Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

The theme of my thesis is the issue of the new strain of influenza A (H1N1 Pandemic 2009) and the associated awareness of vaccination amongst the elderly. The work is divided into two parts, a theoretical and practical part. In the theoretical part, I tried to comprehensively process the available knowledge on the origins, epidemiology and prevention of influenza with particular emphasis on vaccination, oriented towards the elderly. The practical part is focused on mapping the awareness of the elderly of the issue of vaccination against influenza and analysis of results from a research exploratory investigation. The data acquisition method I used was quantitatively oriented research using anonymus questionnaires. Altogether, I distribued 350 questionnaires; the final number for data processing was 191 questionnaires. In connection with the work I set four hypotheses: 1) More than a third of respondents were vaccinated against the new strain of influenza A (H1N1 Pandemic 2009), 2) The most common reason for not being vaccinated was a lack of information. 3) The size of the place of residence significantly contributes statistically to a sense of awareness of respondents on this issue, 4) More than half of respondents would like to obtain more information on the issue of the new strain of influenza type A (Pandemic H1N1 2009). I confirmed or refuted the formulated the hypotheses based on survey evaluation. The results of the survey showed that most respondents do not feel that they are sufficiently informed about the issue of the new strain of influenza, and therefore discard the use of vaccinations. With this work I would like to stress the importance of information, which can help people consider the risks of influenza and motivate them to be vaccinated. Vaccination is an important means of protection against influenza viruses particulary for high-risk groups including the elderly. For this reason I consider the dissemination of information as very important and I hope that my thesis also serves this purpose.

The aim of this thesis is to develop a flexible distributed platform designed toexecute a disease outbreaks simulator in a fast way over many types of platformsand operating systems. The architecture is realized using the Elastic ComputeCloud (EC2) supplied by Amazon and Condor as middleware among the varioustypes of OS. The second part of the report describes the realization of a webapplication that allows users to manage easily the various part of the architecture,to launch the simulations and to view some statistics of the relative results.

The concern for pharmaceutically active compounds (PhACs) as contaminants in the environment and the need to assess their environmental risk have greatly increased since the early nineties. Among PhACs, antibiotics and antiviral drugs are of important concern due to their role in growing antibiotic and antiviral drugs resistance among pathogenic bacteria and influenza viruses, respectively. Besides resistance issue, the compounds may upset sensitive ecosystems as they are designed to be highly bioactive. Clinically-important antibiotics are virtually ubiquitous contaminants in sewage water and surface water. Notably, recent emergence of novel influenza and use of anti-influenza drugs (specially Tamiflu®) during seasonal influenza、 influenza epidemics and for future pandemic are of emerging concern. Every year seasonal influenza epidemic causes tens of millions of respiratory illnesses and 250, 000 to 500, 000 deaths worldwide. WHO (World Health Organization) recommend the use of antiviral drug Tamiflu® during pandemic, as they are easy to use. Currently only Japan uses over eighty percent of Tamiflu® prescribed globally during common seasonal influenza. It is a fact that a huge amount of antiviral drugs and antibiotics ( for post infection cure of respiratory illness) will be used during an influenza pandemic and will arrive to sewage treatment plants (STPs).Unfortunately, these compounds behaviors are mostly unknown in both conventional and advanced STPs. The exposure of antiviral drug in the wild fowl gut and its implications for hastening the generation of antiviral-resistance in avian influenza viruses are also an emerging issue. The major objective of this thesis work was to investigate the occurrence of antibiotics and antiviral drugs in sewage treatment plants and their fate in different sewage treatment plants. The specific objectives were as follows: (a) to established appropriate analytical method for the selected antibiotics and antiviral drugs in sewage treatment plants, (b) to investigate the occurrence and removal of antibiotics and antiviral drugs in sewage treatment plants differ in technology and operation conditions; and (c) to predicts environmental concentration of the target compounds during a pandemics and appraisal of appropriate technology to reduce the risk associated with widespread use under pandemic conditions. In this study we selected twenty antibiotics: one beta-lactam: ampicillin; four macrolides: azithromycin, clarithromycin and roxithromycin; five quinolones: ciprofloxacin, enrofloxacin, levofloxacin, nalidixic acid and norfloxacin; two tetracycline: tetracycline and oxytetracycline; five sulfonamides: sulfadimethoxine, sulfadimizine, sulfamerazine, sulfam- ethoxazole and sulfamonomethoxine; and four others: lincomycin, novobiocin, salinomycin and trimethoprim. Oseltamivir Carboxylate (OC), the active metabolite of oseltamivir phosphate (Tamiflu®) and amantadine (AMN) were selected as antiviral drugs. This dissertation consists of nine chapters: Chapter I describe the background and objective of the study and chapter II represent a brief literature review. In Chapter III, analytical methods for selected antibiotics and antiviral drugs (for the first time) in water and wastewater were described. In Chapter IV, the occurrences and fate of antibiotics in sewage treatment plants were investigated in Japan and China. Clarithromycin was detected in the highest concentration in influent (1129 to 4820　ng/L), followed by azithromycin (160 to 1347　ng/L), levofloxacin (255 to 587　ng/L) and norfloxacin ( 155 to 486 ng/L) and sulfamethoxazole (159 to 176ng/L) in Japan. Ozonation as tertiary treatment of secondary effluent for wastewater reclamation provided significant elimination of antibiotics. Fifty present of the selected antibiotics were removed over eighty percent during ozonation. There was no elimination of antibiotics in dissolve phase during ultra filtration. From Chapter IV a hypothesis was drawn on antibiotics removal and its relation with longer sludge retention time (SRT) in STPs and in Chapter V the role of nitrifier in antibiotics removal was evaluated to verify the hypothesis established from Chapter IV. Nitrifying activated sludge (NAS) can biodegrade the tested antibiotics with different biodegradation rate between　2.74 to 9.95 L/gSS/d. Sulfamethoxazole and sulfamerazine degraded faster than trimethoprim, clarithromycin and enrofloxacin. In Chapter VI, occurrence of antiviral drugs in sewage water discharge and in river water in Japan was conducted during seasonal influenza epidemic and their fate in different sewage treatment facilities were evaluated in Chapter VII. This is the fist findings of antiviral (anti-influenza) drugs in the environment in the world and for the first time the removal mechanism in STPs was elucidated. Finally, it was observed that only primary and secondary treatment processes in STPs were not sufficient to remove these compounds significantly. Overall OC and AMN removal in STP with ozonation as tertiary treatment was 90% and 96% respectively. In ozonation batch experiment, Chapter VIII, ( feed ozone gas concentration 4.0mg/L, ozone gas flow rate 0.23L/min to maintain ozone feed rate of 0.6 mg/L/min), it was observed that AMN and OC concentration decreased linearly with time in all the experiments conducted and it can be, therefore, said that the degradation reactions follow pseudo first-order reaction. The k'O3 (pseudo first-order rate constant for O3) of AMN was 0.596/min (0.00993/sec), and OC was 0.524 /min (0.008725/sec) and over 99% removal within 10min. Chapter VIII described the predicted OC and antibiotics concentration in STPs influent, secondary effluent, after advance tertiary treatment (ozonation) and receiving water during a pandemic with three expected infection scenario ( according to US CDC FluAid model 2.0) in Kyoto city. Both antiviral drugs and antibiotics pose an environmental risk associated to there widespread use during a future pandemic. Ozonation as tertiary treatment can provide a technological solution to reduce the ecotoxicological effect of antibiotics and antiviral drugs uses during a pandemic. In a full scale STP, the antiviral drugs (OC and AMN) reduction were over 90% from secondary effluent after ozonation during seasonal influenza outbreak in Kyoto city in 2008/2009. Finally, (1) analytical methods for commonly used antibiotics and antiviral drugs in water sample was developed with an excellent precision and accuracies, (2) both antibiotics and antiviral drugs were detected in environmental sample, and their behavior in STPs were elucidated. Antivirals in this study were the first time findings in sewage water. This study will provide a surrogate for planning a pandemic preparedness action plan for sewage treatment pants for ecotoxicological risk management. / Kyoto University (京都大学) / 0048 / 新制・課程博士 / 博士(工学) / 甲第14931号 / 工博第3158号 / 新制||工||1474(附属図書館) / 27369 / UT51-2009-M845 / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 田中 宏明, 教授 伊藤 禎彦, 教授 藤井 滋穂 / 学位規則第4条第1項該当

Within the socio-economic sphere, the development of women in the workplace is hindered by the dynamics of health and wellness issues such as HIV and AIDS, their gender dispositions and their social struggles around balancing work and family life. Furthermore, the impact of HIV and AIDS on business has become a priority agenda to address skills attrition and absenteeism. The UN declaration of Commitment (UNAIDS, June: 2001) which prioritizes the needs of women and children, is one of the interventions as a global effort to address the millennium development goals. Through this study, the researcher had investigated, in particular, whether there are difficulties experienced by working women infected or affected by HIV and AIDS. Furthermore, the study investigated the role of EAP in respect of these difficulties. The study is divided into two parts: one that is exploratory in nature in which a qualitative research approach was applied through semi-structured interviews whilst the other was quantitative research in which the survey research design used a questionnaire as the data collection instrument. The following conclusions were made from both the qualitative and quantitative data collected: • Working women infected and affected by HIV and AIDS have difficulties in the work place due to HIV and AIDS. • EAP is supporting working women infected and affected by HIV and AIDS. • There is a need for more resources to support EAP to be involved in strategic decision and business risk management. • The business has put in place measures to manage HIV and AIDS in the workplace through HIV policy formulation and establishment of HIV and AIDS programmes. It made sense for this research to present a picture regarding the extent of women participation in the world of work at a global level and efforts that the workplace have put in place to integrate women. Firstly the investigation defined HIV and AIDS and the intrinsic dynamics of HIV and gender. It then probed the prevalence of HIV and AIDS in the workplace in terms of the impact on the business with focus on women and the difficulties they experience as HIV infected and affected women. This was the focus of this part of the study. Secondly, the role of EAP in general was investigated, with the focus on the impact of EAP with regards to HIV and AIDS and working women. The goal of the research study was defined as: To explore and describe the role of EAP in addressing the difficulties experienced by working women, resulting from the impact of HIV and AIDS. The research question and sub-questions were formulated to give the study focus. The questions included: • What role, if any, does EAP play in supporting HIV infected and affected women in the workplace? • What is the perceived role of EAP in supporting HIV infected and affected women? • What is the perceived role of HIV infected women with regard to the effectiveness of EAP related to HIV and AIDS in the workplace? • What are the difficulties of running a functional EAP service in the context of HIV and AIDS? • What are the feelings of HIV and AIDS infected and affected women in their workplace? The study identified the type of research as applied research. Two phases of the study were carried to understand the challenges of working women with HIV and AIDS faced and the response of EAP. The first was a qualitative study, exploratory in nature, which focused on a sample of women who were either infected or affected by HIV and AIDS. This part of the study aimed to understand their perceptions and experiences of the challenges they faced at work. Furthermore it aimed to understand how they experience and interface with EAP. In the qualitative study, the aim was to understand the role and response EAP has made in South Africa particularly in relation to HIV and AIDS but with specific focus on working women. A case study research design was followed to gather data regarding attitudes, perception and experiences directly from respondents in their natural environment. The aim was to understand and interpret the meaning they give in relation to EAP in their workplace. A non-probability sampling method was used for the qualitative study. In this part of the study, a purposive sampling strategy was used and data was collected through semi-structured interviews of a sample of 24 working women (12 HIV infected and 12 affected by HIV and AIDS). The exploratory research findings confirmed that women infected and affected by HIV and AIDS do have difficulties in the workplace due to HIV and AIDS. The difficulties included psychological, financial and time lost due to HIV and AIDS. It further confirmed that the extent of the difficulties leave women with mental health issues and hopeless feelings, in some cases suicidal. The difficulties were further intensified by the perception that stigma is the key barrier to disclosure and business intervention strategies. All women had used EAP and found it useful during their difficulties. However, they found the role of EAP as positively evident at an individual level to address women’s needs in counselling, however at a company level women did not think EAP was addressing their needs to impact business changes. In the quantitative part of the study, a non-probability sampling method was used based on convenient sampling. There was however a replacement sample used based on a target sampling method for spoilt questionnaires. The quantitative part of the study confirmed the perceptions of the women that were affected and infected by HIV and AIDS. The quantitative study indicated that women were using EAP for HIV and AIDS counselling. The services of EAP that the women used assisted them with issues related to mental health difficulties, especially for depression and bereavement. In addition EAP practitioners were offering practical help such as home visits and referral to other services. The results further indicated a need for more resources to make strategic input and leadership involvement at a business level. The goal of the study and study objectives were achieved and are presented together with detailed recommendations in the research report. / Thesis (DPhil)--University of Pretoria, 2009. / Social Work and Criminology / unrestricted

This is a scientific exploration of the manner in which HIV/AIDS impacts upon the adolescents that are orphaned by AIDS and obliged to live in a child-headed household. What is apparent is that empirical research based on the socio-educational conditions of orphans in child-headed households is a neglected field of study since there is mainly anecdotal evidence of the phenomenon. The central issues of the study are the socio-educational impact of the pandemic upon such children. This study aims to explore, describe and interpret the phenomenon of HIV/AIDS within the context of the participants’ (adolescents in child-headed households) perspectives of their life-world. Apart from endeavouring to gain an insight into the way in which the social and educational aspects of the adolescents’ lives are affected the study attempts to create an awareness that will assist NGOs and the Departments of Education and Welfare in their effort to mitigate the impact of HIV/AIDS. The research abides by a qualitative methodology and an interpretive approach since the children are to be studied in their natural setting of their homes. The researcher employed a face-to-face technique in the form of interviews and observations of the adolescents in their natural environments as well as the Sack’s Sentence Completion Technique to accumulate data for the investigation. The social epidemiology theory served as a theoretical framework for this study. Findings of the study have revealed that HIV/AIDS has a definite negative impact on the social and educational lives of orphans in child-headed households. The study has further revealed that poverty, the lack of support and social discrimination experienced by the orphan in child-headed households, impact negatively on their social lives and education. Further, this research has exposed that orphans in child-headed households are vulnerable since they carry the burden of stigma and discrimination. These unfortunate children are forced to abandon their schooling because of financial constraints, and in many cases take care of ailing parents and assume adult responsibilities in their homes. Also, the South African Educational system has not adapted in keeping with current trends and needs to create more flexible learning opportunities that cater for children who will otherwise have to abandon their studies. / Dissertation (MEd (Curriculum Studies))--University of Pretoria, 2005. / Curriculum Studies / unrestricted

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

The H1N1/09 (sub-type A) virus was declared to be a pandemic influenza on June 11th, 2009. In response, Canadian public health agencies planned mass vaccination clinics to protect the public. However, little information existed to aid in the planning of mass vaccination clinics, as they had not been used in previous pandemic flu outbreaks. This was further complicated by fear of a limited vaccine supply and nurse shortages. Public health nurses (PHNs), as the largest group of public health professionals were pivotal in implementing the mass vaccination clinics. Yet, the available evidence indicated that PHNs involvement in H1N1/09 response planning was limited and their experiences on the frontline in the mass vaccination clinics were not well understood. The purpose of this study was to give PHNs’ a voice to describe their experiences in the H1N1/09 mass vaccination clinics. A framework based on Foucault’s concepts of knowledge, power, and resistance was developed as the theoretical lens to guide the research. Using an interpretive descriptive methodology, a purposeful sample of 23 PHNs (16 front-line immunizers, seven clinic supervisors) participated in semi-structured interviews. Four pandemic planning documents containing policies in place during the pandemic outbreak were also reviewed to provide context to participants’ experiences. Interpretive descriptive analysis was used to analyze the interviews and pandemic documents. Guba and Lincoln’s (1994) trustworthiness framework was implemented to evaluate the rigour of the study’s findings. Two overall core themes emerged to describe participants’ experiences. The core theme ‘the necessity of knowledge’, illustrated participants’ feelings of unpreparedness entering into the H1N1/09 clinics. Limited notice of the pandemic response, uncertainties regarding the clinics’ anticipated timeframe, and a lack of knowledge on vaccination and clinic management, contributed to a loss of power in the participants’ role. In the second core theme ‘essential supports in protecting the population’, many perceived a lack of agency support when they tried to exercise power in their clinical practice. Although participants did not refuse to immunize in, or supervise, the mass vaccination clinics, participants at times did display subtle resistance. Insights gained from participants’ experiences have implications in terms of public health nursing administration, practice, research, and education. A key recommendation is to involve PHNs in future pandemic planning to optimize mass vaccination clinics’ operations. If this cannot happen, PHNs should at least be informed of the disciplinary discourse utilized to guide clinical decisions. This will help nurses be supported in their own pandemic roles and contribute to the provision of quality population care.

For centuries, pandemic influenza has emerged at irregular and unpredictable intervals to cause widespread illness, hospitalization and death. Uncertainty surrounding the timing and severity of future influenza pandemics present challenges for preparedness and response efforts. The objective of this dissertation is to advance pandemic influenza knowledge and preparedness, through a series of interrelated articles that address the follow research questions: 1. What are the likely consequences of a pandemic flu event in Canada? 2. What do mathematical models tell us about preparing for such an event? 3. What is the best way to mitigate the consequences of an influenza pandemic? Six articles were prepared for submission in scientific, peer-reviewed journals. The first is a historical review of the burden of pandemic influenza. The second and third are systematic reviews of the effectiveness of interventions to interrupt pandemic influenza transmission. The fourth and fifth are research papers presenting a novel mathematical model, assessing the preparedness of the Canadian hospital system to accommodate expected surges in patient demand and evaluating intervention strategies to mitigate impact. The sixth is a policy-oriented paper discussing pandemic policy options within the context of public health ethics and risk management principles. Pandemic vaccination, antiviral treatment, voluntary isolation and personal protective measures were identified as the most cost-effective interventions available. Antiviral prophylaxis, community-contact reduction, school closure and quarantine were less effective, and tended to be associated with higher associated economic burdens. The timely implementation of layered intervention strategies appears likely to protect hospital-resource adequacy, though areas of Southwestern Ontario appear to be more vulnerable to surges in patient demand. However, the potential for high health and economic burdens, coupled with the uncertain severity of future pandemics, necessitates a flexibility in preparedness and response plans.

The research paper presents qualitative research and aims to examine the impact of social media on consumers’ stockpiling behavior under the situation of the coronavirus disease (COVID-19) outbreak in Sweden since week 11, 2020. Data is collected by interviewing five middle-aged women in Sweden who are either native Swedes or permanent immigrants and who had experienced stockpiling behavior. The interpretation of collected data is discussed based on the two-step flow theory, risk communication and the theory of planned behavior, and the social contagion theory. The qualitative content analysis is used to analyze the data with the results of three themes: being inclined to reach information, realizing why and when to hoard things, and behavior changes and showing confidence. The five women interviewed all use various social media ways to get information about COVID-19. There is a significant correlation between social media use, risk perception formulation, and stockpiling behavior. Participants have their judgment to look into the authenticity and reliability of related news. They trust the official social media reports, underwent the influence of social media reports, two-way online interaction, and other stockpiling consumers. They also experience the decreasing level of risk perception and thus changes in stockpiling behavior.