As Africa faces the challenges of its renewal or renaissance, the HIV/AIDS epidemic poses the greatest potential barrier to the attainment of this vision (Makgoba, 2001 in Dorrington, Bourne, Bradshaw, Laubscher & Timaeus, 2001). The development of an HIV vaccine that is safe, effective and affordable, has been widely contemplated as a necessary supplement to already established interventions. In preparation for HIV vaccine trials in South Africa the current project aimed to assess students' understanding (knowledge and perceptions) and experiences of vaccination in general, and to explore if these were associated with demographics such as motherhood and gender. A parallel aim was to assess students' knowledge and expectations of HIV vaccination and trial participation. A sample of 33 students was recruited from university residences at the University of Natal, Pietermaritzburg. Participants were interviewed via a semi-structured interview schedule. The data collected was then coded and analysed using content analysis, while Chi - square analysis was used to evaluate if demographics such as gender and motherhood were systematically associated with various responses. The results revealed that the vast majority of participants (97%) knew the purpose of vaccination, stating that it was to promote health and prevent illness. Most participants (67%) knew that vaccination works by mobilising the immune system (vaccination mechanism). The vast majority of participants (91%) could name at least one vaccine preventable disease. Uptake of childhood immunisation was reportedly high (88%) while adult uptake of immunisation was low (33%). A significant minority (36%) reported that they had experienced side effects but understood these to be an integral part of vaccination. Thirty percent of participants stated they were willing to participate (WTP) in a hypothetical vaccine trial, 33 % of participants were not WTP and 15% were not sure. Motivations for trial participation were reportedly influenced most by personal incentives of altruism (39%) and barriers such as perceived significant physical risk (61%). In general, knowledge and experiences of vaccination were not associated with gender or with motherhood. The results suggest that more awareness of HIV vaccine trials is needed. In this regard education should emphasise that the prospective vaccine will be preventive, that only healthy people can volunteer and that the HIV vaccine will not guarantee immunity to HIV infection. Suggestions are made for future research into motivations, barriers and incentives to facilitate an ethical process of vaccine trial participation. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

Malgré les succès spectaculaires de l’immunisation comme mesure de santé publique, certains parents continuent de refuser de vacciner leurs enfants (Diekema, 2005). C’est pourquoi qu’au cours des dernières décennies, des éclosions de maladies évitables par la vaccination comme la rougeole et la coqueluche ont été observées au Canada, surtout chez la population non vaccinée (Hinman, 2000). Au Québec, depuis l’entrée en vigueur de la loi 90 en 2003, les infirmières peuvent procéder à la vaccination sans ordonnance individuelle ou collective conformément au Protocole d’Immunisation du Québec (PIQ). Les infirmières québécoises peuvent alors influencer positivement la couverture vaccinale (Sauvageau & al, 2005). Le but de cette étude est d’évaluer les retombées de la formation VIP (Vaccination par les Infirmières/Infirmiers-Prévention) sur les pratiques vaccinales rapportées par les infirmières (N=12) de CSSS, auprès des parents d’enfants de 0-5 ans lors d’un refus parental. En premier lieu, nous avons identifié et décrit treize pratiques vaccinales en réponse à un refus parental. Par la suite, nous avons identifié des modifications dans certaines des treize pratiques rapportées tel qu’une augmentation dans la description des pratiques de correction des fausses croyances des parents, une amélioration de la justesse des pratiques d’explication et une personnalisation des pratiques décrites. En conclusion, la formation offerte aux infirmières doit permettre à celles-ci d’identifier les préoccupations parentales et d’y répondre adéquatement en utilisant une information juste et individualisée. / In spite of the success of immunization as a public health measure, some parents refuse to vaccinate their children (Diekema, 2005). Over the last couple of decades, outbreaks of vaccine-prevented diseases like whooping cough and measles have been observed in Canada, particularly among the non-vaccinated population (Hinman, 2000). Since the adoption of law 90, nurses in Quebec can provide vaccination without a medical prescription while adhering to the PIQ (Quebec immunization protocol). Nurses in Quebec can, therefore, have a positive impact on immunization uptake in the province (Sauvageau, Boulianne, Clouâtre, Lavoie, & Duval, 2005). The goal of this study was to evaluate the effect of the VIP (Vaccination par les Infirmières/Infirmiers- Promotion) teaching program on the practices of community nurses (CSSS) when faced with a parent refusing vaccination. We first described the nursing practices of nurses (N=12) when faced with parents who refused vaccination. We identified and described 13 practices used by nurses when faced with parental refusal. Secondly, we identified modifications in some of the nursing practices after the VIP teaching program. Nurses must address the fears or questions of parents with pertinent and individualized information. Teaching programs must provide support for nurses to have and maintain an optimal practice.

Introduction En juin 2009, l’Organisation Mondiale de la Santé (OMS) a déclaré l’état de pandémie pour le nouveau virus influenza A(H1N1). Malgré les recommandations des autorités de santé publique, lors de la mise en place de la campagne de vaccination de masse au Québec contre ce virus pandémique, certains groupes de la population ont été plus enclins à être vaccinés que d’autres groupes. Ceci souligne l’importance des déterminants psychosociaux du comportement humain, sujet qui a donné cadre à notre étude. Objectifs Le but de cette étude a été de documenter les attitudes, les connaissances et les influences sociales des parents dont les enfants fréquentent des services de garde éducatifs (SGE) vis-à-vis la vaccination contre la pandémie ainsi que la couverture vaccinale. Méthodologie Un questionnaire auto-administré et anonyme basé sur la théorie des comportements interpersonnels de Triandis a été distribué aux parents d’enfants âgés de 0-59 mois de neuf centres de la petite enfance sur l’île de Montréal. Résultats Le taux de réponse de l’enquête a été de 32,0% (N=185). Le taux de vaccination des enfants s’est retrouvé à 83,4%; ceci représente une couverture plus élevée que la moyenne régionale et nationale. Toutefois, à une question sur l’intention des parents face à une autre pandémie, seuls 46% des parents feraient vacciner leur enfant. Les facteurs les plus significatifs associés à la vaccination de leur enfant ont été les croyances personnelles positives, de bonnes habitudes vaccinales et l’influence des média, tous mesurés par plusieurs indicateurs (RC respectifs de 7,7, 3,1 et 4,2, p<0,05). Conclusion Pour la grippe A(H1N1), plusieurs facteurs contextuels ont joué en faveur des taux de vaccination acceptables chez les enfants. Toutefois, la mise en place d’une campagne de la vaccination par les instances gouvernementales et de santé publique en utilisant divers média pourraient contribuer à un taux de vaccination encore plus élevé en cas d’épidémie ou de pandémie. / Background In June 2009, the World Health Organization (WHO) declared the 2009 A(H1N1) swine flu a pandemic. Despite the recommandations from public health authorities when setting up the mass immunization campaign in Quebec against the influenza A(H1N1), some population groups were more likely to be vaccinated than others. This underlines the importance of psychosocial determinants of human behaviour, which gave a framework for our study. Objectives The aim of this study was to document the attitudes, knowledge and social influences of parents whose children attend early childhood centers (ECC) regarding the vaccination against the pandemic and its coverage. Methods A self-administered and anonymous questionnaire based on the theory of reasoned action of Triandis was distributed to parents of children aged 0-59 months in nine childcare centers on the island of Montreal. Results The response rate of the survey was 32.0% (N=185). The vaccination uptake for children was 84%; this represents a higher coverage than the average regional and national levels. However, only 46% of the parents said that they would vaccinate their child again if a new flu pandemic was being declared by the World Health Organization. The most significant factors associated with vaccination uptake were positive personal beliefs, getting seasonal flu vaccines and the influence of media, all measured by several indicators (respective odds ratio 7,7, 3,1 and 4,2, p<0,05). Conclusion Several contextual factors played in favour of acceptable vaccination rates among children. However, the establishment of a campaign of vaccination by government authorities and public health agencies while using various media to spread information could contribute to higher vaccination rates in a future case of epidemic or pandemic.

在醫療與衛生技術飛快進步下，長壽風險目前已成為國際上普遍重視之議題，為因應死亡率改善所帶來之不確定性影響，壽險公司與退休基金也衍生出各種避險策略，近年來避險策略發展中當以自然避險為主軸，其中又可分為商品間避險與商品內避險法。一般市場上含有商品內避險概念的商品並不少見，如生死合險與還本型保險等，雖然商品內避險法有規避基差風險與免除因保險期間重新配置商品組合造成管理費用之優點，卻也存在無法因應實際死亡率做調整之缺點。因此本研究以英國Money-Back年金商品為例，採用存續期間配適法建構商品內避險最適組合，並配合現金流量分析自然避險策略的真實效果，提供未來壽險公司作為設計商品時之參考。 本研究發現採取商品內避險法時，壽險部分在保險期間後期會發生反轉現象，現金流量淨值波動方向變成與年金險一致，導致商品後期淨值波動過大，失去避險效果；本研究同時發現過去評估自然避險效果時普遍採用的淨值免疫指標存在缺陷，無法兼顧現金流量波動與破產機率。因此我們提出一種創新指標，同時考慮免疫理論中的三大免疫目標，研究結果顯示透過創新指標較能夠完整的評估整體自然避險效果，減少壽險公司於保險期間因現金流量波動劇烈所衍生之資金借貸成本，獲得更佳的避險效果。 / With the improvement of medical and hygienic techniques, longevity risk has become the most important issue in the world. Life insurers and the pension provider propose various kinds of hedging strategies to cope with the uncertainty due to the improvement in mortality. In recent year, the development of hedging strategies focus on natural hedging, which can classified as the hedging strategies according to different insured policies or the same insured policy with survival benefit and death benefit. Endowment is a good example for the hedging strategy from the same insured policy. Although hedging from the same insured policy can avoid basis risk and decrease the cost from rebalance in the insurance period, it couldn't adjust product portfolios by experienced mortality rates. In this paper, we attempt to analyze the natural hedging effect for the Money-Back annuity and use the immunization model to find the optimal collocation of insurance products and evaluate the effect of the natural hedging by cash flow method. We find that life insurance will happened contrary effect in the later insurance period when we try to hedging from the same insured. The changes on the liability of life insurance become the same direction with annuity and lead to more uncertain in later insurance period; We also discover that the indicator which used to evaluate the effect of natural hedging in the past has some defect, so we propose a new indicator which include three immunization goals. We find the new indicator can evaluate the natural hedging effect completely, then it may can help life insurers to avoid the cost of capital due to the unstable cash flow.

Mathematical models provide unique insights to real-world problems. Within the context of infectious diseases, models are used to explore the dynamics of infections and control mechanisms. Human papillomavirus (HPV) globally infects about 630 million people, many of these infections develop into cancers and genital warts. Vaccines are available to protect against the most prevalent and devastating strains of HPV. The introduction of this vaccine as part of a national immunization program in Canada is a complex decision for policy-makers in which mathematical models can play a key role. We use the current recommendations provided by the World Health Organization to explore the integral role mathematical models have in the decision to incorporate the HPV vaccine within a national immunization program. We then provide a review of the literature discussing the role of mathematical models in the decision to include a vaccine in a national immunization program within the context of the HPV vaccine. Next, we evaluate the current standing of mathematical models used within the context of HPV immunization, to highlight the types of models used, underlying assumptions and general recommendations made about these immunization programs. Then, we create and analyze a model to explore the possibility of bettering the current HPV vaccine strategy in Canada. We focus on the effects of the grade of vaccination and the number of doses required to eradicate the targeted strains of HPV.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed on July 19, 2010). Includes bibliographical references (p. 73-79).

La réponse humorale à immunoglobulines A (IgA) constitue un des principaux mécanismes immunologiques permettant de maintenir l'homéostasie intestinale. L'initiation de la réponse IgA se déroule dans les tissus lymphoides associés à l'intestin, où la reconnaissance des antigènes intestinaux entraine l'activation des lymphocytes B naïfs, la commutation isotypique vers IgA et leur différenciation en plasmocytes. Mon travail de thèse a consisté à étudier la contribution du foie et des cellules dendritiques plasmacytoides (pDC) dans la réponse IgA intestinale. L'utilisation de deux modèles murins permettant la déplétion sélective des pDC nous a permis de démontrer que, en dépit de données publiées montrant leur capacité à engager la réponse IgA in vitro, les pDC ne sont pas nécessaires in vivo pour l'induction ou le maintien de la réponse IgA homéostatique. Nous montrons ensuite que le foie abrite une population importante de plasmocytes à IgA. Chez la souris, nous montrons que ces cellules possèdent des caractéristiques phénotypiques distinctes des plasmocytes de l'intestin et proviennent de lymphocytes B récemment activés dans les plaques de Peyer. A l'homéostasie, ces plasmocytes hépatiques secrètent des IgA dirigées contre les bactéries de la flore intestinale. Enfin, dans un modèle murin de consommation chronique d'alcool, nous montrons une corrélation entre une augmentation de cette population cellulaire, une élévation sérique des IgA et des dépôts d'IgA hépatiques, deux désordres fréquemment observés chez les patients atteints d hépatopathies alcooliques. Nos données indiquent donc que le foie constitue un site effecteur alternatif de la réponse / IgA humoral response is one of the main mechanisms by which immune homeostasis is maintained in the intestine. The IgA response is initiated in gut-associated lymphoid tissues, where recognition of intestinal antigens drives naïve B cell activation, IgA class-switch recombination and plasma cell differentiation. My thesis work addressed the contribution of the liver and plasmacytoid dendritic cells (pDCs) in intestinal IgA response. By using two complementary mouse models allowing for selective depletion of pDCs, we have demonstrated that, in contrast to published work showing their ability to drive IgA response in vitro, pDCs are dispensable in vivo for the induction and the maintenance of homeostatic intestinal IgA responses.Then, we showed that the liver contains an important population of IgA plasma cells. In mice, we demonstrated that these cells harbor distinct phenotypic characteristics in comparison to intestinal IgA plasma cells, and are derived from B cells recently activated in Peyer’s patches. At homeostasis, hepatic IgA plasma cells secrete IgA directed against bacteria from intestinal flora. Finally, in a mouse model of chronic ethanol consumption, we found a correlation between an increase in hepatic igA plasma cell population, elevation of serum iGA and IgA deposits in liver sinusoids, two disorders frequently observed in alcoholic liver disease patients. Thus, our results indicate that the liver constitutes an alternative effector site for IgA response initiated in the intestine

[pt] O termo imunização denota a construção de uma carteira de títulos de forma a torná-la imune a variações nas taxas de juros. No caso das entidades de previdência complementar, o objetivo da imunização é distribuir os recebimentos intermediários e finais dos ativos de acordo com o fluxo de pagamentos dos benefícios. Em geral, quanto maior a classe de alterações na estrutura a termo das taxas de juros (ETTJ), mais restritivo se torna o modelo. Embora exista uma vasta literatura sobre o aspecto estatístico e sobre o significado econômico dos modelos de imunização, esse trabalho inova ao prover uma análise detalhada do desempenho comparado dos modelos, sob três perspectivas complementares: o método escolhido, a dimensionalidade e, ainda, o horizonte de investimento. Entretanto, a decisão final do gestor não está restrita à escolha do método de imunização, como também ao horizonte de investimento a ser imunizado, uma vez que outros instrumentos financeiros podem garantir tanto a solvência econômica quanto a financeira. Os limites não operacionais à imunização são analisados por meio da comparação das medianas do relativo de riqueza e da probabilidade de exaustão da carteira. A análise permite concluir que os modelos de imunização tradicional são mais eficientes, especialmente no médio e longo prazo, que os modelos multidimensionais de gestão do risco de taxa de juros. Ademais, demonstra-se que não existem limites naturais à imunização, quando aplicada ao mercado previdenciário brasileiro por um período igual ou inferior a 10 anos. / [en] Immunization is defined as the investment in assets in such a way that the fixed income portfolio is immune to a change in interest rates. In the special case of pension funds, immunization seeks the distribution of the cash inflows in accordance with the outflows represented by the fund´s liabilities. The article compares distinct alternative methods of immunization against the traditional duration-matching strategy. All portfolios were obtained as a result of mathematical programming problems, where the choice of the immunization strategy led to the restrictions imposed on the evolution of the term structure of interest rates. Despite the intensive research related to this subject, there are some gaps to be filled yet, especially those concerned with the investment horizon. That is exactly the main objective of this thesis. The work provides the basis for selecting the most appropriate method for immunization and also demonstrates the superiority of the traditional duration-matching strategy, especially in the medium and long run. Moreover, it is demonstrated that there is no limit other than operational to the immunization process concerning Brazilian markets for investment horizons of less than 10 years.

Submitted by Sofia Meirelles (sofiaksm@gmail.com) on 2015-02-11T16:47:40Z No. of bitstreams: 1 Estratégias de imunização de carteiras de renda fixa no Brasil - Sofia Meirelles.pdf: 1823249 bytes, checksum: c9dbdd216cfecbe8d0f18ca7f411d3cd (MD5) / Approved for entry into archive by Renata de Souza Nascimento (renata.souza@fgv.br) on 2015-02-11T17:06:46Z (GMT) No. of bitstreams: 1 Estratégias de imunização de carteiras de renda fixa no Brasil - Sofia Meirelles.pdf: 1823249 bytes, checksum: c9dbdd216cfecbe8d0f18ca7f411d3cd (MD5) / Made available in DSpace on 2015-02-11T17:07:50Z (GMT). No. of bitstreams: 1 Estratégias de imunização de carteiras de renda fixa no Brasil - Sofia Meirelles.pdf: 1823249 bytes, checksum: c9dbdd216cfecbe8d0f18ca7f411d3cd (MD5) Previous issue date: 2015-01-23 / This paper aims to statistically compare the performance of two hedging strategies for Brazilian fixed income portfolios, with discrete rebalancing. The first hedging strategy matches duration, and hence it considers only small parallel changes in the yield curve. The alternative methodology ponders level, curvature and convexity shifts through a factor model. We first estimate the yield curve using the polynomial model of Nelson & Siegel (1987) and Diebold & Li (2006) and then immunize the fixed income portfolio using Litterman & Scheinkman’s (1991) hedging procedure. The alternative strategy for portfolio immunization outperforms duration matching in the empirical exercise we contemplate. Additionally, we show that rebalancing the hedging portfolio every month is more efficient than at other frequencies. / Este trabalho visa comparar, estatisticamente, o desempenho de duas estratégias de imunização de carteiras de renda fixa, que são recalibradas periodicamente. A primeira estratégia, duração, considera alterações no nível da estrutura a termo da taxa de juros brasileira, enquanto a abordagem alternativa tem como objetivo imunizar o portfólio contra oscilações em nível, inclinação e curvatura. Primeiro, estimamos a curva de juros a partir do modelo polinomial de Nelson & Siegel (1987) e Diebold & Li (2006). Segundo, imunizamos a carteira de renda fixa adotando o conceito de construção de hedge de Litterman & Scheinkman (1991), porém assumindo que as taxas de juros não são observadas. O portfólio imunizado pela estratégia alternativa apresenta empiricamente um desempenho estatisticamente superior ao procedimento de duração. Mostramos também que a frequência ótima de recalibragem é mensal na análise empírica.