Determinants of influenza and pertussis vaccination uptake in pregnancy: a multi-centre questionnaire study of pregnant women and healthcare professionals

BackgroundUptake rates of influenza and pertussis vaccination in pregnancy remain suboptimal.AimTo determine the acceptability of routine vaccination among pregnant women; the confidence of maternity healthcare professionals (HCPs) discussing vaccination; and HCP opinion with regards to the optimum healthcare site for vaccine administration.MethodSeparate questionnaires for pregnant women and maternity HCPs were distributed within four NHS trusts in South England from July 2017–January 2018.ResultsResponses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives [both hospital and community], 7% unidentified) were analysed. Actual/intended uptake of influenza and pertussis vaccination was 78% and 92%, respectively. The commonest reason for declining vaccination was feared side effects for their child. White British women (79%) were significantly more accepting of influenza (odds ratio [OR] 3.25, 95% confidence interval [CI] = 1.67 to 6.32) and pertussis vaccination (OR 4.83, 95% CI = 1.77 to 13.19) compared with non-white British women. Among HCPs, 25% were not-at-all or slightly confident discussing vaccination. Obstetricians felt significantly more confident discussing pertussis vaccination than midwives (OR 2.05, 95% CI = 1.02 to 4.12). Among HCPs, 53%, 25%, and 16% thought vaccines should be administered in primary care (general practice), community midwifery, and the hospital setting, respectively.ConclusionMisconceptions exist regarding safety and efficacy of maternal vaccination, and framing information towards safety for the child may increase uptake. Education of HCPs is essential, and vaccine promotion should be incorporated into routine antenatal care, with an emphasis on women from ethnic minorities. Administration of vaccines in primary care may present a logistical barrier to women, however support for alternative sites appears low among HCPs.

Ethics of Child and Adolescent Palliative Care (DRAFT)

Over the course of childhood a patient’s decision-making capacity evolves. While eighteen is the age of majority in most states, younger patients may well have the ability to process information and make informed decisions. At the same time, the “dual process theory” of maturation reveals that emotional considerations may outweigh cognitive ones. Physicians must understand how to respond to parental requests for nondisclosure of diagnosis and prognosis, as well as differences of opinion between the patient and parents as to appropriate treatment options. Even when a child agrees with her parents regarding a treatment plan, this may reflect undue influence rather than voluntariness. And even when a treatment has a favorable benefit/burden ratio, an adolescent’s refusal may present such a logistical barrier that a modified treatment plan may need to be implemented.

INTERDISCIPLINARY CAPSTONE DESIGN STREAM AT THE UNIVERSITY OF WATERLOO: IMPLEMENTATION PLAN

An interdisciplinary design approach is a collaborative effort involving team members from different engineering disciplines to solve a problem. An opportunity for interdisciplinary education exists in the fourth year capstone design project. Interdisciplinary capstone courses are offered at other Canadian universities but, at the University of Waterloo (UW) the co-operative undergraduate engineering program poses a logistical barrier to students interacting with students in other disciplines for capstone design projects. Currently, students can form their own interdisciplinary team but differences in course structure, project deliverables, and design terminology and method between engineering disciplines is challenging for students and instructors. An investigation into the feasibility of a new interdisciplinary capstone design course at UW is undertaken. A possible home for the interdisciplinary capstone course could be under the Chair of Design Engineering. Overall, receptivity among departments is positive but a more comprehensive analysis is required.