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Vaccination in pregnancy (VIP) protects pregnant individuals and their newborns; yet, uptake remains suboptimal. Pregnant individuals face unique decision-making challenges, and communication with their health care provider (HCP) is crucial for uptake. While there is extensive data on barriers to VIP, interventions applying evidence-based behavior change strategies and co-designed with end users are scarce. Our prior work indicated that a new Canadian intervention was needed. This study aimed to co-design a multicomponent intervention to support informed decision-making and vaccine communication in pregnancy. Our multimethod study followed the Double Diamond phases (ie, Discover, Define, Develop, and Deliver) and partnered with a diverse patient advisory council and a multidisciplinary team of HCPs. During the Discover and Define phases, our previous work, we explored gaps and barriers to VIP in Canada and defined the behavior change strategies to address those needs. During the Develop phase, we co-designed and conducted iterative prototyping of four intervention components: (1) a pregnancy-specific communication approach, (2) a skills course for HCPs, (3) a practice change plan, and (4) a website with evidence-based resources for patients and HCPs. We used online and in-person participatory co-design sessions and peer-to-peer, patient-oriented online focus groups and semistructured in-depth interviews. During the Deliver phase, we refined the intervention components through functionality and usability testing. The Vaccines in Pregnancy Canada (VIP Canada) intervention consists of four integrated components: (1) DECIDE (Determine, Elicit, Consent, Interactive discussion, Deliver, and Empower): a patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy. (2) Skills course for HCPs: 4 self-paced, online modules to learn the rationale for VIP and the DECIDE communication approach and 2 group sessions. Providers found the skills course clear, practical, and applicable across diverse clinical roles and settings. Feedback led to enhancements, including improved audio-visual synchronization, consistent closed captioning, and the addition of downloadable reference materials to support learning. (3) Practice change plan: an action plan HCPs make to integrate vaccine communication into their practice. (4) VIP Canada website: an evidence-based website with resources to support informed vaccine decision-making for patients and providers. Patient feedback informed iterative refinements to the layout and content of the website to enhance navigation, readability, and representation of diverse identities. Functionality and usability testing demonstrated that patients found the VIP Canada website visually appealing, easy to navigate, and supportive of informed decision-making. The VIP Canada is a promising intervention co-designed to drive behavior change by addressing key barriers to vaccine communication and informed decision-making around our patient partners' and HCPs' perspectives and lived experiences to bridge theoretical frameworks with real-world relevance. Next steps include a feasibility study for further refinement and a subsequent effectiveness study.

Background The intracellular concentration of heavy-metal cations, such as copper, nickel, and zinc is pivotal for the mycobacterial response to the hostile environment inside macrophages. To date, copper transport mediated by P-type ATPases across the mycobacterial plasma membrane has not been sufficiently explored. Results In this work, the ATPase activity of the putative Mycobacterium tuberculosis P 1B -type ATPase CtpB was associated with copper (I) transport from mycobacterial cells. Although CtpB heterologously expressed in M. smegmatis induced tolerance to toxic concentrations of Cu 2+ and a metal preference for Cu + , the disruption of ctpB in M. tuberculosis cells did not promote impaired cell growth or heavy-metal accumulation in whole mutant cells in cultures under high doses of copper. In addition, the Cu + ATPase activity of CtpB embedded in the plasma membrane showed features of high affinity/slow turnover ATPases, with enzymatic parameters K M 0.19 ± 0.04 µM and V max 2.29 ± 0.10 nmol/mg min. In contrast, the ctpB gene transcription was activated in cells under culture conditions that mimicked the hostile intraphagosomal environment, such as hypoxia, nitrosative and oxidative stress, but not under high doses of copper. Conclusions The overall results suggest that M. tuberculosis CtpB is associated with Cu + transport from mycobacterial cells possibly playing a role different from copper detoxification.

ObjectiveVaccination in pregnancy (VIP) is a protective measure for pregnant individuals and their babies. Healthcare provider’s (HCP) recommendations are important in promoting VIP. However, a lack of strong recommendations and accessible resources to facilitate communication impact uptake. This study sought to determine the extent of and characterise the resources available for parent-provider vaccine communication in pregnancy in Canada using a behavioural theory-informed approach.DesignScoping review.MethodsIn accordance with the JBI methodology, nine disciplinary and interdisciplinary databases were searched, and a systematic grey literature search was conducted in March and January 2022, respectively. Eligible studies included resources available to HCPs practising in Canada when discussing VIP, and resources tailored to pregnant individuals. Two reviewers piloted a representative sample of published and grey literature using inclusion-exclusion criteria and the Authority, Accuracy, Coverage, Objectivity, Date, Significance guidelines (for grey literature only). Sixty-five published articles and 1079 grey reports were screened for eligibility, of which 19 articles and 166 reports were included, respectively.ResultsFrom the 19 published literature articles and 166 grey literature reports, 95% were driven by the ‘Knowledge’ domain of the Theoretical Domains Framework, while n=34 (18%) addressed the ‘Skills’ domain. Other gaps included a lack of VIP-specific tools to address hesitancy and a lack of information on culturally safe counselling practices.ConclusionThe study suggests a need for resources in Canada to improve VIP communication skills and improve access to vaccination information for HCPs and pregnant individuals. The absence of such resources may hinder VIP uptake.

Although immunization during pregnancy can protect mothers and their infants from vaccine-preventable morbidity and mortality, vaccination rates are often poor. We systematically reviewed the literature from inception to July 4, 2023, for randomized and non-randomized quasi-experimental studies estimating the effects of interventions to increase vaccination during pregnancy. Of 9331 studies screened, 36 met inclusion criteria, including 18 demand-side interventions, 11 supply-side interventions, and seven multi-level (demand and supply-side) interventions. Demand-side interventions commonly addressed patient education, showing modest improvement (pooled RR 1.18; 95% CI: 1.04, 1.33; I 2  = 63.1%, low certainty). Supply-side interventions commonly implemented Assessment-Feedback-Incentive-eXchange interventions with little improvement (pooled RR 1.13; 95% CI: 0.96, 1.33; I 2  = 94.0%, low certainty). Multi-level interventions were modestly effective in increasing vaccination (pooled RR 1.62; 95% CI: 1.09, 2.42; I 2  = 97%, very low certainty). Interventions identified in the literature mostly resulted in low to moderate increases in vaccination with likely high heterogeneity and low to very low certainty in the findings.

Implementing innovations in complex systems always results in unanticipated impacts to the innovation and the system. To nudge complex systems towards more desired states, we must reconceive of innovation implementation within the epistemology of complexity. We draw on the seminal work of Edgar Morin to define complexity, three characteristics of complex systems important for the reconsideration of innovation implementation, and our core principles informing the strategy of complexity-informed implementation fidelity.

ObjectiveTo understand parental perspectives regarding universal newborn screening (UNS) for congenital cytomegalovirus (cCMV) in Canada.DesignA qualitative, patient-led study using the Patient and Community Engagement Research approach consisting of online focus groups and in-depth individual interviews to understand parental preferences regarding UNS for cCMV. Data were analysed iteratively using inductive thematic analysis and narrative story analysis.SettingCanada-wide study conducted via video conference from October to December 2023.Patients12 participants from five Canadian provinces who self-identified as 18 years of age or older and as having parental lived experience with cytomegalovirus (CMV) or cCMV participated in the study.ResultsWe identified three themes: (1) attitudes about UNS for cCMV, including participants’ unanimous support for UNS and confirmation that parental anxiety is not a deterrent for screening, (2) cCMV diagnosis, including the importance of coupling cCMV diagnosis with access to treatment and medical support and (3) awareness of cCMV, where participants shared their frustration about the lack of public and pregnant people’s awareness of cCMV.ConclusionsParental anxiety is not a deterrent for UNS for cCMV. Children with cCMV and their families deserve every opportunity to attain their best possible outcomes. UNS offers children with cCMV access to early intervention if they need it, and also helps to raise awareness and education to prevent future CMV infections.

Chronic hepatitis B (CHB) is a dynamic disease that may be affected by immune changes in pregnancy. Guidelines suggest consideration of nucleos/tide analogs (NA), i.e., tenofovir, (TDF) in highly viremic mothers to reduce vertical transmission risk. HBV variability affects CHB outcome, but little is known about HBV genetic changes in pregnancy due to immune or NA selection. To evaluate HBV diversity in NA treated or untreated pregnant vs. post-partum CHB carriers. In plasma collected from 21 mothers (7 matching pre/post-partum), HBV serological tests, genotype and viral load were assayed. The HBV pre-surface (S) /S overlapping polymerase (P) (N = 20), pre-core (C) /C (N = 11) and/or full genome PCR amplicons (N = 3) underwent clonal sequence analysis. The median age was 31 y, 71% Asian, 68% genotype B or C, 33% HBV eAg+, 5 received TDF (median HBV DNA 8.5 log IU/ml). In untreated mothers, median antepartum vs. post-partum ALT was 21 vs. 24 U/L and HBV DNA was 2.7 vs. 2.4 log(10) IU/ml. ALT and/or HBV DNA flares occurred during pregnant and/or post-partum period in 47% (10/21). Clonal sequencing antepartum showed the presence of minor \"a determinant\" and/or vaccine escape mutants (VEM) but drug resistant variants were infrequent. Analysis of pregnant vs. post-partum samples showed different HBV variants and viral diversity. Differences in immune and/or by NA selective pressures during pregnancy may affect HBV evolution during pregnancy. The presence of minor VEM warrant infant follow-up.

ObjectiveTo examine how cultural health brokers, as trusted intermediaries between formal systems and diverse ethnocultural communities, help navigate decisional conflict and misinformation regarding COVID-19 vaccination and to identify how their work contributes to system resilience in crisis contexts.DesignA community-based participatory action sensemaking research project to capture the real-time work of cultural health brokers in helping people navigate decisional conflict for vaccination.Setting, participantsMulticultural Health Broker Cooperative in Edmonton, Alberta where brokers speak 54 languages and serve more than 10 000 people from diverse ethnolinguistic communities. 28 cultural health brokers (9 male; experience 4–25 years) contributed to data collection and analysis between 16 September 2021 and 16 December 2021.Data collection and analysisThe brokers captured real-time reflections and self-interpretations in the SenseMaker platform through a theoretically informed, codesigned, mixed-method data collection tool. The team engaged in 13 weekly, 90 minute, audio-recorded and transcribed sessions: seven focused on understanding and action planning and five reflecting on the SenseMaker data, the focus of the thematic analysis. Data were managed in NVivo (QSR International, Version 12, 2018).ResultsBrokers collected 277 narratives and conducted 13 sensemaking sessions. Understanding and purpose were identified in 68% of narratives as key to achieving coherence; 81% of narratives highlighted trust as crucial to what was needed for action; 62% of narratives reflected on a potential risk, with loss of trust a concern in 70% of them. A rich understanding of the sources of decisional conflict and misinformation was achieved and managed through outreach. There were four entwined components to navigation of the evolving complexity of COVID-19 vaccination: (1) building and sustaining trust; (2) strengthening relationships; (3) creating safe spaces for collective sensemaking and solution finding; and (4) leveraging cultural and social capital to address barriers. Through these mechanisms, brokers reduced decisional conflict and misinformation, supporting informed, values-congruent decisions.ConclusionsCultural health brokers, embedded within communities and linked to formal systems, play a critical role in crisis response by fostering trust, mobilising resources and enabling collective sensemaking. This study demonstrates how these intermediaries’ contextually and culturally attuned work provides a model for building system resilience for future crisis response.

(Descriptivo): En este artículo de investigación recuperamos la voz de los hijos-niños e hijas-niñas de la gente militante de la izquierda de Chile, a partir del análisis de sus producciones simbólicas y registros de la vida cotidiana tales como cartas, dibujos, objetos realizados entre 1973 y 1989, y entrevistas registradas en documentales de la época que se encuentran actualmente en el Museo de la Memoria y los Derechos Humanos de Santiago de Chile, analizadas desde la perspectiva de los nuevos estudios de la infancia. Reflexionamos respecto al modo en que los niños y niñas elaboran su juicio y sentido de la realidad y construyen un sentido ético que dialoga con la herencia intergeneracional, pero la excede, reflejando su activa participación en la construcción de una comunidad afectiva que trasciende los vínculos consanguíneos.