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Objectives: We sought to identify associations between the experience of traumatic life events and vaccination intention to inform whether trauma-affected individuals require targeted interventions when addressing vaccine hesitancy., Study Design: We conducted an online cross-sectional survey to identify whether direct or indirect exposure to various traumatic life events and the presence of post-traumatic stress disorder (PTSD) symptoms are associated with willingness to receive a COVID-19 vaccine in an Australian sample., Methods: A national online questionnaire was administered to a representative sample of 1050 Australian adults in September 2021., Results: Lower willingness to receive a COVID-19 vaccine was associated with direct experience of a fire or explosion (adjusted odds ratio [aOR]: 0.42; 95% confidence interval [CI]: 0.23-0.78; P = 0.006), direct experience of severe human suffering (aOR:0.39; 95% CI: 0.21-0.71; P = 0.002) and screening positive for PTSD symptoms (aOR:0.52; 95% CI: 0.33-0.82; P = 0.005). Conversely, higher willingness to receive a COVID-19 vaccine was associated with indirect exposure to severe human suffering (aOR: 2.0; 95% CI: 1.21-3.22; P = 0.007)., Conclusions: Our findings suggest that the experience of traumatic events and the presence of PTSD symptoms can contribute to vaccination decisions. Our work adds to the growing recognition of the need to effectively mediate the influence of traumatic experiences on encounters within the medical setting and supports the importance of addressing the needs of trauma-affected individuals in their vaccination experiences., (Copyright © 2022 The Royal Society for Public Health. All rights reserved.)

Objective: Vaccine hesitancy is a persistent barrier to vaccination uptake, and health professionals report interactions with such parents to be difficult. Using discourse analytic techniques, we examine the foundation of a therapeutic relationship: the display of empathy and attempts to build rapport, in consultations between immunisation specialists and vaccine reluctant parents., Methods: Consultations between consenting clinicians and parents in two Specialist Immunisation Clinics in Australia were recorded. Twelve conversations between the clinicians and parents were analysed using interactional sociolinguistic (IS) discourse analytic methods., Results: This paper takes a case study approach by citing two interactions that exemplify the interactional work of the consultants as they strive to engender mutual understanding and goodwill, noting examples of discursive choices that demonstrate empathy and the building of rapport., Conclusion: Awareness of discourse strategies that interweave relational and clinical goals enable a more nuanced understanding of communication skills that support a guiding partnership in vaccine related decisions with parents., Practical Implications: Through highlighting the strategic interactional work that displays empathy and builds rapport, we can inform educational approaches and build a repertoire of communication choices that strengthen the communication skills of health professionals., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine., Method: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations., Results: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines., (© 2021 The Authors.)

The World Health Organization and global partners sought to identify existing measures of confidence in childhood vaccines, as part of a broader effort to measure the range of behavioural and social drivers of vaccination. We identified 14 confidence measures applicable to childhood vaccination in general, all published between 2010 and 2019. The measures examined 1-5 constructs and included a mean of 12 items. Validation studies commonly examined factor structure, internal consistency reliability, and criterion-related validity. Fewer studies examined convergent and discriminant validity, test-retest reliability, or used cognitive interviewing. Most measures were developed and validated only in high-income countries. These findings highlight the need for a childhood vaccine confidence measure validated for use in diverse global contexts., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem: Midwives may feel ill-equipped to manage clinical encounters with non-vaccinating parents., Background: Pregnancy is a peak time in the formation of parents' vaccination views and intention. Midwives are central to maternity care in Australia. While most midwives will have infrequent contact with families who intend not to vaccinate, when they do, they must feel equipped to communicate with them in a manner which fulfils their professional responsibilities, acknowledges parental autonomy and facilitates continued engagement., Aim: To understand how midwives can most effectively communicate with non-vaccinating parents., Methods: We conducted in-depth interviews with 32 non-vaccinating parents and six key informant health professionals, and a focus group of six midwives. Data collection occurred in the Byron Shire of New South Wales, where childhood vaccination rates are persistently lower than national averages., Findings: This study explores four central codes. The first, 'hold on…I'm not sure about this' providing insights into moments of doubt preceding parents' decisions not to vaccinate. The second 'Pregnancy: a decision-making focal point' reinforces the importance of effective vaccination recommendations in the antenatal period. 'Manipulation and ambivalence' examines why overzealous or unclear recommendations about vaccination are unhelpful, and the fourth central code 'engage, inform and encourage' summarise recommendations from health professionals who are experienced in communicating, apparently effectively, with non-vaccinating families., Discussion: Insights from this study are used to recommend practical strategies which may be employed by midwives and maternity units to successfully and professionally manage clinical encounters with non-vaccinating parents., Conclusion: Midwives are well positioned to provide clear recommendations to parents regarding childhood vaccination whilst maintaining engagement and meeting the goals of woman-centred care., (Copyright © 2020 Australian College of Midwives. All rights reserved.)

Objective: To refine communication strategies to assist clinician conversations with vaccine hesitant and declining parents as part of the Sharing Knowledge About Immunisation (SKAI) package., Methods: We recorded and analysed consultations held in two Specialist Immunisation Clinics in tertiary hospitals in Australia between consenting clinicians and parents. We undertook content analysis that was both iterative and informed by the Calgary Cambridge Model of health communication and motivational interviewing., Results: We found common strengths and opportunities in clinician's communication styles. Strengths included: rapport building; communicating care for both the parent and child; exhibiting depth of vaccination-specific communication skill and content knowledge. Opportunities for strengthening communication practices included: eliciting parents' concerns to saturation early in the consultation; structuring the consultation to prioritise and address parents' concerns; recognising and responding to parents' motivation to vaccinate; effectively closing consultations., Conclusion: This study has synthesised clinical communication strategies from expert vaccination communicators using well-established communication frameworks to advance a unique approach to the challenging task of addressing vaccine hesitancy and refusal., Practice Implications: The clinic observations helped us to create a structured consultation guide that can enhance and provide greater structure to a clinician's existing communication skills., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Pregnant women and their unborn children are at high risk from both pandemic and seasonal influenza., Aim: To explore views about influenza vaccination during pregnancy, in a pandemic and immediate post-pandemic context, among mothers and other carers of young children., Methods: In a mixed methods study, caregivers from 16 childcare centres in Sydney, Australia, were surveyed in November and December 2009, and interviews were conducted with caregivers from six childcare centres between June 2009 and May 2011., Findings: Emerging themes from 41 interviews conducted with mothers included: 'pregnancy as a protected state', 'risk negotiation' and 'centrality of healthcare worker interaction'. Of 972 surveys distributed, 431 were completed (a response rate of 44%). Respondents perceived pandemic influenza risks to be greater for pregnant women than for their unborn children. Only 2% (9/383) of women reported being vaccinated against swine flu during pregnancy and 45% (168/383) indicated intent to receive swine flu vaccination in a future pregnancy., Discussion: The low rates of maternal influenza vaccination revealed in this study contrast to recent gains in vaccine uptake. Vaccination decision-making in pregnancy can be complex and contextually driven for some women. Healthcare workers, including midwives, have a key role in addressing women's concerns about maternal influenza vaccination in both pandemic and interpandemic periods., Conclusions: Policy makers need to be cognisant of women's concerns and develop resources for both pregnant women and healthcare workers as part of both future pandemic planning and seasonal vaccination efforts., (Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: The Internet has transformed the way in which people approach their health care, with online resources becoming a primary source of health information. Little work has assessed the quality of online information regarding community water fluoridation. This study sought to assess the information available to individuals searching online for information, with emphasis on the credibility and quality of websites., Methods: We identified the top 10 web pages returned from different search engines, using common fluoridation search terms (identified in Google Trends). Web pages were scored using a credibility, quality and health literacy tool based on Global Advisory Committee on Vaccine Safety (GAVCS) and Center for Disease Control and Prevention (CDC) criteria. Scores were compared according to their fluoridation stance and domain type, then ranked by quality. The functionality of the scoring tool was analysed via a Bland-Altman plot of inter-rater reliability., Results: Five-hundred web pages were returned, of which 55 were scored following removal of duplicates and irrelevant pages. Of these, 28 (51%) were pro-fluoridation, 16 (29%) were neutral and 11 (20%) were anti-fluoridation. Pro, neutral and anti-fluoridation pages scored well against health literacy standards (0.91, 0.90 and 0.81/1 respectively). Neutral and pro-fluoridation web pages showed strong credibility, with mean scores of 0.80 and 0.85 respectively, while anti-fluoridation scored 0.62/1. Most pages scored poorly for content quality, providing a moderate amount of superficial information., Conclusion: Those seeking online information regarding water fluoridation are faced with comprehensible, yet poorly referenced, superficial information. Sites were credible and user friendly; however, our results suggest that online resources need to focus on providing more transparent information with appropriate figures to consolidate the information., (© 2018 FDI World Dental Federation.)

Objective: This study investigated the immunisation knowledge, attitudes and practices among health professionals in two regional Area Health Services of NSW with low and high immunisation rates. It also compared these factors between the areas and between the health professional groups., Methods: A self-administered questionnaire was posted in 2006 to health professionals, located within the North Coast and Hunter New England Area Health Services, whose practice could include immunisation. This included general practitioners (GPs), practice nurses, community nurses, hospital nurses and midwives., Results: Out of 926 surveys sent, 434 were returned (47%). The great majority of the health professionals (97%) believed that vaccines were safe, effective and necessary. However, in approximately one-third of respondents, there were specific concerns about additives, immune system overload and the number of vaccines. Significantly more health professionals in the North Coast area believed that additives in vaccines may be harmful and that adding more vaccines to the schedule would make immunisation too complex. Among GPs, over half felt uncomfortable about giving more than two injections at the one visit., Conclusions: Health professionals in this study had overall confidence in vaccines but had specific concerns about the number of vaccines given to children and vaccine content. These unfounded concerns may reduce parental confidence in immunisation., Implications: There is value in governments and immunisation support workers continuing their efforts to maintain up-to-date knowledge among health professionals and support the delivery of appropriate and targeted information to address concerns about vaccines.

Objective: To provide insight into the effects of focus group composition., Method: In an early phase of an ongoing study of parental reception to messages about childhood immunisation, we conducted four focus groups; two with participants who had never met before (constructed groups) and two with participants who were part of a pre-established first-time mothers' group (natural groups)., Results: Marked differences were noted in the group dynamics, depth of interaction and diversity between groups. Discussions with constructed groups were animated, enthusiastic, expressed more divergent views and articulated greater complexities of the topic. Discussions with natural groups were generally flatter and less enthusiastic, displaying a higher level of apparent conformity to conventional wisdom. The need to protect other participants from potentially disturbing information about vaccination was expressed across groups but acted to censor natural groups, where participants knew more of each others' sensitivities., Implications: Insight into the factors contributing to such differences may enhance understanding of the contexts in which constructed groups are more appropriate. The processes of social censorship may be of primary interest to the researcher. However, where it is paramount to elicit a range of opinions about a potentially controversial topic, we suggest that natural groups in the delicate stage of norming be avoided. The peculiarities of each individual research circumstance are best explored in pilot studies.

There is some evidence that low childhood immunisation rates in Australia may be attributed partly to parental antipathy toward immunisation. The anti-immunisation movement is becoming more organised in its efforts to lobby against childhood immunisation, while the lessening of the public's exposure to the effects of vaccine-preventable disease has provided a climate ripe for such a lobby to have a disproportionate influence on parents. Forty months of Australian print media coverage of immunisation were reviewed for anti-immunisation arguments and their underlying ideological subtexts. Of 2440 articles about childhood immunisation, 115 (4.7 per cent) contained statements opposing immunisation. Eight subtexts that referenced wider discourses about medicine, the state and the body dominated anti-immunisation discourse (cover-up; excavation of the facts; unholy alliance for profit; towards totalitarianism; us and them; vaccines as poisonous chemical cocktails; vaccines as cause of idiopathic ills; and back to nature). Attempts to redress claims made against immunisation must not only address specific claims about vaccine efficacy and safety but be grounded in a reframing of the ideological appeals that currently frame the contents of anti-immunisation discourse.

The in vitro metabolism of [3H] testosterone (17beta-hydroxy-4-androsten-3-one), [3H] androstenedione (4-androstene-3,17-dione) and [3H] dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) by cauda epididymal spermatozoa from the rat, rabbit, hamster, guinea-pig and ram, varied between species. There were differences in the androgens utilized, the extent of their conversion and the identities of the metabolites formed. Of the steroid substrates tested rat spermatozoa metabolized testosterone preferentially while spermatozoa from guinea-pig transformed [3H] dehydroepiandrosterone (DHEA) almost exclusively. Rabbit spermatozoa converted all three [3H] androgens while hamster sperm utilized [3H] testosterone and [3H] DHEA. Spermatozoa collected from rams killed at the abattoir metabolized both [3H] androstenedione and [3H] DHEA but this capacity was dramatically reduced in spermatozoa collected from rams subjected to short-term anaesthesea. The results are discussed in relation to the possible direct roles of androgens in sperm physiology.

We observed that a few patients taking the anti-inflammatory drug fenoprofen showed increases in total and free T3 serum levels without convincing evidence of an associated thyrotoxicosis. To confirm these findings, two volunteers were given fenoprofen for two weeks. Within this time total T3 levels almost doubled and free T3 levels increased threefold. Administration of fenoprofen did not have any measurable effect on T4 or TSH estimations. Cross-reactivities of fenoprofen and 4'-hydroxyfenoprofen were studied with antisera from various total and free T3 assays. Results show that the metabolite cross-reacts with the antisera from Amerlex total and free T3 assay kits. A lesser degree of interference was observed with the Corning total and free T3 assays. 4'-hydroxyfenoprofen had no effect on an 'in house' total T3 assay. Laboratories should therefore be aware of the possibility that their assay may be subject to interference by fenoprofen or its metabolites while clinicians should be aware of this interference in order that they may avoid unnecessary and harmful treatment.