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Background Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy—without withholding information about side effects—is critical. Purpose Determine whether a brief symptom as positive signals mindset intervention can improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination. Methods English-speaking adults (18+) were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to the symptom as positive signals mindset condition or the treatment as usual control. Participants in the mindset intervention viewed a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. The control group received standard vaccination center information. Results Mindset participants (N = 260) versus controls (N = 268) reported significantly less worry about symptoms at day 3 [ t (506)=2.60, p =.01, d =0.23], fewer symptoms immediately following the vaccine [ t (484)=2.75, p =.006, d =0.24], and increased intentions to vaccinate against viruses like COVID-19 in the future [ t (514)=−2.57, p =.01, d =0.22]. No significant differences for side-effect frequency at day 3, coping, or impact. Conclusions This study supports the use of a brief video aimed at reframing symptoms as positive signals to reduce worry and increase future vaccine intentions. Clinical Trial information Australian New Zealand Clinical Trials Registry: ACTRN12621000722897p. [ABSTRACT FROM AUTHOR]

Aim: It has been increasingly recognised that family-centred care (FCC) is associated with enhanced well-being for both parents and infants in paediatric settings, including the neonatal intensive care unit (NICU). Over the past 4 years, our NICU has increasingly adopted a collaborative philosophy of care. The purpose of the study was to examine parental experiences of FCC during both the admission and discharge time points in order to examine differences in parents' experiences and identify areas for improvement.Methods: We conducted interviews at two time points (admission and discharge) with 83 parents (mothers and fathers) of premature and medically fragile infants and analysed the data using thematic analysis.Results: Three key themes (and sub-themes) were identified: disempowerment, hierarchy between parents and staff and the father's peripheral role. The themes were equally prevalent across admission and discharge.Conclusions: The challenges relating to FCC reported by parents at both admission and discharge represent some of the key barriers that parents still face in terms of being truly involved in the care of their infant in the NICU. Similar themes at both time points suggest that parents need equal amounts of support during their stay in NICU, irrespective of the level of care the infant is receiving and whether they are approaching discharge. Implications for improving FCC more generally are discussed. [ABSTRACT FROM AUTHOR]

Background: Open-label placebos are a novel treatment option, in which participants take placebos with full knowledge that they do not contain active medicine. Open-label placebo treatments have been shown to result in patient-reported symptom improvements, but they have not been tested on objectively measurable physiological outcomes such as wound healing.Purpose: The current study aimed to determine whether open-label placebos improved wound healing in punch biopsy wounds compared with no treatment.Methods: In a randomized controlled trial, 70 participants (mean age 27.6 ± 10.1, 58 female) were provided with information about the beneficial effects of placebos and given a 4 mm punch biopsy wound. Participants were then randomized to either an open-label placebo intervention (two placebo tablets twice a day for 10 days) or a no-treatment control group. Wounds were photographed at 7 days and 10 days to determine reepithelialization of the wound surface.Results: No significant differences were observed between the open-label placebo and control conditions in the percentage of wound area healed or for the number of participants with fully reepithelialized wounds at 7 days (placebo 7/32 wounds healed, control 10/33 wounds healed, (χ2[1, N = 65] = 0.60, p = .440, φ = 0.10) and 10 days after wounding (placebo 17/32, control 25/33 wounds healed (χ2[1, N = 65] = 3.64, p = .056, φ = 0.24).Conclusions: Open-label placebo treatment does not improve the healing rate of wounds. Open-label placebos may be beneficial for subjective patient-reported outcomes but do not influence wound healing.Australian New Zealand Clinical Trials Registration: ACTRN12616000411448. [ABSTRACT FROM AUTHOR]

Background: Although generic medicines provide a safe and economical treatment for many illnesses, negative attitudes towards generics are common and branded innovator drugs are often preferred to generic drugs.Objective: The current study examined differences between individuals preferring branded innovator drugs compared with individuals preferring generic drugs or having no preference. We investigated differences in terms of demographics, perceived sensitivity to medicines, symptom burden, and other clinical variables.Methods: A representative general population sample (n = 1000) was recruited using random digit dialling. In a telephone interview, participants were asked about their preferences for and attitudes toward innovator versus generic drugs, perceived sensitivity to medicines, recent symptoms, and other clinical variables, such as the number of general practitioner (GP) visits, and medicine-related information-seeking behaviour.Results: Univariate logistic regression analyses showed that individuals preferring branded innovator medicines reported lower levels of education, more negative attitudes toward generic medicines, higher perceived sensitivity to medicines, a greater symptom burden and more frequent GP visits. There were no between-group differences in whether participants were currently prescribed drugs, or in participants’ medicine-related information-seeking behaviour. Entering all variables into a multivariate logistic regression model confirmed the findings of the univariate models, apart from perceived sensitivity of medicine and symptom burden. The multivariate analysis also confirmed non-European NZ ethnicity and having no current medication prescription to be significantly associated with a preference for branded medicines.Conclusions: Clinicians should be especially aware that the preference for a branded innovator medicine is higher in patients with lower education, higher perceived sensitivity to medicines, higher levels of symptom burden, higher levels of healthcare utilization and not currently taking any prescription medication. [ABSTRACT FROM AUTHOR]

Objective: To examine whether illness perceptions independently predict mortality in early-onset gout.Methods: Between December 2006 and January 2014, a total of 295 participants with early-onset gout (<10 years) were recruited in Auckland and Wellington, New Zealand. The participants were followed up until February 2015, and mortality information was collected. Participants with complete data were included in the current study (n = 242). Cox proportional hazards models were used to examine the association between illness perceptions and mortality risk, after adjustment for covariates associated with disease severity and mortality in gout.Results: In a Cox proportional hazards model adjusted for predictors of disease severity and mortality in gout (number of tophi, serum urate level, and frequency of flares), consequence beliefs, identity beliefs, concern beliefs, and emotional response to gout were associated with all-cause mortality (hazard ratios [HRs] 1.29, 1.15, 1.18, and 1.19, respectively; P < 0.05 for all). In the fully saturated model, the association between consequence beliefs and mortality remained robust after additional adjustment for ethnicity, disease duration, diuretic use, serum creatinine, and pain score (HR 1.18 [95% confidence interval 1.02-1.37]; P = 0.029).Conclusion: Negative beliefs about the impact of gout and severity of symptoms, as well as concerns about gout and the emotional response to gout, were independently associated with all-cause mortality. Illness perceptions are important and potentially modifiable risk factors to target in future interventions. [ABSTRACT FROM AUTHOR]

Objective:To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis. Design:Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models. Main outcome measures:Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data. Results:Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%,p = .19). Conclusion:The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment. [ABSTRACT FROM PUBLISHER]

Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months ( p=0.03) and decreased viral load ( p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART. [ABSTRACT FROM AUTHOR]

Objectives: Symptom misattribution is a central process in the nocebo effect but it is not accurately assessed in current side effect measures. We have developed a new measure, the Side Effect Attribution Scale (SEAS), which examines the degree to which people believe their symptoms are treatment side effects.Methods: The SEAS was tested in three New Zealand studies: a vaccination sample (n = 225), patients with gout or rheumatoid arthritis (n = 102), and patients switching to a generic medicine (n = 69). The internal reliability of the scale was examined using Cronbach's alpha. To assess validity, the Side Effect Attribution Total Score and Side Effect Attribution Binary Score were related to a number of psychological measures associated with side effect reporting.Results: The scale showed good internal reliability across the three studies, with Cronbach alphas ranging from 0.840 to 0.943. Analysis of the effect sizes showed that the Attribution Total Score was generally more strongly associated with nocebo responding than Attribution Binary Score. Participants had greater Side Effect Attribution Total Scores if they had higher expectations for vaccination side effects (r = 0.18, p = .028), more worry about future vaccine effects (r = 0.16, p = .046), a higher perceived sensitivity to medicines (r = 0.50, p < .001), greater anxiety (r = 0.25, p = .016), greater intentional non-adherence (r = 0.30, p = .003), greater medicine information seeking (r = 0.26, p = .010), lower trust in pharmaceutical agencies (r = -0.29, p = .026), and lower medicine efficacy beliefs (r = -0.46, p < .001).Conclusions: The SEAS provides a more nuanced assessment of symptom attribution beliefs. It appears to be more sensitive measure than just a side effect total, as it is associated with a greater number of relevant psychological variables. Future research should examine the scale in other populations and settings. [ABSTRACT FROM AUTHOR]

Objective: Following a switch from either a generic or branded antidepressant (venlafaxine) to a new generic, we investigated the factors associated with a preference for branded medicines, side effects reported following switching and efficacy ratings of the new generic drug., Design: A cross-sectional survey of patients switched to a new generic., Setting: Patients accessing venlafaxine information online from the New Zealand government pharmaceuticals funding website., Participants: 310 patients, comprising 205 originally on branded venlafaxine and 105 previously taking a generic version., Main Outcome Measures: An online questionnaire assessing demographic factors, perceived sensitivity to medicines, trust in pharmaceutical agencies, sources of switch information, preference for branded medicine, new medicine perceptions, side effects and efficacy ratings., Results: Preference for branded medicine was significantly stronger in older patients (OR=1.04, 95% CI 1.01 to 1.05), those taking branded venlafaxine (OR=2.02, 95% CI 1.13 to 3.64) and patients with a higher perceived sensitivity to medicine (OR=1.23, 95% CI 1.06 to 1.19). Different factors predicted side effects in those switching from the branded and those switching from the generic venlafaxine. Trust in pharmaceutical agencies and the number of side effects were significant predictors of efficacy ratings of the new generic in both patients switching from a branded and those switching from a generic version of venlafaxine., Conclusions: In patients switching from a branded medicine and those already taking a generic, different demographic and psychological factors are associated with preference for branded medicine, side effect reporting and perceived efficacy of the new drug. When switching to new generic, there appears to be a close bidirectional relationship between the experience of side effects and perceived drug efficacy. Trust in pharmaceutical agencies impacts directly on perceived efficacy and increasing such trust could reduce the nocebo response following a generic switch., Competing Interests: Competing interests: KP has previously received research funding from Pharmac, the New Zealand Government’s Pharmaceutical Management Agency., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The belief that one is especially sensitive to the actions and side effects of medicines can influence treatment adherence and side-effect reporting. In this study, we investigated the prevalence of perceived medication sensitivity in the general population and its relationship to symptom complaints, information seeking about medications, use of medical care and demographic factors., Methods: A nationally representative sample of 1000 New Zealand residents completed the Perceived Sensitivity to Medicines scale and symptoms experienced during the previous 7 days. Demographic data and medical visits, medication use and information seeking about medicines were also collected., Results: Over 20% of the general population reported being very sensitive to the effects of medication (20.2%) and that small amounts of medicines can upset their body (25.3%). Participants who reported high levels of perceived sensitivity to medicines reported significantly more symptoms (M = 9.54, SE = 0.47) than people with low (M = 5.04, SE = 0.49) or moderate (M = 5.91, SE = 0.24) levels, ps < .001. This relationship was strongest in participants who were currently taking prescription medication. Those with high perceived sensitivity also reported being more likely to seek information about medicines, and had significantly more general practitioner visits., Conclusions: Perceived sensitivity to medicines is common in the population and associated with important clinical variables including information seeking, GP visits and symptom reporting. Identifying patients with higher perceived sensitivity to medicines may improve patient care by providing the basis for targeted and personalised interventions to reduce side effects and improve adherence to medications., (Copyright © 2015 John Wiley & Sons, Ltd.)