No description available.

No description available.

Background: Rotavirus is one of the most common diarrheal diseases in children less than 5 years of age. Rotavirus vaccines have greatly reduced this burden in the United States. An examination was conducted to determine possible disparities in RV vaccination rates compared to DTaP. Methods: Children were actively enrolled during two rotavirus seasons from January-June of 2010 and 2011 in the Emergency Departments (ED) and inpatient floors from all Children's Healthcare of Atlanta (CHOA) sites (Scottish Rite, Egleston, and Hughes Spalding) with acute gastroenteritis (AGE). Data and a stool sample were collected from enrolled children and samples were tested for presence of rotavirus using an enzyme immunoassay (EIA) kit (Rotaclone). Vaccination records were abstracted from the state immunization registry and primary healthcare providers to examine complete and incomplete vaccination status. This cohort of children with vaccination records were used for this analysis. Cases were identified as children receiving a complete RV dose series and controls were identified as children with incomplete RV doses. A logistic regression model was used to determine disparities seen amongst children with incomplete vaccination status. Results: Of the 660 patients that were approached for this study, 414 participants were included in this retrospective cohort analysis. 46.9% had incomplete rotavirus vaccination status and were more likely to be positive for rotavirus AGE (OR 1.76, 95% CI 1.46-2.13). Black infants had a higher rate of incomplete RV compared to whites (p-value 0.0006). When controlling for covariates, racial differences were no longer significant (OR 1.37 95% CI 0.77-2.57); however household size (p-value 0.0343), age at onset of illness (p-value 0.0061), and DTaP vaccination status (p-value < 0.0001) were all significant in determining vaccination status for children. Conclusions: Racial disparities and socioeconomic differences are not evident in determining rotavirus vaccination rates; however, household size, a possible social determinant, has an effect on RV status. In addition, timely vaccinations are important in preventing incomplete RV vaccination status, due to RV vaccine age restrictions.

Developing countries face imminent choices for introducing needed, effective but expensive new vaccines, given the substantial immunization resources now available from international donors. Cost-effectiveness analysis (CEA) is a tool that decision-makers can use for efficiently allocating expanding resources. However, although CEA has been increasingly applied in developing-country settings since the 1990’s, its use lags behind that in industrialized countries. This thesis explored how CEA could be made more relevant for decision-making in developing countries through 1) identifying the limitations for using CEA in developing countries 2) identifying guidelines for CEA specific to developing countries 3) identifying the impact of donor funding on CEA estimation 4) identifying areas for enhancement in the 1996 “Reference Case” (a standard set of methods) recommended by the US Panel on Cost-Effectiveness in Health and Medicine, and 5) better understanding the decision-making environment in developing countries. Focusing on pediatric immunization in developing countries, thematic analysis was used to distill key concepts from 157 documents spanning health economics, clinical epidemiology and health financing. 11 key informants, researchers active in developing countries, were also interviewed to explore the production and use of evidence in public health decision-making. Results showed a divergence between industrialized and developing nations in the emphases of methodological difficulties, in the general application of CEA, and the types of guidelines available. Explicitly considering donor funding costs and effects highlighted the need to specify an appropriate perspective and address policy-related issues of affordability and sustainability. Key informant interviews also revealed that opinion-makers, international organizations and the presence of local vaccine manufacturing have significant influence on decision-making. It is suggested that CEA could be more useful with a broadened reference case framework that included multiple perspectives, sensitivity analysis exploring differential discount rates (upper limits exceeding 10% for costs, declining from 3% for benefits) and supplemental reports to aid decision-making (budgetary and sustainability assessments). This study has implications for improving health outcomes globally in the context of public-private collaborative health funding. Further research could explore defining an extra-societal (multi-country) perspective to aid in efficient allocation of immunization resources among countries.

Developing countries face imminent choices for introducing needed, effective but expensive new vaccines, given the substantial immunization resources now available from international donors. Cost-effectiveness analysis (CEA) is a tool that decision-makers can use for efficiently allocating expanding resources. However, although CEA has been increasingly applied in developing-country settings since the 1990’s, its use lags behind that in industrialized countries. This thesis explored how CEA could be made more relevant for decision-making in developing countries through 1) identifying the limitations for using CEA in developing countries 2) identifying guidelines for CEA specific to developing countries 3) identifying the impact of donor funding on CEA estimation 4) identifying areas for enhancement in the 1996 “Reference Case” (a standard set of methods) recommended by the US Panel on Cost-Effectiveness in Health and Medicine, and 5) better understanding the decision-making environment in developing countries. Focusing on pediatric immunization in developing countries, thematic analysis was used to distill key concepts from 157 documents spanning health economics, clinical epidemiology and health financing. 11 key informants, researchers active in developing countries, were also interviewed to explore the production and use of evidence in public health decision-making. Results showed a divergence between industrialized and developing nations in the emphases of methodological difficulties, in the general application of CEA, and the types of guidelines available. Explicitly considering donor funding costs and effects highlighted the need to specify an appropriate perspective and address policy-related issues of affordability and sustainability. Key informant interviews also revealed that opinion-makers, international organizations and the presence of local vaccine manufacturing have significant influence on decision-making. It is suggested that CEA could be more useful with a broadened reference case framework that included multiple perspectives, sensitivity analysis exploring differential discount rates (upper limits exceeding 10% for costs, declining from 3% for benefits) and supplemental reports to aid decision-making (budgetary and sustainability assessments). This study has implications for improving health outcomes globally in the context of public-private collaborative health funding. Further research could explore defining an extra-societal (multi-country) perspective to aid in efficient allocation of immunization resources among countries.

BACKGROUND: Nova Scotia has the highest rate of cervical cancer, predominantly attributed to the Human Papillomavirus (HPV). In 2007, the HPV vaccine was approved and a successful school-based program was implemented. Little is known however, which strategies used by public health nurses (PHNs) helps improve vaccine uptake. METHODS: A retrospective, exploratory correlation study examined the relationship between school-based PHN strategies, and uptake of HPV vaccine. RESULTS: HPV vaccine initiation was significantly associated with PHNs providing reminder calls for: consent return (p = .017) and missed school clinic (p = .004); HPV education to teachers (p < .001), and a thank-you to teachers (p < .001). Completion of the HPV series was associated with consents being returned to the students' teacher (p = .003), and a PHN being assigned to a school (p = .025). CONCLUSIONS: These findings will help guide PHN’s best practice for optimal uptake of the HPV vaccine.

Background: Unmitigated immunization pain in infants has the potential to impact long-term health outcomes. Teaching parents in the prenatal period may increase utilization of pain management (PM) strategies in clinical practice. Objective: To assess the efficaciousness of teaching parents in the prenatal environment and its impact on the number of analgesic PM strategies utilized during the 2-month immunization appointment. Methods: This partially blinded cluster randomized controlled trial enrolled mothers from prenatal classes at Mount Sinai Hospital. Classes were randomized to receive a presentation on either immunization PM or general immunization information. Results: One hundred and ninety-seven mothers from 28 classes participated in this study. There was a statistically significant increase (p<0.01) in the use of one or more analgesic interventions in the group that received a presentation on immunization PM compared to those who received general immunization information. Conclusions: Prenatal classes are a suitable environment to educate parents about immunization PM.

Background: Unmitigated immunization pain in infants has the potential to impact long-term health outcomes. Teaching parents in the prenatal period may increase utilization of pain management (PM) strategies in clinical practice. Objective: To assess the efficaciousness of teaching parents in the prenatal environment and its impact on the number of analgesic PM strategies utilized during the 2-month immunization appointment. Methods: This partially blinded cluster randomized controlled trial enrolled mothers from prenatal classes at Mount Sinai Hospital. Classes were randomized to receive a presentation on either immunization PM or general immunization information. Results: One hundred and ninety-seven mothers from 28 classes participated in this study. There was a statistically significant increase (p<0.01) in the use of one or more analgesic interventions in the group that received a presentation on immunization PM compared to those who received general immunization information. Conclusions: Prenatal classes are a suitable environment to educate parents about immunization PM.

Thesis (Ph.D.)--University of Tasmania, 2003. / Includes bibliographical references.

Thesis (M.P.H.M.)--Mahidol University, 1999.