Background With COVD-19 cases on the rise globally and two approved vaccines, determining vaccine acceptance is imperative to avoid low inoculation rates. The aim of this study was to evaluate the changes and determinants of vaccine acceptance among citizens and non-citizens, over time during the pandemic in Kuwait. Methods Data were obtained from the COVID-19 Snapshot Monitoring (COSMO Kuwait) study that was implemented according to the WHO tool for behavioral insights on COVID-19. Data was collected online, every two weeks throughout the pandemic. Individuals living in Kuwait during the pandemic were surveyed, representing an independent sample of the population during each data collection wave. Results A total of 7241 adults living in Kuwait participated. Sixty-seven percent of those participating agreed to take a vaccine if it was available and recommended. However, the proportion of vaccine acceptance drastically dropped overtime as COVID-19 related restrictions were eased, among citizens (73 to 47%) and noncitizens (80 to 60%). Some factors associated with increased odds of agreeing to take the COVID-19 vaccine, among citizens and non-citizens, included increased frequency of informing oneself about the virus (OR, 1.34–1.83; 95% confidence interval 1.16–2.55), having high versus low confidence in doctors (OR, 1.79–2.11; CI 1.17–3.80), increased agreement with containment policies (OR, 1.11–1.27; CI 1.05–1.41), expressing more fears and worries (OR, 1.05–1.12; 1.01–1.24), and the increased perceived likelihood of getting infected with influenza (OR, 1.3–1.4; CI 1.03–1.84). Decreased odds of agreement were associated with increased age (OR, 0.37–0.61; CI 0.26–0.95), being female (OR, 0.56–0.62; CI 0.43–0.73), and not taking the influenza vaccine in 2019 (OR, 0.61; CI 0.43–0.87). Conclusion Vaccine acceptance was multifactorial, heterogenous among citizens and non-citizens, and changed over time. While acceptance was relatively high, it decreased throughout the pandemic and as restrictions in the country loosened. This increase in vaccine hesitancy reveals a challenge in achieving high inoculation levels, and the need for effective vaccine-promotion campaigns and increased health education in the country.

Our study examines the association of the presence of mildew, cockroaches, and pets in homes as well as household dust allergens with the prevalence and/or severity of allergic diseases. No study has concurrently assessed home environment exposures in relation to allergic conditions in the general US population. Data from 5409 participants from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) living in their current homes for ≥one year were analyzed. Multivariate logistic regression analyses between home exposures and allergic diseases prevalence and severity were performed. In adjusted analyses, mildew was associated with higher current asthma, allergies, and allergic rhinitis prevalence; endotoxin, with higher current asthma prevalence; and dust Canis familiaris (Can f) 1, with higher allergic rhinitis prevalence. However, presence of cockroaches and dust Dermatophagoides farinae (Der f) 1 were associated, respectively, with lower current asthma and allergies prevalence. Presence of mildew, dust Der f1, Dermatophagoides pteronyssinus (Der p) 1, Felis domesticus (Fel d) 1, and endotoxin were all associated with asthma and/or wheeze severity. Non-atopic asthma was more frequent with mildew and/or musty smell dust and higher dust Fel d1 concentration, while atopic asthma was more prevalent with higher Can f1 and endotoxin concentrations in dust. This study confirms previous relationships and reports novel associations, generating hypotheses for future research.

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BACKGROUND: Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed. OBJECTIVE: To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance. DESIGN: Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN MEASURES: The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY RESULTS: Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01). CONCLUSIONS:The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION: clinicaltrials.gov NCT03784950