Sudden cardiac arrest (SCA) remains one of the most devastating complications of pediatric hypertrophic cardiomyopathy (HCM). Despite major advances in genetic diagnostics, cardiac imaging, and risk stratification strategies, the prevention of sudden cardiac death (SCD) in children and adolescents with HCM remains an unresolved clinical challenge. Contemporary guideline-based approaches and pediatric-specific risk models have improved decision-making regarding implantable cardioverter-defibrillator (ICD) implantation in diagnosed patients; however, these strategies are inherently limited by their reliance on an established HCM phenotype. A substantial proportion of pediatric patients experience SCA as the initial clinical manifestation of disease, without any warning symptoms. In this expert review, we conducted a MEDLINE-based literature search using the keywords HCM, SCA, and pediatric to synthesize current evidence on the epidemiology, age-specific characteristics, and arrhythmogenic mechanisms of pediatric HCM, and also highlight the limitations of existing risk stratification models and prevention strategies. We discuss emerging insights into electrical vulnerability that may precede overt structural disease, as well as the evolving role of electrocardiography-based screening strategies. By integrating clinical experience with recent advances - including artificial intelligence - enhanced electrocardiography - we propose a shift from post-diagnosis risk prediction toward upstream detection of vulnerable individuals.
Across ages and cultures, planning actions adaptively during tool use is a hallmark of human intelligence and a critical factor in human survival and proper function. Previous cross-sectional studies showed that adaptive planning begins in infancy and improves with age and experience. However, little is known about how developmental improvements in adaptive planning occur. Do infants gradually adapt their action planning with one object and then generalize this skill to other objects, or does learning remain tool-specific? Here, we longitudinally tested nine infants in weekly sessions across the age range when tool use is rapidly developing. Infants were presented with a familiar tool (spoon) and three unfamiliar tools (brush, hammer, magnet) with handles pointing to the right or left. For each trial, we scored whether infants used an adaptive radial grip (evidence of action planning) or an inefficient ulnar grip (no evidence of planning). Across several months of testing, every infant gradually learned to use an adaptive radial grip for the spoon, but none showed improvement for the unfamiliar tools. Adaptive planning with the spoon was further limited to self-directed actions (bringing food to their own mouth) rather than other-directed actions (feeding a puppet). Learning was characterized by high variability before stable achievement of an efficient grip. Across all tools, right-pointing handles elicited more radial grips than left-pointing handles. Our findings replicate previous cross-sectional research and provide new insights into the longitudinal progression of adaptive planning during tool use in infancy. Specifically, the development was gradual rather than abrupt, and learning remained highly tool-specific without generalization, emphasizing the critical role of specific and extensive experience with particular tool-action combinations.
Spinal cerebrospinal fluid (CSF) leak is a disabling and often misdiagnosed condition characterised by CSF hypovolemia. Associated neurological symptoms are diverse and often leave individuals bed-bound due to their orthostatic nature. Prior literature describing the difficulties in diagnosis, treatment, and ongoing impact of CSF leak is, thus far, confined to Europe and North America. This study provides a novel account of lived experiences of spinal CSF leak in Australia and Aotearoa New Zealand (NZ). An online survey exploring symptoms, diagnosis, treatment, and effect on daily life of a person's "first" CSF leak was designed with consumer involvement. Responses were received from May to August 2025. Open-text responses were analysed using thematic analysis. In total, 106 surveys were completed. Over 70 symptoms were reported; the most common were orthostatic headache (95.3%), neck pain (85.8%), and brain fog (79.2%). Most people considered their diagnosis (73.6%) and treatment (65.3%) difficult, underscored by limited clinician awareness and access to care, leaving individuals to self-advocate. Amongst symptomatic participants (73.6%), median EuroQol Visual Analogue Scale score was 40 (interquartile range 25-64; indicating low health-related quality-of-life) and mean Headache Impact Test-6 score was 69 ± 5 (indicating severe impact). Other challenges identified included navigating change to social identity and daily functioning. The spinal CSF leak experience in Australia and NZ is comparable to reports from other high-income countries, highlighting the global need to increase awareness of spinal CSF leak, support timely diagnostic, referral and treatment pathways, and mitigate its impact on quality of life.
Sporting events are opportunities for athletes to shine and fans to celebrate. Mass gatherings, including mega sporting events, are linked to substantial communicable disease transmission and requires multi modal, complex preparation and trained response teams. The 2026 FIFA World Cup™ tournament will span 48 teams in three different host countries. This expert commentary aims to review frequently implicated infections and high consequence pathogens; review preparedness strategies for healthcare personnel(HCP), infection prevention and control(IPC) teams, emergency department(ED) and disaster preparedness teams; and emphasize the need for closed loop communication and use of technology. The authors hope this commentary is practically used as a reference for clinicians and public health entities in host cities but also a blueprint for considerations in future sporting events-which are projected to increase.
Visual Thinking Strategies (VTS) is a structured, evidence-based pedagogical method that has been increasingly embraced in medical education to foster essential clinical competencies such as observation, interpretation, communication and empathy. Originally developed for use in K-12 classrooms, VTS involves a standardised facilitation method centred on three carefully sequenced questions posed in response to a visual artwork. Although deceptively simple in format, effective facilitation of VTS requires extensive training and adherence to specific practices that activate collaborative and critical thinking processes. As interest in arts-based pedagogies grows in medical education, VTS stands out as a method with defined guidelines and demonstrable educational outcomes. However, this paper argues that the expanding adoption of VTS be accompanied by a commitment to fidelity-in how the method is implemented, studied and described in the academic literature. While an increasing number of medical educators are enthusiastically incorporating VTS into their curricula, the literature belies a concerning trend of deviations from the method's core components. These include altered wording of the three core questions, inconsistent naming of the method, facilitation by untrained individuals and inadequate or inaccurate methodological descriptions. Such deviations, even when subtle, can compromise the internal validity of research findings and risk misrepresenting the nature and effectiveness of the intervention. This lack of fidelity could threaten the integrity of educational outcomes and the credibility of arts-based approaches in the broader field of medical education. Compounding the issue, peer reviewers and journal editors may lack sufficient familiarity with VTS to identify these inaccuracies, enabling flawed implementations to persist in the literature. We contend that ensuring fidelity to the original VTS methodology is a shared responsibility across researchers, educators, institutions and scholarly publications. Adherence to the method maintains its pedagogical and scholarly value. To that end, we offer practical recommendations, such as formal VTS facilitator training (with greater accessibility to educators in low-resource settings), accurate reporting standards, peer reviewer education and the cultivation of a community of certified practitioners. As VTS continues to gain traction, we recommend that educators aim for fidelity in its use and study, ensuring that its full potential to enrich clinical education is realised and preserved for future generations of learners.
The small GTPase RAB1 is essential for life. A knockout of RAB1 is not only embryonically lethal, but even triggers cell death in a cultured cell line, underscoring its importance for cellular homeostasis. Previous work has shown that RAB1 plays a key role in protein and membrane trafficking as a player in the ER-to-Golgi trafficking pathway. Here, RAB1 has been shown to interact with COPII vesicles that have left the ER and are arriving at the Golgi. In addition, RAB1 is an essential part of autophagy initiation, where loss of RAB1 leads to defects very early in the pathway. To complicate matters further, there is a non-trivial overlap in phenotype between a Golgi trafficking defect and an autophagy initiation problem, as ATG9A vesicle trafficking and the general importance of the Golgi in autophagy illustrates. Given these hurdles, how would one get a handle on the molecular mechanism of RAB1? In this Punctum, I discuss our recent mapping of a new RAB1 interactome that provides fresh insights into its multifaceted functions.
Hard-to-control hypertension, comprising uncontrolled and resistant hypertension, is highly prevalent, meaning many patients with hypertension remain at risk of adverse outcomes despite treatment. To discuss the role of managed care in addressing hard-to-control hypertension, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights were that despite multiple effective, low-cost pharmacotherapy options, a significant proportion of patients have blood pressure above recommended goals because of confounding factors at both the micro and macro levels; and managed care-specific challenges in hard-to-control hypertension include competing organizational priorities, data gaps, and lack of integration of existing resources. Opportunities to advance care in hard-to-control hypertension include focusing on prevention and providing additional patient and clinician support such as with education and enhancing use of digital technologies. Other insights were that top payer priorities in hypertension include reducing cardiovascular events and other complications and meeting quality goals, and that current clinical guidelines and provider input are important elements of payer decision-making. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.
Elective surgical postponements and cancellations adversely affect patient experience, clinical outcomes, and theatre efficiency within the UK NHS. The Postponement and Cancellations in Elective Care study aimed to establish the national incidence and underlying causes of elective surgical postponements at preoperative assessment and cancellations occurring within 24 h of planned surgery. This 7-day prospective service evaluation (November 11-18, 2024) collected data from participating NHS England trusts via an online platform. Preoperative assessment postponements were defined as any factor preventing a patient with a 'to come in' date from undergoing surgery as planned, or preventing preoperative assessment completion as 'good to go' within 2 weeks for those without a 'to come in' date. Cancellations were defined as a decision not to proceed within 24 h of planned surgery. Seventy-eight trusts provided complete incidence data covering 22 573 preoperative assessment appointments and 19 905 planned procedures. The national preoperative assessment postponement incidence was 8.7% (95% confidence interval, 6.9-10.8%), most commonly attributable to further investigation or tests (n=595, 27.2%). The national cancellation incidence was 9.9% (95% confidence interval, 8.7-11.3%), most frequently associated with acute medical conditions (n=515, 23.8%) and list overruns (n=315, 14.5%). The Postponement and Cancellations in Elective Care study provides the first national overview of elective surgical pathway disruption in the UK. Nearly half of postponements were attributable to requirements for additional investigation or specialty review, indicating the importance of earlier optimisation and robust preoperative assessment fit to proceed criteria. Acute medical conditions continue to impact short-notice cancellations. Standardised pathways, improved scheduling, and strengthened perioperative coordination could reduce disruption and improve theatre utilisation.
Studies examining quality of life outcomes have shown that Autistic people experience lower scores across domains (e.g., physical, psychological) compared to other groups, with their lowest scores consistently reported in social functioning. However, to date, little is known about different adult life experiences that Autistic adults have beyond the typically tested outcome of living independently in the community, which may not be a desired outcome culturally for all Autistic people, particularly outcomes that could lead to improved social functioning, like being in relationships. Survey data were collected from a nationally representative sample of 272 U.S. residents with autism. Respondents were asked about secondary school transition activities, support, and later life experiences of moving into their own home, falling in love, getting married, pregnancy, becoming a caregiver, and being arrested. Logistic regression results indicated goal setting and psychological empowerment were significant predictors of all adult life experience outcomes tested, and autonomy/decision-making predicted moving into one's own home and falling in love. Social skills predicted both falling in love, getting married, and being arrested. For support, the number of people supporting the Autistic youth was related to increased odds of falling in love. While transition programs are typically focused on furthering education and employment success in later life, skills taught to students to support those outcomes also relate to a broader range of life experiences for Autistic youth and adults. Programs to support Autistic students and youth should include, at a minimum, activities that build goal setting and psychological empowerment skills in hopes that Autistic adults can experience a fulfilling life of their choosing.
 Patient satisfaction after total hip and knee arthroplasty (THA, TKA) is influenced by multiple factors, including patient-reported pain and function. We aimed to examine whether functional abilities or pain during specific activities are associated more than other aspects with satisfaction 1 year after THA and TKA.  This cohort study included all primary elective THAs and TKAs performed between January 2012 and June 2022 at a tertiary care university hospital. Ordinal logistic regression models were used to assess associations between patient satisfaction and WOMAC Pain and Function summary scores and items, 1 year postoperatively.  1,772 THAs and 1,323 TKAs were included. Individually, all scores and items were associated with satisfaction. However, multivariable models revealed differences in the strength of association. Global pain score (odds ratio [OR] THA: 2.80, 95% confidence interval [CI] 2.40-3.29; TKA: 3.61, CI 2.96-4.44), pain while walking on the flat (OR THA: 1.79, CI 1.45-2.22; TKA: 1.74, CI 1.43-2.11), and pain going up or down stairs (OR THA: 1.64, CI 1.37-1.96; TKA: 1.68, CI 1.44-1.97) showed the strongest associations in both populations. Among THAs, activities walking on the flat (OR 1.41, CI 1.17-1.68), putting on socks (OR 1.29, CI 1.12-1.48), and ascending stairs (OR 1.26, CI 1.08-1.46) contributed most to satisfaction, whereas among TKAs, walking on the flat (OR 1.41, CI 1.18-1.69), rising from sitting (OR 1.32, CI 1.11-1.58), and getting in or out of a car (OR 1.31, CI 1.10-1.57) did.  After THA/TKA, patient satisfaction is associated with pain during basic daily tasks-especially walking and stair climbing. Key functional drivers differ by joint: socks and stairs matter for THA, rising from sitting and getting in/out of a car matter for TKA.
Few studies have been done on the association between eating legumes and ulcerative colitis (UC). In order to ascertain whether eating legumes changes the risk of developing UC, this case-control study was conducted. Three hundred and forty patients with newly diagnosed UC and 782 controls were studied and evaluated using a 168-question food frequency questionnaire. The odds ratios (ORs) and matching 95% confidence intervals (CIs) for the association between eating legumes and the risk of getting UC were calculated using binary logistic regression. Adjustments were made for age, energy, physical activity, alcohol consumption, smoking, meat, grains, dairy, fruit, nuts, vegetables, and body mass index. After adjusting for every known risk factor associated with UC, when the highest and lowest categories of intake were compared, it was shown that patients who consumed more legumes had a lower odds of having UC (OR = 0.21, 95% CI, 0.12-0.36, P for trend <0.001). This case-control study found a significant inverse relationship between legume intake and UC risk. Taking a lot of potential covariates into account did not alter this association. More investigations in the framework of prospective cohorts are warranted to confirm these findings.
Amyloidosis is a group of rare diseases that often manifest in multi-organ symptoms requiring an effective multidisciplinary team of care providers to manage. This study aimed to identify the best practices and key barriers to patient-centric care at US specialized amyloidosis centers (SACs) which have emerged as central hubs for multidisciplinary amyloidosis care. We conducted and analyzed interviews with 77 stakeholders of amyloidosis diseases, including specialist physicians from 17 SACs across the US, patients, patient advocacy group representatives, and referring physicians. The most commonly mentioned best practices were patient-centric multidisciplinary care, timely intake of new high-risk patients, and responsiveness to patient questions. Expanding local physician education was noted as critical to earlier diagnosis. Fifteen out of 17 SACs are actively involved in clinical trials for amyloidosis treatments. Key barriers to care identified were patient distance to SACs, limited medical records and data sharing, and insurance hurdles. Most SACs keep track of metrics, such as patient volume, patient demographics, time to first appointment, as part of internal or in external registries to measure progress. These findings offer practical insights for optimizing amyloidosis care and highlight the structural and informational gaps that must be addressed to improve access and outcomes. Current State of Care for People With Amyloidosis at Specialized U.S. Centers: What Works and What We Need to Improve Why was this study done? Amyloidosis is a rare disease that can affect several organs in the body. Because it is complex and not well-known, people with amyloidosis often have challenges getting the right diagnosis and care. In recent years, specialized amyloidosis centers (SACs) have been set up across the United States by hospitals to provide appropriate care to these patients. This study aimed to understand how these centers work, what they do well, and what challenges they face. What did the researchers do? The research team spoke with 77 people across the U.S., including doctors, nurses, patients, referring physicians, and leaders of patient advocacy groups. All participants were involved in amyloidosis care. The interviews explored how SACs provide care, how patients access services, and what could be improved. What did the research find? Participants described several best practices at SACs, such as coordinated care by teams of different specialists, fast intake for high-risk patients, and strong communication with patients. Most SACs also track data on patients and many are involved in clinical trials. Patients valued the compassion and responsiveness of SAC staff. However, some challenges remain. Patients and doctors still see a lot of delays in diagnosis. Travel distance to centers, insurance barriers, and limited emotional support were common issues. Many patients said they received little information at the time of diagnosis. Telemedicine was helpful for some but not ideal for all situations. What do these findings mean? This study shows that SACs offer many benefits for people with amyloidosis, but improvements are still needed–especially in education, emotional support, and coordination with local care providers. The researchers and participants hope that by sharing their perspectives, newer SACs and doctors, as well as patients, can be better informed about providing and receiving care that centers the patient experience.
Back pain is a common presentation in healthcare settings. The most serious cause is cauda equina syndrome (CES), a surgical emergency caused by acute compression of the lumbosacral nerve roots. In the UK, diagnosis requires a thorough clinical examination and emergency magnetic resonance imaging (MRI). Once confirmed on imaging, definitive treatment is urgent surgical decompression usually within 24 hours. Delays in diagnosis or treatment can lead to life-changing consequences including bowel and bladder incontinence, sexual dysfunction, lower limb paralysis and chronic pain. This narrative review provides a 2025 update to the 2023 review published in this journal. It covers the anatomy, epidemiology, aetiology, pathophysiology, classification, clinical presentation, examination, investigations, differentials, treatment, and management of CES. Major updates are based on the new UK 2025 Getting It Right First Time (GIRFT) interactive pathway. Important changes include: (1) the standardisation and timing of red flag symptoms, (2) the use of bladder scans as a rule-in rather than rule-out investigation, (3) aim for 24-hour MRI local diagnostic capabilities with standardized imaging sequences and proximal scanning in absence of cauda equina compression, (4) declassification of CES, (5) emphasis on all patients with established CES to receive urgent decompressive surgery as National Confidential Enquiry into Patient Outcome and Death (NCEPOD) level 1/2. This review uses the authors' experience of suspected CES pathway improvement to propose a pathway for the management of suspected CES in the emergency department at district general hospitals without 24-hour MRI capability based on the most recent national GIRFT guidelines.
Managing medications safely can be challenging for people with dementia and carers living in the community and medication errors can be a source of preventable harm. Resources to support people in medication management must address their information needs and prioritise these alongside those of broader stakeholders. We aimed to generate content statements for inclusion in tailored medication management literacy resources for people with dementia and carers. Using a community-based participatory research approach, we established a Medication Management Guidance Partnership: collaboration between the research team, research advisory group, and partner organisations. A mixed-method approach generated 49 statements (Phase 1) then we conducted an online modified Delphi process to gain consensus (Rounds 1 and 2) and prioritise statement order (Round 3) for inclusion in resources (Phase 2). Primary criterion for consensus required ≥80% of participants rating statements as important (≥7 on 9-point Likert-type scale). Secondary criteria assessed response variability, and statements were required to meet all criteria for inclusion. People with dementia (n = 5), carers (n = 5), healthcare professionals and/or national consumer organisation representatives (n = 13) reached consensus on 44 statements across six information domains. 'Information about decision-making' was ranked highest, followed by 'general question prompts', 'information about common medications', 'addressing complexities,' 'getting guidance in different languages' and 'additional supports.' Our 'menu' of statements about medication management priorities, endorsed by end-users, can be used to guide development of resources to improve medication management and potentially reduce medication-related harm in this population.
Under the requirements of Industry 4.0, the performance requirements for improving the hydraulic controller of the mechanical hand wrist are getting higher and higher. To address issues such as response delay and insufficient accuracy in traditional methods, this study proposes a hydraulic control based on a dynamic model. The core innovation lies in embedding the dynamic model into the control loop and integrating multiple intelligent algorithms for closed-loop optimization. Experimental verification shows that the maximum trajectory tracking error of the SHD controller is only 0.28 mm, the fault detection accuracy is as high as 98.3%, and the energy conversion efficiency is 98.1%. It is significantly superior to existing advanced controllers in terms of accuracy, stability, and response speed, such as the controller combining quantum-inspired neural networks with robust control, the controller combining meta-learning with fuzzy wavelet control, and the controller combining federated learning with edge control. The above research results provide an efficient solution for the precise and intelligent control of hydraulic systems in complex lifting operations.
Through-knee amputation (TKA) preserves a longer residuum and enables end-weight bearing and prosthetic self-suspension, unlike above-knee amputation (AKA). Despite this, TKA is rarely performed. The lived experience of individuals with TKA remains unexplored. This cross-sectional qualitative study used semi-structured interviews to explore the experiences of 20 community-dwelling individuals with TKA or AKA, sampled for sex and mobility from two UK limb centres. Reflexive thematic analysis was used to compare and contrast groups. "Hide or Pride" examines why some individuals choose to conceal or display their amputations, highlighting the unique challenges each group faces. "Staying Positive" emphasises the importance of an optimistic outlook, particularly in the TKA group who feel relieved to have retained more of their leg. "Getting On With It" addresses changes in activities, falls, phantom sensations, and prosthetic issues. It notes frustrations in the TKA group about their longer thigh in tight spaces and the comfort challenges faced by the AKA group. TKA may be a viable option from the patient perspective. Understanding shared and distinct experiences of TKA and AKA can inform clinical decisions about amputation level and rehabilitation. The diverse sample enhances the transferability of findings to similar high-income contexts. Through-knee amputation should not be overlooked on the assumption that patients are less satisfied compared to above-knee amputation.The decision on amputation level should be discussed considering patients’ goals as through-knee amputation provides some practical advantages, but some prosthetic limb-users in this study experienced issues with componentry for some sports.Pre-operative counselling should include discussion around the appearance of residual limbs and prosthetic limbs and how to access psychological support.
Most older adults with disabilities in China and across Eastern Asian prefer to age in place, relying on home- and community-based care. Their family caregivers frequently encounter significant challenges, including a pronounced lack of knowledge and skills for providing daily living assistance, highlighting a critical need for accessible, practical training. Furthermore, existing community-based support programmes for caregivers often fail to incorporate an integrated family perspective. This oversight neglects the crucial dynamics and internal interactions within the family unit, which are fundamental to the overall adaptation and resilience of the entire family system. This study aims to develop a nurse-led, family-oriented resilience intervention programme for caregivers of older adults with disabilities. The programme is designed to enhance caregivers' practical competencies and to strengthen overall family adaptation within the context of Chinese community settings. We followed the Medical Research Council (MRC) framework for developing and evaluating complex interventions to guide the development process. This involved integrating empirical evidence from our prior studies, identifying relevant theories of family resilience, and validating the preliminary intervention content. We employed a two-round Delphi method with an expert panel to validate the initial programme draft. For each proposed activity, we calculated the coefficient of variation (CV) and Kendall's coefficient of concordance (Kendall's W) to assess expert consensus. The two-round Delphi consultation yielded high positive and authority coefficients. In the first round, the mean importance scores for items ranged from 4.19 to 4.96 (overall mean 4.77 ± 0.21), with a coefficient of variation (CV) between 0.04 and 0.16 and Kendall's W was statistically significant (p < 0.01). In the second round, scores ranged from 4.16 to 4.96 (overall mean 4.82 ± 0.19), with a CV between 0.04 and 0.15, and a significant Kendall's W (p < 0.01). Based on this expert feedback, we refined the intervention into an 8-week programme, delivered via weekly home visits, integrating two core components: caregiving skill and family resilience. The weekly themes are (1) Getting to know each other; (2) I am not fighting alone (cleaning care and coping, social support for caregivers); (3) Thank you, embrace you (family resilience and internal support); (4) Love flows through communication (dietary care and coping, family communication and coping); (5) Riding the wind and waves together (excretion care and coping, social support for peers); (6) Community with me (mobile care and coping, social support for community); (7) Supplementing energy (safety protection and basic first aid, social support for external systems); and (8) Radiating the caregiver's radiance (individual self-resilience and self-support). Guided by the MRC framework, we developed a theory-driven, culturally appropriate, nurse-led and family-oriented resilience intervention for caregivers of older adults with disabilities. The program's flexible delivery allows adaptation to local resources and caregiver needs, help caregivers overcome practical challenges and enhance family resilience. Future research should utilize a three-arm randomized controlled trial to evaluate the feasibility, acceptability and preliminary effectiveness of this complex intervention. This nurse-led, family-oriented resilience intervention offers a practical, home-based training programme that equips family caregivers of older adults with disabilities with essential caregiving skills and strategies to strengthen family adaptation, thereby supporting the implementation of community-based aged care services in China and similar Eastern Asian contexts.
Pregnant women face increased risks from influenza complications, underscoring the importance of vaccination. This study evaluated knowledge and attitudes about influenza vaccination and self-reported vaccination rates among pregnant women in Split-Dalmatia County, Croatia. A cross-sectional study was conducted from March to July 2020 in primary healthcare gynecological clinics in Split, Croatia. A convenience sample of pregnant women completed an anonymous 33-question survey after providing informed consent. Data were analyzed with a chi-square test, Fisher's exact test, or Kruskal-Wallis test, as appropriate. Among 323 participants, only 10 (3.2%) received the influenza vaccine during pregnancy. Most respondents (96.3%) reported that healthcare providers did not offer them influenza vaccine. Insufficient knowledge about influenza vaccination was observed, with a median score of 38.46 (IQR = 23.08-53.85) out of 100. Higher education was significantly associated with better knowledge about influenza vaccination (P = 0.006), while age was not (P = 0.441). The primary reason cited for not getting vaccinated was a lack of information about the influenza vaccine (n = 144, 46%). Media sources such as radio, television, and the Internet were the most common sources of vaccine information (n = 89, 40%), while only a small fraction (n = 15, 6.7%) received information from their gynecologist. Low self-reported vaccination rates among pregnant women in Split-Dalmatia County were primarily due to insufficient awareness and inadequate information from healthcare professionals. Improved education and proactive vaccine promotion by healthcare providers are critical to addressing this gap.
Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay-a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals' eligibility, and real-world complexities like infections. Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing. Our results show that only 34.89% and 42.97% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays. These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness. Vaccination against COVID-19 has prevented many hospitalizations and deaths, yet delays in getting vaccinated have limited these benefits. We examined why people in Hong Kong postponed vaccination and proposed vaccination delay as an important metric for understanding vaccine hesitancy and rollout success. Using repeated survey data collected during the pandemic, we analyzed how trust in health authorities and psychological factors—such as confidence, perceived barriers, and social responsibility—affected both vaccination intention and timing. We found that higher trust and confidence were linked to earlier vaccination. Recognizing vaccination delay as a key public health measure can help governments design strategies that build trust, encourage timely uptake, and improve preparedness for future pandemics.