681 United Kingdom behavioral scientists had signed an open letter to their government asking it to reveal the evidence that shows that behavioral fatigue exists. Nothing was forthcoming. The provenance of concept remains a mystery but modelers have argued that the delay in implementing lockdown policies, for which it was at least partly responsible, led to the loss of at least 20,000 lives. Here, I consider whether behavioral fatigue is a real phenomenon by assessing (a) direct evidence consistent and inconsistent with its existence and (b) indirect evidence drawn from other domains. I conclude that evidence for it is not sufficient to constrain policy. It is reasonable to conclude that behavioral fatigue is either a naïve construct or a myth that arose during the development of policy designed to tackle the Covid-19 crisis.
covid-19
uk
compliance
policy
lockdown
behaviour science
restrictions
humanity, statistic, wrong, communicate, fit
opinion, science, society, insight, economist
The public’s role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness, access, and acceptance in the United States

Given the social and economic upheavals caused by the COVID-19 pandemic, political leaders, health officials, and members of the public are eager for solutions. One of the most promising, if they can be successfully developed, is vaccines. While the technological development of such countermeasures is currently underway, a key social gap remains. Past experience in routine and crisis contexts demonstrates that uptake of vaccines is more complicated than simply making the technology available. Vaccine uptake, and especially the widespread acceptance of vaccines, is a social endeavor that requires consideration of human factors. To provide a starting place for this critical component of a future COVID-19 vaccination campaign in the United States, the 23-person Working Group on Readying Populations for COVID-19 Vaccines was formed. One outcome of this group is a synthesis of the major challenges and opportunities associated with a future COVID-19 vaccination campaign and empirically-informed recommendations to advance public understanding of, access to, and acceptance of vaccines that protect against SARS-CoV-2. While not inclusive of all possible steps than could or should be done to facilitate COVID-19 vaccination, the working group believes that the recommendations provided are essential for a successful vaccination program.
covid-19
vaccine
pandemic
public
awareness
acceptance
access
social
uptake
vaccination, adherence, hesitancy, uptake, sectional
tackle, european, fund, database, indonesia
Timing of COVID-19 Vaccine Approval and Endorsement by Public Figures

The global spread of COVID-19 has created an urgent need for a safe and effective vaccine. However, even if a safe and medically effective vaccine is developed, hesitancy by citizens to receive it would undercut its effectiveness as a tool for limiting the spread of COVID-19.1,2,3 A potential driver of hesitancy in the United States is the politicization of a potential vaccine, including when one might be approved with respect to the presidential election and which public figures are endorsing its safety and efficacy.4,5 Using a pair of randomized survey experiments, we show that announcing approval of a COVID-19 vaccine one week before the election compared to one week after considerably reduces both beliefs about its safety and efficacy and willingness to receive it. However, endorsement by Dr. Anthony Fauci increases reported beliefs about safety and willingness to receive a vaccine among all partisan subgroups. Further, an endorsement by Dr. Fauci increased uptake and confidence in safety even if a vaccine receives pre-election approval. The results here suggest that perceptions of political influence in COVID-19 vaccine approval could significantly undermine the viability of a vaccine as a strategy to end the pandemic.
covid-19
vaccine
pandemic
efficacy
public
global
hesitancy
politicization
belief
vaccine, trial, approve, drug, healthy
vaccination, adherence, hesitancy, uptake, sectional
Vaccination Attitude and Communication in Early Settings: An Exploratory Study

Background: This study assesses attitudes towards vaccination in mothers of new-born babies and explores its association with different exposures to communication. Methods: Data were collected through questionnaires administered by means of interviews. Results: Data highlighted that 20% of mothers showed an orientation towards vaccine hesitancy. As for the reasons behind the attitude to vaccine hesitancy, data showed that concern is a common feature. As for the different exposures to communication, 49% of mothers did not remember having received or looked for any information about vaccination during pregnancy and post-partum; 25% stated they received information from several healthcare and non-healthcare sources; 26% declared having received or looked for information by means of healthcare and non-healthcare sources, as well as having taken part in a specific meeting during antenatal classes or at birth centres. The attitude towards vaccine hesitancy tends to reduce as exposure to different communication increases. Conclusions: This study supports the hypothesis that participation in interactive meetings in small groups focused on vaccination during the prenatal course or at the birth point may act as an enabling factor contributing to a decrease in the tendency to experience vaccine hesitation.
vaccine
communication
hesitancy
attitude
vaccination, adherence, hesitancy, uptake, sectional
intention, behavior, message, guideline, preventive
Risk for In-Hospital Complications Associated with COVID-19 and Influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020
Oct. 23, 2020 · · Original resource · article

What is already known about this topic? Patients hospitalized with COVID-19 are reported to be at risk for respiratory and nonrespiratory complications. What is added by this report? Hospitalized patients with COVID-19 in the Veterans Health Administration had a more than five times higher risk for in-hospital death and increased risk for 17 respiratory and nonrespiratory complications than did hospitalized patients with influenza. The risks for sepsis and respiratory, neurologic, and renal complications of COVID-19 were higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients. What are the implications for public health practice? Compared with influenza, COVID-19 is associated with increased risk for most respiratory and nonrespiratory complications. Certain racial and ethnic minority groups are disproportionally affected by COVID-19.
covid-19
usa
hospitalization
complication
comorbidity
report
official data
risk
ethnicity
disproportionate impact
longitudinal change
sars, respiratory, clinical, cov, syndrome
patient, hydroxychloroquine, cohort, mortality, observational
Estimating the COVID-19 R number: a bargain with the devil?

Bob May's limerick alludes to both the promises and dangers of characterising epidemic control by a single number. The basic reproduction number (R0) is the average number of infections produced by a single infectious person in a population with no immunity. R0 has a close relative named the effective reproduction number (R), which is the average number of infections produced by a single infected person in a population with partial immunity. In The Lancet Infectious Diseases, You Li and colleagues2Li Y Campbell H Kulkarni D et al.The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number (R) of SARS-CoV-2: a modelling study across 131 countries.Lancet Infect Dis. 2020; (published online Oct 22.)https://doi.org/10.1016/S1473-3099(20)30785-4Google Scholar estimate how the imposition and lifting of non-pharmaceutical interventions (NPIs) changed the R number for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 131 countries in the first half of 2020.
covid-19
immunity
reproduction number
non-pharmaceutical intervention
death, england, estimate, excess, wale
bayesian, causal, measurement, replication, statistical
The Missing Link in the Covid-19 Vaccine Race
Oct. 20, 2020 · · Original resource · article

Operation Warp Speed and global vaccine research efforts have succeeded in rapidly launching three vaccine candidates for coronavirus disease 2019 (COVID-19) into Phase III clinical trials. A recent letter from Centers for Disease Control and Prevention (CDC) Director Redfield underscored the possibility of “large-scale” distribution of a coronavirus vaccine as early as November 1, 2020. However, recent polling reveals that the majority of Americans remain skeptical of both the safety and efficacy of a potential Covid-19 vaccine. Even more troublesome is the fact that a comprehensive, collaborative vaccine marketing campaign has not been initiated to educate the U.S. public on and encourage widespread Covid-19 vaccination. Accordingly, this article lays out a plan of action, utilizing proven immunization marketing strategies and novel approaches, that could be used to combat vaccine hesitancy toward Covid-19. A vaccine may indeed be our ticket out of this pandemic, but targeted marketing is needed to increase public optimism toward that fact.
covid-19
vaccine
safety
efficacy
hesitancy
marketing
immunization
campaign
coronavirus
distribution
vaccine, trial, approve, drug, healthy
tackle, european, fund, database, indonesia
Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities
Oct. 19, 2020 · · Original resource · article

BackgroundEconomic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014–16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession.MethodsIn this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick–Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied.FindingsBetween 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09–0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698–33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15–0·80]), men (0·67 [0·22–1·13]), and individuals aged 30–59 years (0·43 [0·16–0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15–29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed.InterpretationThe Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally.
brazil
health
unemployment
low income
death, england, estimate, excess, wale
mobility, crime, gdp, employment, restriction
Covid-19’s known unknowns

The more certain someone is about covid-19, the less you should trust them
covid-19
communication
uncertainty
trust
epidemiology
expertise
modeling
statistics
discussion
editorial
empirical evidence
step, offline, fight, hardcover, horton
herd, immunity, far, hope, know
COVID-19 in Spain: a predictable storm?

As of Oct 12, there have been 861 112 confirmed cases and 32 929 deaths due to COVID-19 in Spain. More than 63 000 health-care workers have been infected. Spain was one of the most affected countries during the first wave of COVID-19 (March to June), and it has now been hit hard again by a second wave of COVID-19 infections. While the reasons behind this poor outcome are still to be fully understood, Spain's COVID-19 crisis has magnified weaknesses in some parts of the health system and revealed complexities in the politics that shape the country.
covid-19
testing
epidemiology
editorial
spain
crisis management
case number
second wave
health system
politics
strategy
country, surge, city, economy, rich
hotspot, u.s, rise, record, come