Background: To prevent the spread of Vaccine Preventable Diseases (VPD’s), school-aged children in the United States are required to receive vaccinations. In certain states, parents have the option to exempt their child from becoming vaccinated due to medical, religious, or personal reasons. The purpose of this research was to identify which states require mandatory vaccination education prior to granting vaccine exemptions and to identify the various types of required vaccination education.Methods: Immunization program managers from states requiring parents seeking exemptions to receive mandatory vaccination education were asked a series of open-ended questions. The interviews were conducted via telephone. The education-related questions identified: 1) which states require mandatory education prior to granting vaccine exemptions; 2) delivery methods for education; 3) standardization of materials; 4) renewal and evaluation of education; 5) the greatest obstacles to providing education; and 6) use of immunization registries to track vaccination education.Results: Ten states reported mandatory vaccination education requirements prior to granting vaccine exemptions. Three methods of vaccination education delivery were identified: printed material, face-to-face education, and/or online technology-driven education. Seven states have standardized vaccination education and use state exemption rates as a means to evaluate the education. Half of states required parents to renew vaccination education, but the time period for renewals varied from state-to-state. There were two general obstacles to delivering vaccination education, namely, lack of resources and lack of parent involvement.Conclusion: Parental education regarding vaccines impacts parents’ decisions to vaccinate their children. The method of delivering mandatory vaccination education varies greatly between states. Each method for vaccination education delivery has inherent advantages and disadvantages, indicating the need for further research to determine which method of education delivery is most effective. A combination of delivery methods may, in fact, be the best option. Identifying the most effective delivery method for vaccination education, as well as the most optimal time period for renewing the education, will assist other states developing mandatory vaccination education materials.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13512号 / 論医博第2262号 / 新制||医||1061(附属図書館) / (主査)教授 川上 浩司, 教授 近藤 尚己, 教授 長尾 美紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Background The use of vaccines is among the most cost-effective tools for preventing infectious diseases and their complications. However, poor uptake and increasing exemption to routine childhood vaccination have been linked with outbreaks of infectious diseases such as measles, pertussis, and more recently poliomyelitis in the US. The objective of the study is to determine the prevalence, pattern, and predisposing factors of vaccine exemptions to childhood immunization amongst parents of children in the Northeast Region from 2017 to 2021. Methods The routine immunization data of children between 1-24 months in the Northeast region, Tennessee from 2017- 2021 was extracted. Based on the population of children within the birth cohort, a random sample of children was selected from birth certificates of children born in the first three months of 2 years prior in Tennessee’s eight counties in the Northeast region. Descriptive statistics with trends, Chi-square, and logistic regression were conducted to delineate factors associated with vaccine exemption in the region. Result The prevalence of vaccine exemption was 2% on average, but the vaccine exemption rate increased significantly from 1.5% in 2019 (pre-COVID pandemic) to 2.5% in 2020 (peri-COVID period). However, the mother’s level of education (aOR=2.37; CI=0.55-10.17), mother’s age (aOR=0.59; CI=0.14-2.51), TennCare attendance (aOR=0.57; CI=0.15-2.21) do not show statistically significant association with exemption to childhood vaccination in Northeast region in Tennessee. Conclusion There appears to be an increasing trend in the vaccine exemption to routine childhood immunizations in the Northeast region of Tennessee over the years. However, the impact of other factors associated with exemptions to childhood vaccinations needs further research.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13607号 / 論医博第2317号 / 新制||医||1073(附属図書館) / その他リバプール熱帯医学研究科国際公衆衛生学コース / (主査)教授 長尾 美紀, 教授 川上 浩司, 教授 近藤 尚己 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit: a distinctive stamp. Recent problems in healthcare facilities, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient's attention from a sterile environment and/or noxious event. In doing so, healthcare facilities have become special environments with a caring spirit. This study examined a specific aspect of creating a caring environment: determining whether or not a positive distraction, a child's art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old during an immunization procedure. The researcher conducted a randomized controlled study in two locations using a child's self-report pain scale, heart rate, parent/guardian report, and nurse report measures. After collecting and analyzing data from 76 well-participants receiving one to five immunizations, the researcher found no statistically significant difference between the conditions for any of the measures. Thus, the null hypothesis, the art-light mosaic image would not assist in lowering pain and distress in pediatric patients, 4 to 6 years old, during an immunization procedure, was not rejected. From these results, the researcher recommended future studies incorporate training the parent and child on how to use the distraction, combine the distraction with a topical analgesic, provide a clear understanding of pain and distress from the child's point of view, and develop more sensitive self-report measures of pain for children. / Ph. D. / In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit. Recent problems in places that provide healthcare, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient’s attention from an unfriendly environment and/or unpleasant event. In doing so, healthcare facilities have become special places with a caring spirit. This study investigated one area in creating a caring environment: determining whether or not a positive distraction, a child’s art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old receiving a vaccination. The researcher conducted a study in two locations using proven measures to determine the child’s anxiey. After collecting and analyzing information from 76 well-children receiving one to five vaccinations, the researcher found no difference between the children’s anxiety watching or not watching the positive distraction during a vaccination. Therefore the researcher stated the positive distraction, an art-light mosaic image, would not help lower pain and distress in children, 4 to 6 years old, during a vaccination. From these results, the researcher recommended future studies include training the parent and child on how to use the distraction, combine the distraction with a cream designed to rub on the skin to relieve pain, provide a clear understanding of pain and distress from the child’s point of view, and develop better measures to determine pain in children.

Yes / Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision-making process. This research aimed to explore the factors that influence healthcare workers' experience and perceptions about delivering childhood immunization in Fiji. A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi-structured open-ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Parents and/or caregivers all over the world are expected to comply with existing childhood immunisation programmes in order to prevent outbreaks of preventable childhood diseases. The most important justification for this study was the 2010 measles outbreak in the Western Cape province of South Africa. This outbreak correlated with the study conclusions of Corrigall, Coetzee and Cameron (2008:41) as they found the immunisation coverage in the Western Cape to be insufficient to prevent outbreaks of preventable childhood diseases. From the literature, it seemed that attitudes and factors that influence parent and/or caregiver compliance with the routine childhood immunisation schedule in the Witzenberg sub-district of the Western Cape persist. In doing this study, the researcher’s purpose was to discover what those factors were. The aim was to determine, understand and describe the attitudes and factors influencing parent and/or caregiver compliance with the routine childhood immunisation schedule, and the nature thereof. The set objectives were to gain knowledge of and insight into the factors influencing participants’ adherence with routine childhood immunisation; and participants’ feelings, attitudes, and experiences surrounding immunisation within the context of their health care environment. A quantitative research approach, with a smaller qualitative component, was selected for this study which had an exploratory descriptive design. The population targeted for data collection included parents and/or caregivers of children aged 0 to 60 months in the Witzenberg sub-district (N=8374), as well as in community health centres (CHCs) that provided immunisation and/or other primary health care services in the mentioned subdistrict (N=16). The non-probability convenience sampling of parents and/or caregivers consisted of 376 participants (n=376), while 8 CHCs (n=8) were selected through systematic sampling. The measuring instrument used as the data collection technique for this study was a selfadministered questionnaire. A pilot study was conducted to pre-test the questionnaire, and its reliability and validity were further ensured by submitting it for review to research experts in methodology and nursing. A combination of quantitative and qualitative methods was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA version 9-software. Tesch’s approach to qualitative data analysis was used as a guideline with the purpose of identifying and categorising the essential qualitative data and grouping it together in one descriptive framework. The main findings were that parents and/or caregivers involved in this study were positive about immunisation and their experiences within the health service environment. They also felt that health workers were playing an important role in their decision-making process. However, their knowledge regarding the purpose of and contra-indications for immunisation were insufficient, and most parents reported that their children experienced side effects after immunisation. Key recommendations on conclusion of the study include clear, accurate and specific information to parents about the purpose of immunisation and its contra-indications and side effects. Vaccinators and managers should be informed about the persistent problem with mild vaccination side effects and refresher courses should be provided with regard to infection control, administration techniques and the reporting of adverse effects. / AFRIKAANSE OPSOMMING: Daar word van ouers en/of versorgers oor die wêreld verwag om aan bestaande kinderimmunisasieprogramme te voldoen ter voorkoming van vaksien-voorkombare siektes. Die belangrikste regverdiging vir die studie was die masel-uitbreking in die Wes-Kaapprovinsie van Suid-Afrika in 2010. Die uitbraak het die studiebevindinge ondersteun van Corrigall, Coetzee en Cameron (2008:41), wat bevind het dat immunisasiedekking in die Wes-Kaap onvoldoende was om ʼn uitbreking van voorkombare kindersiektes te verhoed. Volgens die literatuur het dit voorgekom asof die gesindhede en faktore wat ouers en/of versorgers se houding jeens die roetine- kinder-immunisasieskedule in die Witzenberg sub-distrik van die Wes-Kaap beïnvloed, voortduur. Die navorser het met hierdie studie ten doel gehad om die faktore te ontdek, ten einde die gesindhede en faktore wat ‘n invloed uitoefen te bepaal, te verstaan en te omskryf. Die doelwitte was om kennis in te win oor en insig te verkry in die faktore wat ouers en/of versorgers se aanhanklikheid met routine kinder immunisering beinbloed; en in ouers en/of versorgers se gevoelens, houdings en ondervindings ten opsigte van immunisasie in hulle gesondheidsorg-omgewing. ‘n Kwantitatiewe navorsingsbenadering met ‘n kleiner kwalitatiewe komponent is geselekteer vir die studie wat ‘n ondersoekend-beskrywende navorsingsontwerp gehad het. Die populasie wat geteiken is vir data-insameling was ouers en/of versorgers van kinders van 0 tot 60 maande in die Witzenberg sub-distrik (N=8374), asook gemeenskapsgesondheidsentrums wat immunisasie en/of ander primêre gesondheidsorgdienste in die genoemde sub-distrik aanbied (N=16). Die nie-waarskynlike gerieflikheidsteekproef van ouers en/of versorgers het uit 376 deelnemers (n=376) bestaan, terwyl 8 (n=8) gemeenskapsgesondheidsentrums deur middel van sistematiese steekproefbepaling geselekteer is. Die meetinstrument vir data-insameling in die studie was self-geadministreerde vraelyste. ‘n Loodsstudie is uitgevoer as vooraf-toetsing van die vraelys en die geldigheid en betroubaarheid daarvan is verder verseker deur die vraelys aan navorsingskenners in navorsingsmetodologie en verpleging te onderwerp. ‘n Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die analisering van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer waarna beskrywende statistieke deur middel van Statistica weergawe 9-sagteware gebruik is om dit te analiseer. Tesch se benadering tot kwalitatiewe data-analise is as riglyn gebruik met die doel om belangrike data te identifiseer, te kategoriseer en in ‘n beskrywende raamwerk te groepeer. In die studie is daar hoofsaaklik bevind dat ouers en/of versorgers positief is oor immunisasie en hul ondervinding binne die gesondheidsorgomgewing, en dat gesondheidswerkers ʼn belangrike rol in hul besluitnemingsproses speel. Hul kennis aangaande die doel van en kontra-indikasies vir immunisasie was egter onvoldoende en die meeste ouers en/of versorgers het gerapporteer dat hul kinders ná immunisasie probleme met newe-effekte ondervind het. Die hoofaanbevelings wat uit die studie voortgespruit het, was dat duidelike, akkurate en spesifieke inligting aan ouers en/of versorgers verskaf moet word aangaande die doel van immunisasie en die kontra-indikasies daarvoor. Immuniseerders en bestuurders moet ook ingelig word oor die voortdurende voorkoms van newe-effekte sodat opknappingskursusse oor infeksiebeheer, korrekte toedieningstegnieke en die rapportering van newe-effekte aangebied kan word.

Descriptive research was conducted to describe the relationships among host and environmental factors and immunization compliance in two year old children. Secondary data was collected from a sample of 306 well baby clinic records in a public health department in a Southwestern state. Results revealed statistically significant differences between the compliant and noncompliant groups for income and number of children living at home. Higher income, higher maternal age, fewer number of children, and races other than of Spanish origin were significantly correlated with children who received all immunizations at the appropriate age. Significant relationships were found between children who received all immunizations at the public health department versus children who received immunizations from both a public and private provider. Compliant children made more visits for immunizations and fewer other visits than noncompliant children. These factors can assist in identifying children at highest risk for failure to receive immunization on time.

Made available in DSpace on 2016-08-19T18:16:03Z (GMT). No. of bitstreams: 1 INQUERITO DE COBETURA VACINAL.pdf: 863654 bytes, checksum: b9703ce75fe6c140e760409b85f26a68 (MD5) Previous issue date: 2011-10-07 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / Vaccination of children in the first year of life is essential for the prevention of various diseases and is one of the factors associated with reduced infant mortality rate. The identification of coverage and the factors responsible for delay or lack of immunization is critical for proper monitoring of vaccination programs and to identify and reach children who are not vaccinated properly. This study aimed to assess vaccination coverage in children 0-18 months of age living in São Luís - MA. The present study describes the results of a household survey to estimate vaccination coverage of the basic scheme until the second year of life in St. Louis - Ma, the cohort born in 2005.The study adopted the methodology recommended by the Pan American Health Organization to conduct surveys of vaccination coverage. Of the 630 planned interviews were conducted 561 (89%). The results show a higher proportion of girls, with a predominance of white children as they raise their levels of education and family income. The distribution of coverage by census tracts is heterogeneous, being the poorest coverage was generally lower socioeconomic strata. The BCG vaccine was the best coverage and there is a significant difference between the production data and data obtained by the inquiry, referring to all vaccines. Vaccination at 18 months (valid doses) are lower than desired, except for BCG (96% coverage). The vaccination coverage (valid doses), complete basic scheme for all the vaccine is only 51%. The survey data were a result far short when compared with administrative data. The data collected show that those recorded by official agencies overestimate the coverage of this population segment suggesting immunity in mass, a factor causing an erroneous false protection and demonstrates a failure in the evaluation of the service, and then other necessary strategies for monitoring actions of the National Immunization Program / A vacinação das crianças no primeiro ano de vida é fundamental para a prevenção de várias doenças transmissíveis e é um dos fatores associados à redução da taxa de mortalidade infantil. A identificação da cobertura vacinal e dos fatores responsáveis pelo retardo ou pela falta de imunização é fundamental para a adequada monitorização dos programas de vacinação e para se identificar e atingir as crianças que não são vacinadas corretamente. Este estudo teve como objetivo analisar a cobertura vacinal em crianças de 0 a 18 meses de idade residentes no município de São Luís - MA. O presente estudo descreve os resultados de um inquérito domiciliar para estimar a cobertura vacinal do esquema básico até o segundo ano de vida em São Luís - Ma, da coorte nascida em 2005. O estudo adotou a metodologia preconizada pela Organização Pan-Americana da Saúde para a realização de inquéritos de cobertura vacinal. Das 630 entrevistas previstas foram realizadas 561 (89%). Os resultados mostram maior proporção de meninas, havendo um predomínio de crianças brancas à medida que se elevam os níveis de escolaridade e renda da família. A distribuição da cobertura vacinal por setores censitários é heterogênea, encontrando-se as piores coberturas geralmente em estratos de menor nível socioeconômico. A BCG foi a vacina de melhor cobertura e observa-se uma diferença significativa entre os dados de produção e os dados obtidos através do inquérito, referentes a todas as vacinas. As coberturas vacinais aos 18 meses (doses válidas) encontram-se inferiores ao desejado, exceto para BCG (96% de cobertura). A Cobertura vacinal (doses válidas), esquema básico completo para o conjunto das vacinas é de apenas 51%. Os dados do inquérito tiveram um resultado muito aquém quando comparados com os dados administrativos. Os dados aqui coletados demonstram que aqueles registrados pelos órgãos oficiais, superestimam a cobertura desse segmento populacional sugerindo imunidade em massa, fator este errôneo gerando uma falsa proteção e que demonstra uma falha no sistema de avaliação do serviço, sendo então necessárias outras estratégias para monitorização das ações do Programa Nacional de Imunização.