Problématique : Une évaluation économique, commandée par le ministère de la Santé et des Services sociaux du Québec, vise à évaluer le rendement de deux programmes d'immunisation, soient la vaccination primaire et la vaccination antigrippale. Un des volets de cette étude économique nécessitera l'utilisation d'un questionnaire auto-administré auprès de personnes vaccinées contre l'influenza plusieurs semaines après leur vaccination. Objectif : Vérifier la fiabilité et la validité d'un questionnaire auto-administré sur l'efficacité populationnelle et les coûts assumés lors de la vaccination par les adultes vaccinés contre l'influenza. Cet outil sera utilisé pour une évaluation économique selon une perspective sociétale du programme d'immunisation contre l'influenza chez les adultes. Méthode : Un test-retest a été réalisé en soumettant le questionnaire à un échantillon de convenance de 499 personnes âgées de [supérieur ou égal à]50 ans de la Montérégie. Un premier questionnaire a été administré dans les CLSC en novembre 2004 (test) durant le temps d'attente après l'injection du vaccin. Le deuxième questionnaire a été envoyé 10 semaines plus tard par la poste aux participants en janvier 2005 (retest). Les variables testées sont de nature qualitative (variables sociodémographiques, statut vaccinal, lieu de vaccination, moyen de transport, absence du travail) ou quantitative (date et durée de la vaccination, distance parcourue, revenu annuel, coût du transport, autres coûts). La fiabilité a été évaluée par la comparaison des réponses déclarées entre les deux questionnaires alors que la validité de certaines variables a été évaluée par la comparaison entre les réponses fournies par les participants et des sources de référence. Les principaux tests statistiques utilisés sont: l'accord observé (P[indice inférieur omicron]), le kappa de Cohen ([kappa]) et le coefficient de corrélation intra-classe (CCI). Résultats : Le taux de participation a été de 95%. Les variables sociodémographiques obtiennent un P[indice inférieur omicron] entre les deux questionnaires variant de 82% à 98% et un [kappa] de 0,556 à 0,936. Les autres variables qualitatives affichent un P[indice inférieur omicron] de 89% à 100% mais un [kappa] variant de -0,007 à 0,862. Quant aux variables quantitatives transformées en catégorie, P[indice inférieur omicron] varie de 45% à 100% et [kappa] de 0,031 à 1,000. La divergence entre les indices de concordance [Kappa] et P[indice inférieur omicron] est attribuable aux paradoxes de kappa. Les variables de temps, soient la date de vaccination et la durée de vaccination, présentent une faible fiabilité avec respectivement un P[indice inférieur omicron] de 57% et 49% et un CCI de 0,305 et 0,690. Un grand nombre de réponses manquantes (38%) est constaté pour la variable date de vaccination. La validité des variables sélectionnées (statut vaccinal, lieu et date de vaccination, taille de la ville et moyen de transport) est jugée relativement bonne avec un P[indice inférieur omicron] variant de 58% à presque 100%. Conclusion : À l'exception des variables de temps, le questionnaire est assez fiable. La validité des variables évaluées est bonne. Le taux de participation et l'effectif élevés assurent une puissance statistique adéquate pour les analyses. La participation volontaire des sujets peut être une source de biais de sélection. La fiabilité et la validité étant étroitement liées, elles sont défavorablement influencées par le biais de mémoire. Celui-ci peut être engendré par le délai de réponses entre les deux questionnaires. Malgré tout, ce questionnaire pourra être utilisé dans l'étude économique après quelques modifications.

Bakgrund: Barnets upplevelse av den första vårdkontakten är av stor betydelse, eftersom smärtsamma ingrepp på barn kan medföra problem vid framtida sjukvårdsbesök och kan orsaka långvarig sjukvårdsrädsla. På BVC kan procedurrelaterad smärta förorsakas vid venprovtagning eller vaccination. Exempel på smärtlindringsmetoder vid procedurrelaterad smärta är amning, EMLA och distraktion. Syfte: Studiens syfte var att beskriva BVC-personalens upplevelser av små barns behov av smärtlindring vid vaccination och/eller venprovtagning samt de metoder som användes för smärtlindring. Metod: För att besvara vårt syfte gjorde vi bandinspelade, semistrukturerade intervjuer med 8 personer som arbetar inom BVC med små barn i åldern 3 månader, 1-2 år och 5-6 år. Analys: Intervjutexten analyserades med kvalitativ innehållsanalys (Graneheim & Lundman, 2004). Resultat: Vid analysen framkom följande fyra domäner: Upplevda behov av att smärtlindra barn vid vaccination och Metoder för smärtlindring av barn vid vaccination, Upplevda behov av att smärtlindra barn vid venprovtagning och Metoder för smärtlindring av barn vid venprovtagning. Det framkom vid analysen att det var få som upplevde behov av att smärtlindra små barn vid vaccination, däremot vid venprovtagning var upplevda behov att smärtlindra små barn större. Med barnets stigande ålder använder sig intervjupersonerna av flera olika metoder samtidigt, så som att distrahera eller att använda sig av leksaker. Diskussion: Resultatet jämförs med metoder för smärtlindring som har stöd i forskning. Redan använda metoders verkan bekräftas men förslag på ytterligare smärtlindringsmetoder ges. Med ökad spridning av redan befintlig kunskap, kan BVC- personal med sin lyhördhet bemöta och guida barnet på ett sätt som kan motverka och lindra procedurrelateradsmärta.

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Since the introduction of vaccines, many deaths due to various diseases including measles, have been drastically reduced. In Canada, there is a recommended vaccine schedule for all residents of the country; however, vaccine practises and immunisation schedules can vary from location to location as well as vary from country to country, leading to discrepancies in vaccine coverage and herd immunities. In addition, some anti-vaccination movements have been noted to persuade individuals into refusing vaccines, even in historically well immunised locations. In order to investigate the effect of varying vaccine coverage, a two patch metapopulation model for measles incorporating a single dose vaccine is formulated and studied. / October 2016

Syften med uppsatsen var att ta reda på hur folk som är en del av anti-vaccinationsrörelsen kommunicerar i sociala medier. Uppsatsen undersöker hur de kommunicerar i inlägg och kommentarer i en sluten grupp på Facebook. Med hjälp av ett kodschema så blev 97 inlägg analyserade och placerad i olika kategorier med olika variabler. Utifrån kodschemat blev flera tabeller skapade som visade den mest relevanta faktan. Utifrån den information, och med flera detaljerat beskriva exempel-inlägg, beskrivs den generella stämningen i gruppen och hur de talar med varandra. Resultatet blev att de kommunicerar med varandra på ett vänligt och stöttande sätt, bidrar med relevant information när det frågas efter, men med lite fientlighet visas mot de som kommer med motsatta åsikter. Gruppen var sluten, vilket innebär att bara individer som delar samma åsikter som dem är medverkande på plattformen, vilket också betyder att åsikter blir så gott som aldrig utmanade. / The purpose of this essay has been to figure out how people that are a part of the anti-vaccination movement communicate in social media. The essay explores how they communicate in posts and comments in a closed group on Facebook. With the help of a coding scheme, 97 posts became analysed and placed in different categories with different variables. A couple of tables were created from the code scheme that demonstrated the most relevant facts. From that information, and with several detailed descriptions of example posts, describes the general mode in the group and how they speak with each other. The result was that they communicate with each other in a nice and supporting way, contribute with relevant information when it was asked for, but with some hostility shown towards those who come with opposite views. The group was closed, which means that only individuals who share the same views as them are involved with the platform, which also means that opinions are almost never challenged.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Francisella tularensis is a Gram-negative pathogenic organism that causes the disease tularemia. This disease can be potentially fatal without treatment. Francisella tularensis virulent strains can cause disease in humans with an infectious dose as low as 10 organisms. As a result of this low infectious dose, high mortality, and ease to produce an aerosol inoculum, the Centers for Disease Control and Prevention has classified Francisella tularensis as a Tier I select agent, the highest threat level. Much research has been done to determine the cause for the extreme virulence. However, despite these efforts, little is known about the mechanisms by which Francisella goes undetected inside host cells until it is too late for the host to respond. Researchers in the Jones' laboratory utilized a transposon site hybridization (TraSH) screen with human monocyte derived macrophages (MDMs) as the host cell and an enzyme-linked immunosorbent assay (ELISA) screen of pools of transposon mutants searching for virulence determinants and genes responsible for Francisella capsule or LPS. Through the TraSH screen, our group identified a locus of genes, FTT1236, FTT1237, and FTT1238c as being important for survival within human MDMs. From the mutant library screen using ELISA, I identified the same genes, FTT1236 and FTT1238c. In addition, I also identified wzy, wbtA, FTT0846, and hemH as being involved in LPS and or capsule production. A similar ELISA screen was done by researchers in Apicella laboratory using a different monoclonal antibody that identified insertions in, dnaJ, manB and an intergenic region between FTT0673 and FTT0674c that potentially disrupted LPS and capsule biogenesis. Previously, FTT1236, FTT1237, and FTT1238c mutants were observed by our laboratory to be serum sensitive and activate MDMs by an unknown mechanism. I further characterized these mutant strains by analyzing the changes in the LPS core. I identified core truncations for the FTT1236 and FTT1237 mutants, but not FTT1238c. Combining this new data with previously published work and bioinformatical analysis of the FTT1236, FTT1237 and FTT1238c proteins, I hypothesized that these proteins have functions similar to Waa proteins of other organisms, which are involved in LPS core assembly and O-antigen ligation. With functional complementation and mass spectrometry of LPS preparations, I have designated FTT1236, FTT1237, and FTT1238c as WaaY, WaaZ, and WaaL respectively. In addition to this work characterizing the biochemical functions of these gene products, I examined the effect of mutations in these genes on the virulence of Francisella. In contrast to infection with wild type Schu S4, mice infected either intraperitoneally or intranasally displayed significant inflammatory responses to infection and the strains were significantly attenuated by either route of infection. I also observed that waaY and waaL mutant strains disseminated to the liver and spleen after an intranasal infection despite their lack of O-antigen and capsule. At an i.n. dose of 106 CFU these mutant strains still caused lethal murine infection, but death occurred around day 12 post infection; mice infected with <20 CFU of Schu S4 succumb at day 5 post infection. The cause of the death in mice infected with these mutant strains was pulmonary edema, rather than multiple organ failure induced by Schu S4. Of the additional seven mutant strains identified from the ELISA screens, I characterized their physical phenotypes, virulence defects, and their potential as an attenuated live vaccine. All of these strains were determined to be sensitive to human pooled serum to various degrees. Three of these strains, dnaJ::Tn5, hemH::Tn5, and FTT0673p/prsAp::Tn5 did not have identifiable defects in capsule or LPS biosynthesis, nor were they attenuated in mice. The remaining four strains, FTT0846::Tn5, manB::Tn5, wzy::Tn5, and wbtA::Tn5, were found to have LPS O-antigen and capsule defects, and two of these strains had LPS core defects (FTT0846::Tn5 and manB::Tn5). Each of these four strains was attenuated in mice, when compared to WT. I also tested the ability of mice infected with waaY::TrgTn, waaL::TrgTn, and wbt::Tn5 to be protected from lethal challenges of Schu S4. All three strains provided some level of protection against lethal Schu S4 challenges. In addition, I also tested Francisella LPS and capsule to provide protection against lethal challenges of LVS and Schu S4. I determined that LPS and capsule protected against high doses of LVS, but LPS did not provide any protection when immunized mice were challenged with Schu S4. Interestingly, we observed that mice immunized with capsule were partially protected from lethal Schu S4 challenges. In addition, I observed a novel difference between virulent Francisella strains and LVS, in that virulent strains have O-antigen glycosylated and LVS appears to be lacking this characteristic. Collectively, this work adds to the growing data of the importance of LPS and the role of capsule role in immune evasion as well as the significance of capsule and LPS mutant strains to provide protection against Schu S4.