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    • The results of the hierarchical

    2018-10-23

    The results of the hierarchical regression suggest that countries with higher mean years of schooling are less likely to report positive vaccine sentiment, however within a country those with some education hold more positive views on vaccine importance, effectiveness, and religious compatibility (though markedly not safety) than those without. There is evidence in the recent literature to suggest that more highly educated elites in the Netherlands (Hak et al., 2005), the United States (Gilkey et al., 2014; Jones et al., 2010), and Canada (Foty et al., 2010) hold vaccine skeptic views, which is in keeping with the highest level of education of surveyed respondents (Masters/PhD) having the same vaccine importance sentiment as those with no or little education. Further systematic reviews have highlighted the variability of correlations found between education and vaccine confidence, with no clear pattern except to show that education does not always imply confidence (Brown et al., 2010; Larson et al., 2014a, 2014b). Other individuals with low income, and the unemployed, also exhibit less positive vaccine views A limitation of this study is the generality of the survey questions, which do not reveal whether the attitudes are related to specific vaccine(s) which an individual may have concerns about. A study of repeated surveys of rifampicin attitudes in France (Peretti-Watel et al., 2013) also considers general vaccine-skepticism, finding a link between children unvaccinated against MMR and unfavorable attitudes towards vaccines as a whole. The ability to investigate the effect of skepticism towards a particular vaccine on other vaccines and would help understand how skepticism towards a particular vaccine can drive other harmful vaccination behaviors. To address these issues, we propose an extension to the five-point Likert scale questions to include statements on immunization intent for specific vaccines. A further limitation is the inability in the present study to track temporal changes of immunization attitude. Repeated surveys allow for a better understanding of the complex interplay between socio-economic, political, and religious characteristics, vaccine sentiment, immunization intent, and immunization rates (de Figueiredo et al., 2016). Monitoring systems can be developed to track confidence, forecast areas of concern, and lessen hesitancy through targeted intervention.
    Funding sources ARC and XZ received funding from the Centre for Infectious Disease Epidemiology and Research, National University of Singapore. HL and WS and The Vaccine Confidence Project receive support for vaccine confidence research from the European Centres for Disease Control (ECDC), European Commission Innovative Medicines Initiative (IMI), and World Health Organization (WHO). Additional funders listed below. Gallup International Association has contributed pro bono support for the data collected in the 67 countries in this study. NJ thanks EPSRC grants: EP/N014529/1 and EP/I005986/1.
    Author contributions
    Disclosure
    Introduction In response to growing concern about the increasing incidence and morbidity of falls (Cigolle et al., 2015; WHO, 2012), the Joint Commission (United States) established fall prevention as one of its national patient safety goals in 2015 (The Joint Commission, 2015). Postoperative falls may occur more often than falls in the general population (O\'loughlin et al., 1993; Berggren et al., 2008), yet their demographics and epidemiology have not been well-described. A few studies examine the characteristics and risk factors for postoperative falls, but most are retrospective, inpatient, orthopedic, or too small for risk factor assessment (Church et al., 2011; Clarke et al., 2012; Jorgensen et al., 2013). In the general population, a history of falls is a strong predictor of falling again (Tinetti and Kumar, 2010; Deandrea et al., 2010), worse function (Skalska et al., 2014), and poor quality of life (Stenhagen et al., 2014). Falls are also associated with functional dependence and poor quality of life in the preoperative surgical population (Kronzer et al., 2016b). A link may therefore also exist between falls and outcomes in surgical populations. Indeed, in a restricted patient population, preoperative falls have been associated with postoperative complications, and on a crude basis, with readmission (Jones et al., 2013). However, the value of ascertaining fall history preoperatively has not been definitively established.