Category: Covid-19

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Dynamic predictors of COVID-19 vaccination uptake and their interconnections over two years in Hong Kong - Nature.com

Bacteria rapidly colonize the gut of a newborn immediately following birth, creating the microbiome.1 Social and environmental factors influence the makeup of the microbiome after birth. In fact, babies born by Caesarian section initially develop microbiomes that are distinct from their parents when compared to infants delivered naturally who pick up bacteria as they pass through the vaginal canal.2 The early days of the COVID-19 pandemic required social distancing measures and heightened hygiene practices, but it wasnt clear how this might affect the infant microbiome. Now, communicated in Scientific Reports, researchers report that infant microbiome diversity plummeted when the pandemic spiked.3

Sarah Vogel, a developmental psychologist at Boston University, was working at New York University when SARS-CoV-2 began to spread across the globe. At the time, Vogel and her colleagues were carrying out a large study exploring how factors likesocioeconomic status and caregiver wellbeing affect early development in infants. When lockdown restrictions came into effect, the laboratory closed, and the project came to an abrupt halt, except for one small project on the microbiome. The researchers initially planned to explore how the microbiome influences neurocognitive development. However, they anticipated that the lockdown would alter infants exposure to bacteria, so they quickly pivoted to studying whether the pandemic slashed gut microbiome diversity.

Unable to go into the laboratory, the team needed to adapt their working protocol. You can picture me at home throughout 2020 on the phone with parentstexting them, calling them, emailing themtrying to get them to participate in this part of the study, Vogel said. Gut bacteria are normally sampled from stool, so Vogel and her team mailed stool collection kits to participating families. They then sent the unsightly packages off for sequencing to determine the microbiomes makeup from the bacterial RNA in the samples.

The team hypothesized that social distancing measures, such as daycare closures, fewer outdoor activities, and limited social interactions might limit the bacteria infants contact and reduce their microbial milieu. Indeed,Vogel found that infant microbiome diversity declined as soon as the pandemic began. This was true for the number of bacterial species within an individual, but also for bacterial diversity between infants, whose microbiomes became similar after the pandemic. This is a fairly moderately sized effect, Vogel noted. But to what extent these differences translate to observable differences in health remains a little bit unclear.

Researchers have previously tried to study how microbiome diversity affects child health, but their work yielded mixed results. Some researchers demonstrated that a drop in gut diversity predisposed children to a slew of unwanted immune reactions like asthma and food allergy, while others found that there isnt enough evidence to make this connection.46 In this study, Vogel said, None of the parents that I spoke to gave any indication that their child was experiencing any kind of health concerns out of the normal.

Edoardo Pasolli, a bioinformatician at the University of Naples Federico II who was not involved in the study said, The choice of the infant microbiome was a good one because we know that changes during the first weeks, months, and years of life can be affected by multiple factors, much more than the adult microbiome that is more stable. Given the malleability of the infant microbiome, its possible that gut diversity returned to prepandemic levels once New York relaxed lockdown restrictions. However, the researchers were unable to run follow-up experiments on the infants. There may be more of a delay on the maturation of the microbiome, Pasolli speculated.

With only 54 infants under the age of one, Vogel lacked the statistical power to study changes in most individual bacterial lineages. However, she observed a decline for the Pasteurellaceae family, including the genus Haemophilus, a phenomenon linked to scrupulous cleaning practices in other studies.7

The team accounted for many variables that might affect microbiome diversity, like age and demographic background, Pasolli noted. They also controlled for breastfeeding, which Vogel said has one of the largest effects on microbiome diversity.8 However, its unclear whether these findings are generalizable since all of the participants lived in New York City, which Vogel said faced tougher restrictions than other places. We were hit much harder and much earlier, she explained. Its possible that infant gut microbiomes elsewhere may not have changed as much.

If she were to repeat the study, Vogel said that she would aim to recruit a more geographically diverse cohort of participants to study the microbiome in different environments. She would also like to explore how infant microbiomes differ between households that are disproportionately affected by lockdowns, such as ones containing essential workers versus those who work entirely from home.

We know that lifestyle has a big impact on the human microbiome, Pasolli said. He suggested that future studies should track changes in infant microbiomes over time to see whether they recover their diversity in the wake of a pandemic.

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The COVID-19 Pandemic Abruptly Altered the Infant Microbiome - The Scientist

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COVID-19 cases continue to rise in North Texas. The Dallas Fort Worth Hospital Council says there were 706 people hospitalized in our area Wednesday, which is up 67 patients from the day before. The World Health Organization says the pandemic is in a different phase due to lower impact but it is still a pandemic.

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NEW YORK (AP) More U.S. hospitals are requiring masks and limiting visitors as health officials face an expected but still nasty post-holiday spike in flu, COVID-19 and other illnesses.

While many experts say this season likely wont prove to be as deadly as some other recent winters, it still could mean hundreds of thousands of hospitalizations and many thousands of deaths across the country.

New York City last week instituted a mask mandate for the citys 11 public hospitals. Similar measures were ordered last week at some hospitals in Los Angeles and Massachusetts. Some hospitals reinstated masking rules for employees months ago, in anticipation of a seasonal rush of sick people.

Flu and COVID-19 infections have been increasing for weeks, with high levels of flu-like illness reported in 31 states just before Christmas. Updated national numbers are to be released Friday, but health officials predict infections will grow in many states well into January.

What were seeing right now, in the first week of January, is really an acceleration of flu cases, in particular, said Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention.

There is some good news. Flu and COVID-19 cases may peak by the end of the month and then drop, Cohen said. Though the flu has been skyrocketing, this years cases are being caused by a strain that usually doesnt cause as many deaths and hospitalizations as some other versions. Whats more, signs suggest current flu vaccines are well-matched to the strain.

I dont think its going to be overwhelming, said Dr. William Schaffner, Vanderbilt University infectious diseases expert. He deemed the current season moderately severe.

The CDC is pointing the public to an agency website where people can look up their county, which can help them make decisions about whether to wear masks or take other precautions. Cohen urged people to get vaccinated and to seek treatment for flu and COVID-19.

Vaccinations are down this year, officials say. About 44% of U.S. adults had gotten flu shots by Dec. 23, according to the most recently available CDC vaccination survey data. Only about 19% of U.S. adults were reported to have received an updated COVID-19 shot as of early December.

COVID-19 cases are causing more severe disease than the flu but have been rising less dramatically. Health officials are keeping an eye on JN.1, a new version of the ever-evolving coronavirus. The omicron variant was first detected in the U.S. in September and just before Christmas accounted for an estimated 44% of COVID-19 cases.

The JN.1 variant may spread easier or be better at evading our immune systems, but there is no evidence that it causes more severe disease than other recent variants, health officials say. Current evidence indicates vaccines and antiviral medications work against it.

The CDC also has reported disappointing vaccination rates against another seasonal bug, respiratory syncytial virus, or RSV. That is a common cause of mild cold-like symptoms, but it can be dangerous for infants and older people. RSV cases rose in the fall but appear to have plateaued and are even going down in some places, according to the latest data.

At Hillsdale Hospital in southern Michigan, a 65% increase in respiratory illness activity in late December triggered a limitation to visitors in the birthing center. Only a spouse, a support person and grandparents can visit. They all must wear a mask and not show symptoms of sickness.

The restriction is common for the hospital around this time of year, said Dr. Nichole Ellis, a pediatrician who is the hospitals medical chief of staff. But its more difficult this season, she added.

In the past, we would have one disease that we were tracking or monitoring at one time, Ellis said. But now, babies and children will have multiple diseases at the same time. Its not that they just have RSV but theyre getting RSV and COVID at the same time, or influenza and RSV at the same time because all of the diseases are prevalent in our community.

Kenya Hunter in Atlanta contributed.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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More hospitals are requiring masks as flu and COVID-19 cases surge - The Associated Press

The full emergence of seasonal respiratory season is ongoing in the United States right now with spikes in incidence rates of influenza and COVID-19 spreading throughout the country.

Separately, but related to incidence rates, is the concept of data and analytics as they continue to be an evolving part of medicine and public health and how to address COVID-19. One of the specific areas being explored is vaccination statistics and how they can prevent the spread of severe disease and hospitalizations. A large, comprehensive study measured how widespread COVID-19 vaccination needed to be in order to provide protection against serious disease in adults by age groups. The study was published last year in The Lancet Regional Health - Americas.

From the study, the number needed to vaccinate (NNV) is a significant analytic they calculated.

What that really represents is the number of people to be vaccinated that would reduce the number of hospitalizations or emergency department visits by 1, explained study coauthor Shaun Grannis, MD, vice president, Data and Analytics, Regenstrief Institute. So if in an unvaccinated population of 10 people, if there were typically 5 hospitalizations, then we look at that same population of 10 that were vaccinated and that the number of hospitalizations then decreases by 1 to 3. So, if we see a decrease among a given population, we're looking for that number that we need to [vaccinate]that minimum number we need to treat to decrease the adverse outcome by 1. So we looked at number needed to [vaccinate] for hospitalizations. And we also looked at the number needed to vaccinate for emergency department (ED) visits as well.

The Study Specifics

An analysis of real-world data from over 1.2 million patients from health systems in 4 geographically dispersed statesIndiana, Oregon, Texas and Utah was conducted by the CDC's VISION Network. The study determined both the aforementioned NNV to prevent 1 COVID-19 associated hospitalization and the number needed to be vaccinated to prevent 1 COVID-19 associated emergency department visit.

Of the 1,285,032 patients included in the study, there were 938 hospitalizations and 2076 emergency department encounters. Looking at age groups, 555,729 (43.2%) patients were aged 1849 years, 363,299 (28.3%) 5064 years, and 366,004 (28.5%) 65 years.

Additionally, a majority of the people were female (n = 765,728, 59.6%), White (n = 990,224, 77.1%), and non-Hispanic (n = 1,063,964, 82.8%). In terms of vaccination, 37.2% of patients received a booster and 62.8% received only two doses.

The median number needed to vaccinate to prevent 1 hospitalization was 205 people, Grannis said. So if you vaccinate 205 people, you'll prevent at least 1 hospitalization. The number needed to vaccinate [to prevent] 1 emergency department visit was 156.

And in terms of understanding how this pertains to public health, Grannis says this data provides information to various people including decision makers who determine the number of vaccines needed to clinicians having one-on-one patient encounters and counseling them on the benefits of vaccination.

This is a concrete number that helps providers, helps public health officials, and helps decision makers understand the effectiveness and the volume of vaccines required to have a particular impact, Grannis said. So for example, as a physician, I like to understand what the effectiveness of a particular intervention is. And so I like to be able to tell and communicate with my patients that by receiving this vaccine, you are reducing your risk for adverse outcomes. In fact, you're reducing your risk for hospitalization.

Contagion spoke to Grannis about the significance of using NNV to extrapolate data needed in real-world settings and determining how they play a role in reducing hospitalizations and ED visits as well as other ancillary findings related to the study.

Reference Adams K, Riddles JJ, Rowley EAK, et al. Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021-February 2022, VISION Network: a retrospective cohort study.Lancet Reg Health Am. 2023;23:100530. doi:10.1016/j.lana.2023.100530

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Identifying COVID-19 Vaccine Analytics to Prevent Hospitalizations, ED Visits - Contagionlive.com

Patients who were hospitalized with COVID-19 may have a higher risk of long-term cognitive complications, according to researchers in Denmark who published their findings in JAMA Network Open. Compared to healthy individuals, patients hospitalized with COVID-19 performed worse on a series of cognitive tests and were more likely to suffer from anxiety, depression, or have impaired memory at 6-months post-infection.

The long-term effects of COVID-19 are associated with more than 200 symptoms, affecting 65 million individuals worldwide, wrote study authors. Apart from respiratory symptoms, the most frequent symptoms are related to brain health, including cognitive and mental symptoms.

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Researchers performed a prospective cohort study of 345 people in Copenhagen, Denmark, to see whether COVID-19 infection was associated with long-term cognitive, psychiatric, or neurological complications. They also evaluated the magnitude and types of complications associated with infection and compared it to patients who were healthy or hospitalized with another illness.

For the study, each of the 3 cohortsthose hospitalized with COVID-19, patients in the hospital for medical conditions of similar severity, and healthy controlsperformed cognitive, psychiatric, and neurological tests, and the scores were compared between the 3 groups during an 18-month follow-up period.

Patients hospitalized with COVID-19 had observably reduced cognitive abilities compared to healthy individuals, based on scores from the Screen for Cognitive Impairment in Psychiatry (SCIP) and the Montreal Cognitive Assessment (MoCA) tests. However, impact of the disease on cognition was not significantly worse than what was experienced by patients hospitalized for a different condition of similar severity.

Researchers also found that patients with COVID-19 performed worse than healthy patients on psychiatric and neurological assessments. At 18 months, patients who were hospitalized with COVID-19 were more likely to have a new onset psychiatric diagnosis, fatigue, and impaired olfaction. These patients also had increased reports of anxiety and depression compared to healthy individuals, along with other subjective symptoms involving memory and sleep between 6-month and 18-month follow-up, study authors wrote in the article.

However, like the trend of cognition scores, patients with COVID-19 generally did not have worse psychiatric health compared to patients hospitalized for other diseasesthey were not significantly more likely to have anxiety or depression. Further, scores on the neurological assessment were fairly similar between patients with COVID-19 or another hospitalized illness;however, those with COVID-19 were more likely to have olfactory dysfunction and impaired executive function.

The authors noted that there are limitations to this study. Some of the primary limitationsincluded long follow-up, different baseline groups, the presence of different strains of COVID-19, and a lack of available cognitive scores associated with COVID-19 prior to the pandemic.

Authors concluded that brain health after COVID-19 seems overall comparable to that after other diseases of similar severity.

Reference

Peinkhofer C, Zarifkar P, Christensen RHB. Brain Health After COVID-19, Pneumonia, Myocardial Infarction, or Critical Illness. JAMA Netw Open.2023;6(12):e2349659. doi:10.1001/jamanetworkopen.2023.49659

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COVID-19 May Be Linked to a Long-Term Decrease in Cognitive Abilities in Hospitalized Patients - Pharmacy Times

January 04, 2024

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What should rheumatologists know about what we've learned about COVID-19 and long COVID in 2023? Hosted by Dr. Leonard Calabrese.

Leonard H. Calabrese, DO, is the chief medical editor, Healio Rheumatology, and professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic.

Wed love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

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Disclosures: Calabrese reports professional relationships with AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB.

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COVID-19, long COVID and the rheumatologist with Leonard Calabrese, DO - Healio

A new research study from the Smidt Heart Institute at Cedars-Sinai aimed to understand the possible connection between COVID-19 vaccination and a difficult-to-diagnose heart condition called postural orthostatic tachycardia syndrome, or POTS. The study validated that patients who were immunized with a COVID-19 mRNA vaccination and then went on to have new or exacerbated POTS all had preexisting conditions that can lead to a POTS diagnosis.

POTS is associated with nervous system dysfunction and causes an abnormal increase in heart rate after standing or sitting up. It used to affect primarily women of childbearing age. However, for POTS cases that developed during the COVID-19 pandemic, men were equally affected.

We were surprised when all the patients in our small cohort already had conditions that could make them more likely to develop POTS even without vaccination, such as palpitations, fast heart rates, orthostatic intolerance, hypermobile joints, asthma, systemic lupus, fainting and chronic abdominal pain, said Peng-Sheng Chen, MD, the corresponding author of the study and an international expert on the condition who leads one of only a few specialty clinics on the syndrome in the nation.

These findings suggest it may be helpful to keep an eye on patients with underlying health issues after COVID-19 vaccination to monitor for post-vaccine POTS, said Chen, who also holds the Burns and Allen Chair in Cardiology Research at Cedars-Sinai.

The observational study, recently published in the peer-reviewed journal Heart Rhythm and presented during the American Heart Association Scientific Sessions, analyzed data from 10 patients treated at the Cedars-Sinai multidisciplinary POTS clinic between July 2021 and June 2022. When provided guideline-directed care, all study participants reported an improvement in their POTS condition.

Although there is an association between POTS and COVID-19 vaccination, a previous study of patient data across the Cedars-Sinai Health System found that patients diagnosed with COVID-19 were five times more likely to develop the cardiac condition after infection than after vaccination.

COVID-19 infection itself seems to be either causing or unmasking a startling amount of POTS or POTS-like conditions globally, said Debbie L. Teodorescu, MD, a cardiology fellow at the Smidt Heart Institute and first author of the study. In our cohort, most patients responded well to treatment, but a subsequent COVID-19 infection tended to bring significant setbacks in recovery. That is why we urge all patients to be meticulous about avoiding COVID-19.

Read more from the Cedars-Sinai Blog:Long COVID: What to Know

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New Study: Is There a Link Between COVID-19 Vaccination and POTS? - Cedars-Sinai

Studies have shown a significant portion of hospitalized patients with COVID-19 infection experienceacute kidney injury(AKI) and other kidney abnormalities. However, a retrospective cohort study byUC Davis Healthresearchers shows COVID-19 is not strongly linked to long-term loss of kidney function.

Early in the COVID-19 pandemic, kidney abnormalities were often recognized in patients with COVID-19, saidHiba A.M. Hamdan, the principal investigator of the study and health sciences assistant clinical professor in theDivision of Nephrology. Given how infectious COVID-19 was and the large numbers of individuals being hospitalized with the virus, it was imperative we better understand the short and longer-term kidney sequelae of COVID-19 infection so we could prepare if we saw a significant uptick in the incidence of chronic kidney disease.

During the first year of the pandemic,studiesshowed that over a quarter of patients hospitalized with COVID-19 developed AKI. Also known as acute renal failure, AKI is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. There were also reports of sustained long-term loss of kidney function after COVID-19, although the follow up periods were not very long.

To examine if COVID-19 led to long-term kidney issues in hospitalized patients, researchers conducted an analysis of electronic health record data from adults receiving care in theUniversity of California (UC) Health System, which is comprised of six medical centers. They looked at:

In total, the AKI inpatient cohort included 5,451 individuals with COVID-19. Patients had an average age of 59 years, were 59% percent male and 45% Hispanic. The rate of patients with COVID-19 that experienced AKI ranged from 20-38% and varied over the course of the period reviewed.

To determine the long-term kidney function of the cohort, researchers measured theestimated glomerular filtration rate(eGFR) trajectories in those with COVID-19 and in a separate cohort who experienced AKI without COVID-19. Researchers followed the patients through Dec. 31, 2022, and concluded there was no significant difference in eGFR loss between the groups over the approximately two years of follow-up.

Similar findings were also noted in a very large cohort that examined long term effects of COVID-19 on kidney function, in patients who didnt have a hospitalization event detected within 10 days after the initial SARS-COV 2 PCR testing.

This study has important implications because we examined a very diverse cohort from one of the largest healthcare systems in California and had one of the longest reported follow-up periods of kidney function following COVID-19 infection, explained Hamdan. Our hope is that these findings help guide our healthcare system and others in planning for post COVID-19 care. This also has implications for other respiratory viruses and how they can impact kidney function.

In addition to Hamdan, research co-authors included Brian Paciotti, data systems manager; Blythe Durbin-Johnson, principal statistician of biostatistics; Juan Pablo Moreno Ortiz, fellow of nephrology;Brian Young, professor of nephology; andBaback Roshanravan, associate professor of nephrology.

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Research shows COVID-19 is not strongly linked to long-term loss of kidney function - Newswise

COVID-19 vaccination and background characteristics

Table1 presents summary statistics of these variables for all samples and separately by whether they were Internet health information seeking. In all samples, the COVID-19 vaccination rate was 73.1%, the proportion of males was 45.8%, the mean age was 51.3 years, 93% were Han Chinese, and most of the respondents marital status (75.1%) were married. In addition, the survey sample was in good health, with an overall sample self-reported health score of 3.47 points. The living area distribution of the overall sample shows that 46.1% of the respondents live in the eastern region, 33.3% live in the central region, and 20.6% live in the western region.

The Internet health information seeking group had a COVID-19 vaccination rate of 84.5%, while the non-Internet health information seeking group had a COVID-19 vaccination rate of 71.6%. This difference was statistically significant (p<0.01). Additionally, there were statistically significant variations in the two groups distributions of age, education level of primary school and below, education level of high school and above, household wealth status of poor, household wealth status of rich, occupational type, and health (p<0.01). The Internet health information seeking group is younger, more educated, wealthier regarding household assets, work in a state-owned enterprise, and healthier than the group not use Internet to seeking health information. There are no significant differences between the two groups regarding gender, ethnicity, marital status, and living area.

The correlation between the independent variables and the control variables and the result variables is analyzed, and the results are shown in Table2. As can be seen from the results table, there is a positive correlation between independent variable internet health information seeking and dependent variable (correlation coefficient r=0.093, P<0.01). Other relevant control variables are also correlated with the outcome variables.

Table3 shows the results that Internet health information seeking has a significant positive impact on COVID-19 vaccination. The average COVID-19 vaccination rate among individuals that non-Internet health information seeking was about 71.6% (Table2, row 13). The COVID-19 vaccination rate among individuals that Internet health information seeking was 4.1% points higher (Table2, row 1). The result is significant at the 1% level. Furthermore, individuals who are younger, belong to ethnic minorities, possess moderate household wealth, are married, maintain better health, and reside in the central and western regions of China exhibit elevated rates of COVID-19 vaccination. This correlation demonstrates statistical significance at the 1% level. Gender and middle-school education were also significantly associated with COVID-19 vaccination rates. Vaccination rates are higher among females and those with middle-school education. The result is significant at the 5% level.

The results of this study thus far indicate a correlation between Internet health information seeking and COVID-19 vaccination rates. To ensure the robustness of our models results, we conduct rigorous validation using the propensity score matching method. Due to the fact that Internet health information seeking is not a random event and can be influenced by a variety of factors, such as age, studies have shown that the younger generation is more likely to use the Internet than the older generation [25], and the level of education is also an important influence, and people with a high level of education are more likely to be proficient in using the Internet [20], there is the possibility of bias in the estimates. This issue, if left unaddressed, could result in significant deviations in the distribution of relevant eigenvalues. Therefore, implementing the propensity score matching method becomes essential for accurately estimating the impact of Internet health information seeking. Given that the population of individuals without Internet health information seeking is seven times larger than those with Internet health information seeking, we employ the one-to-seven matching method. In addition, both caliper matching and kernel matching are employed to ensure the reliability of our analyses.

Table4 shows the matching results. The ATT value derived using one-to-seven matching was 0.050 and significant at the 1% level, indicating that the percentage of vaccination was 5.0% higher with Internet health information seeking than without. The ATT values obtained using Caliper matching and Kernel matching were 0.045(P<0.01) and 0.052 (P<0.01), respectively, which were consistent with the results of one-to-seven matching, and this result verified the robustness of the regression analysis results.

Second, considering the impact of different occupations on COVID-19 vaccination behavior, we replaced our dependent variable with COVID-19 vaccination intention (1=Yes 0=No)(column 2). In the CGSS2021 questionnaire, the specific question about this variables was Which of the following statements best suits your situation?. We define intention to receiving vaccine if their answer is I wanted to be vaccinated.and the results were similar.

In this subsection, we delve into potential mechanisms to gain a deeper comprehension of how disseminating vaccine health information through the Internet influences individuals vaccination behavior. Table5 presents a tripartite breakdown of the pathways through which Internet health information seeking shapes vaccination patterns.

Drawing insights from existing literature, recognizing vaccination benefits is a pivotal driver of vaccine uptake. We embarked on an exploration of the link between Internet health information seeking and individuals perceptions regarding the merits of vaccination, encompassing notions such as the supremacy of vaccination benefits over drawbacks and the establishment of immunity through vaccination. As delineated in Table5, columns 1 and 2, the outcomes revealed a heightened likelihood among Internet health information seeking individuals to acknowledge the superior advantages of vaccination and the potential for immunization through this method. This accurate understanding consequently serves as a catalyst propelling Internet health information seeking individuals towards vaccine adoption.

Approaching the matter from an alternative angle, empirical studies have demonstrated the profound influence of attitudes towards information on individual health behaviors. This investigation explored the impact of Internet health information seeking on individuals recognition of the positive effect of Internet-based information on health behaviors. As depicted in Table5, column 3, the findings underscore a stronger propensity among Internet health information seeking individuals to acknowledge the constructive impact of online information on health behaviors. This acknowledgment engenders a greater acceptance of the veracity of Internet information, thereby fostering the execution of health-conscious behaviors. A visual representation of this impact mechanism is illustrated in Fig.1.

The mediating effects of cognitive factors

We extend our analysis to encompass the heterogeneous effects of Internet health information seeking by incorporating interaction terms. As evidenced in Table6, our investigation reveals limited indications of heterogeneous effects across various demographic and household attributes within our surveyed cohort. These attributes encompass gender, education level, household wealth, health status, and geographical location. Notably, we did identify specific subgroups in which Internet health information seeking seems to have a discernible impact on vaccination likelihood.

Upon closer examination, our findings indicate that older age, Han Chinese ethnicity, and unmarried status correlate with an augmented probability of vaccination due to Internet health information seeking, as indicated in Table6. This pattern can be ascribed to distinct factors that operate within these subgroups. For instance, older individuals might exhibit heightened receptivity to health-related information, rendering them more responsive to the effects of Internet health information seeking on vaccination rates, as detailed in Table6, row 2. Furthermore, the influence of Internet health information seeking on vaccination rates appears to be more pronounced among the unmarried demographic. This can potentially be attributed to the relatively higher availability of time and energy among unmarried individuals, in contrast to their married counterparts who often contend with familial responsibilities. As elaborated in Table6, row 7, those without marital commitments might allocate more resources to safeguarding their physical well-being, making them particularly responsive to the impact of Internet-based health information on their vaccination choices.

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