Predictors of perceived memory impairment were investigated in 40 elderly normal adults and 28 individuals with Alzheimer's disease. Measures of perceived memory impairment, global cognitive functioning, memory, use of memory strategies, memory strategy efficacy, and depressive symptomatology were obtained for all participants. The elderly normal and Alzheimer's disease groups did not differ in the extent to which they reported perceived memory impairment. For both participant groups, more frequent use of memory strategies and lower perceived memory strategy efficacy were significant predictors of perceived memory impairment. Depressive symptomatology was an additional, significant determinant of perceived memory impairment for the elderly normal group.

Pilot testing is crucial when preparing any community-based vaccination coverage survey. In this paper, we use the term pilot test to mean informative work conducted before a survey protocol has been finalized for the purpose of guiding decisions about how the work will be conducted. We summarize findings from seven pilot tests and provide practical guidance for piloting similar studies. We selected these particular pilots because they are excellent models of preliminary efforts that informed the refinement of data collection protocols and instruments. We recommend survey coordinators devote time and budget to identify aspects of the protocol where testing could mitigate project risk and ensure timely assessment yields, credible estimates of vaccination coverage and related indicators. We list specific items that may benefit from pilot work and provide guidance on how to prioritize what to pilot test when resources are limited.

Health workers (HWs) have a key role in promoting vaccine acceptance. This study draws on the Behavioral and Social Drivers of Vaccination (BeSD) model and our team’s investigation of vaccine hesitancy in a sample of 1197 HWs across 14 Caribbean countries in 2021. We conducted a cross-sectional Internet survey of 6718 HWs across 16 countries in Latin America in spring 2022, after the COVID-19 vaccine had recently become widely available in the region. The survey assessed HWs’ attitudes regarding COVID-19 vaccines and vaccines in general. As a proxy measure of COVID-19 vaccine acceptance, we used the willingness to recommend the COVID-19 vaccine to eligible people. Ninety-seven percent of respondents were COVID-19 vaccine acceptant. Although nearly all respondents felt that the COVID-19 vaccine was safe and effective, 59% expressed concerns about potential adverse effects. Despite uniformly high acceptance of the COVID-19 vaccine overall and across Latin American subregions, acceptance differed by sex, HW profession, and COVID-19 history. Social processes, including actions and opinions of friends, family, and colleagues; actions and opinions of religious leaders; and information seen on social networks shaped many respondents’ opinions of vaccines, and the magnitude of these effects differed across both demographic and geographic subgroups. Information campaigns designed for HWs should underscore the importance of vaccine safety. Messages should be tailored to specific audiences according to the information source each is most likely to consult and trust.

Objective: This paper explores vaccination policies for health care workers (HCWs) in effect in all 35 Pan American Health Organization (PAHO) countries plus the British territory of Anguilla to highlight strengths and challenges within the region and inform relevant policies and interventions. Methods: Data were collected in two phases. Phase 1 (March–September 2021) was conducted as part of a global survey examining characteristics of national vaccination policies for HCWs. The questions addressed policy enforcement, antigens included in policies, funding, vaccination monitoring, and emergency vaccination plans. Respondents were representatives from 21 countries. In Phase 2 (March–August 2023), 15 country representatives who did not respond to the initial survey completed an amended, web-based version of the original questionnaire. Results: Of the 36 countries, 15 (42%) reported having a national HCW vaccination policy, and 3 (8%) planned to introduce one within 5 years. Among those with policies, 80% integrated them into occupational health regulations. All policies covered influenza and hepatitis B, while many also included tetanus, measles, rubella, diphtheria, and COVID-19. Over half of respondents had emergency vaccination mechanisms, and 44% reported national monitoring systems. Ten countries had comprehensive vaccination policies for HCWs. Conclusions: To strengthen HCW vaccination policy in the Americas, future efforts should support countries in developing tailored national policies, expanding antigen coverage—especially for outbreak-prone diseases—and investing in strong monitoring systems. Additionally, scaling up behavioral research, enhancing communication strategies, and institutionalizing emergency mechanisms will be critical for addressing vaccine hesitancy and ensuring both pandemic preparedness and routine care continuity.

Since the 1970s the World Health Organization (WHO) has promoted household surveys with a cluster sample design as an important method to estimate vaccination coverage in low- and middle-income countries. When calculating the survey sample size, planners begin with an educated guess at the outcome proportion and a target precision for the estimate and calculate an effective sample size that would achieve that precision if using a simple random sample. Then they account for correlated outcomes in the cluster sample using an estimated design effect (DEFF) that depends, among other things, on the unknown rate of homogeneity of the outcome as parameterized with an intracluster correlation coefficient (ICC). From the 1970s until 2015, WHO materials suggested that vaccination coverage surveys could be self-weighting and their ICCs would rarely exceed 1/6 or 0.1667. Recommendations drafted in 2015 and finalized in 2018 suggested using a probability sample with survey weights that vary and using a more conservative ICC value of 1/3 = 0.3333 for routine immunization surveys if there was no recent evidence-based estimate available. In this manuscript, we examine variability in survey weights and ICCs for 18 binary outcomes from two recent nationally representative vaccination coverage surveys in Pakistan with 152 districts serving as strata in the sample design, and either 49 or 64 clusters per stratum. The observed values of these parameters are summarized and used to (i) help planners use appropriately small values of ICC when the outcome is expected to have extreme values and (ii) suggest how WHO recommendations on ICC and weights might be refined in a forthcoming update.

The World Health Organization (WHO) and Pan American Health Organization (PAHO) make statistical software scripts freely available to conduct standardized analysis of vaccination coverage surveys. The software and accompanying documentation are named the Vaccination Coverage Quality Indicators (VCQI). The software examines data from child vaccination records and caregiver recall to calculate indicators of vaccination access, coverage, continuity, and quality. VCQI produces output tables and figures that may be copied directly into reports and presentations, as well as survey response data sets augmented with child-level outcome indicator variables calculated according to WHO guidance. It can analyze data from routine immunization surveys, post-campaign coverage surveys, and maternal tetanus coverage surveys. VCQI may be used for either the primary analysis of data from new surveys or secondary analysis of earlier surveys. It can analyze data from USAID Demographic and Health Surveys, UNICEF Multiple-Indicator Cluster Surveys, or WHO Expanded Programme on Immunization surveys. Future versions of VCQI may be extended to analyze data from electronic immunization registries. VCQI has been available as a set of Stata scripts since 2015, and as of 2025, the core routine immunization indicators are also available as a new R package named vcqiR. To publicize VCQI's features and capabilities and to celebrate the milestone of R package availability, the authors share this special report to describe the VCQI vision and design, discuss analyses and insights available from it, and map our vision of what the future may hold for flexible standardized analysis of vaccination coverage data.