published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Public Health / Master / Master of Public Health

BACKGROUND Influenza is a potential threat to life, economies and security in our globalized world. However, it is still unclear how efficacious non-pharmaceutical interventions are in reducing the virus’ transmission and how the underlying mechanisms of its transmission modes work. Since 2008, numbers of randomized controlled trials (RCTs) regarding the efficacy of hand hygiene interventions in reducing influenza transmission have been published, yet no metaanalysis has ever been performed. Besides, a guinea pig model in 2009 showed that the efficiency of aerosol transmission is adjusted by the ambient temperature and humidity. Therefore, further evidence is needed to confirm the hypothesis. OBJECTIVES To evaluate the efficacy of hand hygiene interventions alone or combined with facemasks in reducing influenza transmission in the community and to investigate the possible roles of latitude, temperature and humidity in relation to the efficacy of the interventions in controlling the spread of influenza. SEARCH METHODS This meta-analysis followed the PRISMA statement. I searched the MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Library databases. SELECTION CRITERIA I included all RCTs assessing the effect of hand hygiene interventions in preventing influenza spread in community settings with clear outcome definitions of laboratory confirmed influenza, clinically diagnosed influenza-like illness (ILI) and their related absenteeism. DATA COLLECTION AND ANALYSIS I ranked the methodological quality of each outcome with GRADEprofiler. I also assessed the heterogeneity across RCTs using I2 statistic and publication bias through visual inspection of Begg’s funnel plots and statistical assessment of regression and rank-correlation. I conducted the meta-analysis with random-effect models and further performed separate analyses for developed and developing countries data in case of a significant level of heterogeneity being noted across the studies. I also incorporated meta-regression to assess the association of latitude, temperature and humidity with the efficacy of hand hygiene interventions. RESULTS I identified 1,593 articles in the initial database search, excluded 1,535, included five from reference lists of review articles, retrieved full articles of 33 and included ten for analysis. The quality of evidence of both laboratory confirmed influenza and ILI were high while that of absenteeism was low. The combination of hand hygiene interventions and facemasks contributed to a significant 45% reduced risk of influenza-related absenteeism in the combined country data while it contributed a significant 23% to a reduced risk of both laboratory confirmed influenza and ILI in developed countries subgroup analysis. The metaregression revealed that the efficacy of the combination of hand hygiene interventions with facemasks increased in a less humid environment. CONCLUSIONS The combination of hand hygiene interventions with facemasks is an effective low-cost intervention to prevent influenza. Further studies to assess the association between humidity and mode of influenza transmission are critically important to support the international guideline on hand hygiene interventions and facemask use. / published_or_final_version / Public Health / Master / Master of Public Health

Backgrounds: Receive seasonal influenza vaccination is the most safe and effective way to prevent seasonal influenza and its complications. According to the WHO, the number of hospitalizations among older people due to influenza could be reduced by a ranged from 25% to 39% as a result of vaccination. It has also been revealed to reduce overall mortality rate of the influenza seasons by a range from 39% to 75%. Moreover, influenza vaccination protects almost 90% healthy adults against clinical disease in industrialized countries, under the precondition that the vaccine antigens and circulating viruses are well matched with each other. However, the prevalence of elderly Chinese people undertaking influenza vaccination is still sub optional, the percentage of which is 62.4%. Previous researches reveal that there are a number of reasons for non-compliance to influenza immunization, including the unfavorable side-effects, doubt to the effectiveness of the vaccine, the fear of needles, as well as unawareness of the seriousness of flu. These are all factors associated with personal willingness. Aims and objectives: The aims of this paper are to explore factors that influence vaccination rate in older people and to examine other countries’ experience to identify useful policies. The specific objectives are: 1. To identify from the published literature factors which contribute either positive or negative impacts on vaccination rates in older people. 2. To group these factors into appropriate categories. 3. To make suggestions on policies to improve vaccination rates based on the identified factors and other countries’ experience. Methods: Relevant publications were achieved through PUBMED. Search strategies as well as criteria for inclusion and exclusion had been predetermined and applied. Analysis includes both community perception factors and interpersonal factors. Results: 17 English literatures were reviewed, revealing predictors of seasonal influenza vaccination for and against, which could be grouped into four categories: Factors relate to demographic, factors relate to Health Belief Model, factors relate to social support, factors relate to advice and information being provided. Conclusion: According to this literature review, demographic factors, factors relate to Health Belief Model, social support and information being provided are revealed to be associated with the elders’ inclination to get influenza vaccination. / published_or_final_version / Public Health / Master / Master of Public Health

Skin is the major protective barrier in a human body. In premature infants, the immature skin barrier reduces the protection against germs. Emollient therapy is an effective prophylactic measure to improve premature infants’ skin condition so as to protect the premature infants against infection. A systematic review of studies shows that emollient therapy is a simple, safe and cost effective intervention for premature infants to improve skin condition. Evidence shows that emollient therapy can also decrease transdermal water loss, conserve heat and energy, stabilize fluid and electrolytes and prevent nosocomial sepsis. The potential of implementing the proposed evidence-based guideline is explored. It will be carried out in a clinical setting. The transferability of the findings, feasibility and cost-benefit ratio of the emollient therapy will be discussed. In order to ensure the evidence-based guideline will be carried out smoothly, a communication plan is necessary to be made in consultation with the stakeholders. A pilot study will also be conducted before the innovation is implemented to ensure frontline staff members to be familiar with the emollient therapy. At the end, the effectiveness of the emollient therapy will be evaluated in terms of skin score. Patients’ outcome and healthcare provider’s outcome will also be evaluated. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Objective: Pregnancy has been recognized as a risk factor for severe pandemic influenza illness and this “vulnerable” group is suggested to be heightened alertness to the disease by WHO. This systemic review aims to identify the factors affecting the uptake of influenza vaccination among pregnant women as the immunization uptake among this particular group of population is low or suboptimal worldwide. Methods: Systematic literature reviews were conducted by using MEDLINE and PubMed with the key words: “influenza vaccination uptake” and “pregnant women” in the period of January 2004 to January 2013. It was further supplemented by a manual search for literatures and articles on the WHO website, Centers for Disease Control and Prevention (CDC) website, Google Scholar, and reference lists of reviews captured by initial searches. Results: Of the 222 articles identified, 10 studies were found to be relevant in this system literature review. Influenza vaccine coverage among pregnant women was highly diverse (6.2-76%) among the 10 studies. Overall, pregnant women were more likely to take the vaccination against influenza if they: (1) believed the benefits of the vaccine outweighed the potential barriers, (2) believed the influenza was severe and they were highly susceptible to the disease, and (3) were influenced by the positive cues to action such as recommendation from health care professionals and the experience of the influenza vaccination uptake. Conclusion: Overall, greater emphasis on vaccine effectiveness and safety, and the recommendation from health care providers is needed to increase the number of pregnant women influenza immunization in the future public health campaigns. / published_or_final_version / Medicine / Master / Master of Public Health

Introduction A future healthy world is highly associated with the children and their mothers, the Millennium Development Goals (MDGs) prioritize the child and maternal health with the targets “the under-five mortality rate should be reduced by two thirds from 1990 to 2015”. A transform program in the Philippines, launched by a NGO, aims to change the life of ultra-poor, and the interventions’ impact was measured in this study. Method The study selected participants who had completed the surveys in the short term (n=2183) and long term (n=196). The Chi-square test, Cochran-Armitage trend test, and Generalized Estimating Equation (GEE) model were applied to examine the hypotheses: (1) the program would have positive impacts on child health, (2) the child mortality is related to the maternal social-demographic factors and health behaviors. In the GEE model, the univariate and multivariate binary logistic regression was used to estimate the crude and adjusted odds ratio (OR). Result The univariate and multivariate analysis both show the maternal age is closely associated with the child mortality, and the child mortality of older women is higher than the younger in the short term survey (univariate: OR:8.36, 95%CI:4.17-16.77, multivariate: OR: 8.89, 95%CI: 4.27-18.54). In the long term, the results demonstrate that the child mortality of delivering in hospital (OR:0.29, 95%CI:0.11-0.76) and birthing home (OR: 0.46, 95%CI: 0.21-0.98) both lower than home (reference group). Compared to Bacolod, the child mortality rate of Gensan and Koronadal is lower in the short term. We found no difference in other maternal social-demographic factors and health behaviors. During the survey period, the literacy, PhilHealth, institutional delivery, delivery care provider, postnatal home visits, breastfeeding, and child mortality all improved, and the improvements of PhilHealth, postnatal home visits, breastfeeding were statistically significant. Conclusion The findings suggest that the program needs to constantly deliver more community-based interventions, such as: institutional delivery, skilled birth attendance, postnatal care, which would transform the children health of ultra poverty in the long run. / published_or_final_version / Public Health / Master / Master of Public Health

Despite the World Health Organization identifying pregnant women as the highest priority group for seasonal influenza vaccination, many pregnant women remain unaware of the recommendation and have substantial concerns about the adverse effects of the vaccine on them and their unborn foetuses. Few interventions have been conducted to improve influenza vaccine uptake among pregnant women. Among these studies, the results are inconsistent and the quality is generally low. Brief education has been previously shown to improve women’s health practices during pregnancy. An open-label randomized control trial was conducted to assess the effect of providing brief education on influenza vaccine uptake among pregnant women. A total of 163 unvaccinated pregnant women in at least their second trimester were recruited from antenatal clinics of four public hospitals in Hong Kong. They were randomized to receive standard care or a one-to-one brief education session that provided an overview of the safety and benefits of the vaccine to both pregnant women and their foetuses. Participants were followed up by telephone at two to three weeks postpartum to ascertain vaccination status. The primary study outcome was the influenza vaccine uptake rate and the second study outcomes were the proportion of participants initiating discussion about influenza vaccine with their health care providers, the proportion attempting to be vaccinated, and their knowledge of influenza infection and vaccination. A total of 163 participants were recruited with 155 (95%) participants completing follow-up. The overall influenza vaccine uptake rate was 17.8%. When compared with those receiving standard care, the vaccination rate was higher among participants who received the intervention (23.5% vs. 12.2%; p=0.06). In addition, the increase in the rate of self-initiated discussion with HCPs before and after the intervention was significantly higher in intervention group (26.7% vs. 9.3%; p<0.001) but not in standard care group (13.3% vs. 8%; p=0.481). Among participants who did not receive influenza vaccine, pregnant women in intervention group were substantially more likely to have made an unsuccessful attempt to be vaccinated (39.3% vs. 9.2%; p<0.001). Almost one-third of the pregnant women who had attempted to receive the vaccine (n=13) reported they received advice against vaccination during pregnancy from HCPs. If participants had not been advised against influenza vaccine and were successfully vaccinated, the overall difference in the vaccine uptake rate between the two treatment groups would have been statistically significant (34.6% vs. 18.3%; p=0.02). Brief education can be one strategy to improve vaccination uptake rates among pregnant women. In addition, it is clear from this and other studies that recommendations from HCPs substantially influence vaccination behaviours among pregnant women, both positively and negatively. Therefore, multicomponent approaches should be considered in future vaccination programmes and the synergistic effect of both brief education and HCP recommendations should be further evaluated. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

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