Darbo tikslas: Nustatyti Vilniaus miesto poliklinikų pacientų požiūrį į vakcinaciją. Darbo uždaviniai: 1. Įvertinti pacientų požiūrį į vakcinacijos saugumą, naudą, veiksmingumą, vaikų skiepijimų kalendorių. 2. Įvertinti pacientų požiūrį ir žinias apie vakcinaciją nuo: gripo, pneumokokinės infekcijos, žmogaus papilomos viruso infekcijos, difterijos, stabligės. 3. Nustatyti pacientų informacijos apie skiepus šaltinius bei informacijos pakankamumą. 4. Įvertinti veiksnius galinčius turėti įtakos pacientų požiūriui į vakcinaciją. Metodai: Tyrimas atliktas anoniminės anketinės apklausos būdu, anketas užpildė 593 respondentai. Duomenų analizei naudoti neparametriniai testai ir logistinė regresija. Statistinė duomenų analizė atlikta SPSS 16.0, WinPepi kompiuterinėmis programomis. Rezultatai: 57,1 % respondentų sutiko su teiginiu, kad skiepai yra saugūs, 60,4 % - jog duoda žymiai daugiau naudos nei žalos, 61,5 % - jog yra efektyvūs. 84,5 % sutiko, kad skiepyti vaikus reikia pagal nustatytą vaikų skiepijimo kalendorių, 95,4 % tėvų vaikai buvo paskiepyti pagal jį. Kad gripas yra pavojinga infekcija sutiko 85,4 % pacientų. Kad skiepyti reikia 65 metų ir vyresnius sutiko 43,7 %, suaugusius bei bet kuriuo amžiaus vaikus, kurie serga lėtinėmis ligomis – 51,9 %, moteris, kurios gripo sezono metu bus nėščios – 32,4 %, asmenis, kurie gyvena kartu su sergančiais lėtinėmis ligomis bei 4 metų vaikais – 58,0 % dalyvių. Kad vakcinos nuo gripo yra saugios sutiko 48,5 %, o kad efektyvios – 51,0 %... [toliau žr. visą tekstą] / Goal of the paper work: Identification of the attitude to vaccination of patients in the outpatient clinics of Vilnius. Tasks of the paper work are as follows: 1. Evaluate the attitude of the patients to safety, benefit, efficiency of vaccination, and the calendar of children’s vaccination. 2. Evaluate the attitude of the patients to vaccination against: flu, pneumococcal infection, human papillomavirus infection, diphtheria, tetanus. 3. Establish sufficiency of information sources of the patients about vaccination and information. 4. Evaluate the factors capable to have influence on the attitude of the patients to vaccination. Methods: The research was conducted by using an anonymous questionnaire, which had been completed by 593 respondents. The data analysis was done by using non-parametric tests and logistic regression. The statistic data analysis was done by using software SPSS 16.0, WinPepi. Results: 57,1 % of the respondents have agreed with the statement that vaccinations are safe, 60,4 % think that they are more useful than harmful, and 61,5 % - they are effective. 84,5 % have agreed that children must be vaccinated in accordance with an established calendar of children’s vaccination and 95,4 % of the children of parents have been vaccinated in accordance to it. 85,4 % of the patents think that flue is a dangerous infection. 43,7 % have agreed that it is required to vaccinate persons of 65 years old and older, 51,9 % - that children of any age who has chronic... [to full text]

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The world continues to face outbreaks of disease due to natural causes as well as the threat of biological warfare. Mathematical modeling provides an avenue by which to predict and ultimately prevent widespread outbreaks. A wide variety of modeling tools have been used in the study of the spread of diseases, including Ordinary Differential Equations, Partial Differential Equations, and Difference Equations. In this study, an agent-based model is used to study the spread and control of epidemics and is based on Sirakoulis, et al. [1]. The computer program NetLogo [2] is used for simulation. The development and set-up procedures for this model are fully discussed. The model is used to study the effectiveness of vaccination and quarantine as methods of epidemic control. It is determined that the most effective means of controlling an epidemic is to quarantine individuals with symptoms. In addition, the effect of the adjacent contact coefficient in the model is examined and further development and uses of the model are discussed.

La vaccination figure parmi les interventions sanitaires les plus efficaces et les plus rentables connues. Pourtant, des inégalités de couverture persistent entre les régions et les pays. Les interventions visant à améliorer la couverture vaccinale sont généralement regroupées soit comme interventions pour améliorer l’offre ou la prestation des services de santé, soit comme interventions pour stimuler la demande pour les services de vaccination. L’objectif de cette étude est d’évaluer si les interventions du côté de la demande qui visent à améliorer la couverture vaccinale peuvent accroître la vaccination de routine des enfants dans les pays en développement. Nous avons effectué une revue systématique et une méta-analyse des essais randomisés contrôlés ainsi que d’autres types d’études scientifiques réalisées dans des pays en développement. La population ciblée comprenait les parents et les gardiens d'enfants de moins de deux ans qui sont exposés à une intervention visant à accroître la demande de vaccination de routine des enfants. La recherche des études originales dans les différentes bases de données a été limitée aux études publiées avant septembre 2013 (dernière mise à jour le 25 Mars 2014) dans 6 langues. Onze études ont été sélectionnées puis classifiées dans deux catégories: (a) éducation ou transfert de connaissances (7 études) et (b) incitations (4 études). Les résultats de la métaanalyse ont démontré un impact positif des interventions sur la demande de vaccination des enfants dans les pays en développement (RR 1.30; 95% CI 1.17, 1.44). Ces impacts positifs ont été constatés autant pour les interventions qui comprennent l’éducation ou transfert de connaissances (RR 1.40; 95% CI1.20, 1.63) que pour les interventions de type incitation (RR 1.28; 95% CI 1.12, 1.45). Les résultats suggèrent que diverses stratégies visant à accroître la demande peuvent conduire à une augmentation de la couverture vaccinale dans différents pays en développement. / Vaccination is one of the most cost effective health interventions known. However, inequalities of the vaccination coverage persist between regions and countries. The interventions to improve the vaccination coverage are usually grouped either as interventions to improve the supply or the delivery of health services, or as interventions to stimulate the demand for immunization services. The objective of this study is to evaluate whether demand-side interventions can increase routine immunization of children in developing countries. We conducted a systematic review and a meta-analysis of randomized controlled trials and other types of scientific studies conducted in developing countries. The targeted population consisted of parents and guardians of children under two years of age which are exposed to an intervention designed to increase demand for routine immunization of children. Research studies in different databases were restricted to primary studies published before September 2013 (last update on March 25th, 2014) in 6 languages. Eleven studies were selected and classified into two categories: (1) education and knowledge transfer (7 studies) and (2) incentives (4 studies). The results of the meta-analysis demonstrated a positive impact of demand-side intervention for vaccination of children in developing countries (RR 1.30, 95% CI 1.17, 1.44). These positive impacts were found as well in the interventions that include education and knowledge transfer (RR 1.40, 95% CI1.20, 1.63) that in the interventions using incentives (RR 1.28, 95% CI 1.12, 1.45). The results suggest that strategies to increase demand are effective in improving uptake of childhood vaccines in developing countries.

Complex patterns of HCV infection are increasingly reported, particularly in highly exposed individuals, with multiple and variable subtype profiles seen in many chronic patients. This study aims to address some of the questions arising from this increasingly diverse and dynamic picture, both within hosts and at a population level. In Chapter 2 I find evidence for a highly dynamic infection profile in acute HCV, both in terms of viral load and the dominant subtype. I extrapolate these observations from individual patients to formulate a model of HCV transmission across a high-risk population in order to predict the impact of current and anticipated interventions in Chapters 3 and 4. I show that antiviral therapy and a putative vaccination can still have a significant impact on HCV prevalence at the population level, even when the latter offers only partial protection and in the epidemiological background of ongoing exposure. Thus, in an epidemic with more than one circulating strain it will be crucial for any individual or combination of interventions to target all variants present. In Chapter 5 I demonstrate that early viral load kinetics of patients initiating treatment are indicative of treatment outcome. Strain differences are also evident in the virologic response to treatment with hard-to-treat genotype 1 exhibiting a slower rate of viral load decline than genotypes 2 and 3.

The public health problem of ensuring that teens and preteens receive the HPV vaccination series justified this study, using a convenience sample (N=122) of parents, 68 of whom were English-speaking parents (ESP) and 54 were Spanish-speaking parents (SSP). Among ESP, 94.1% (n=64) were females and 5.9% (n=4) were males. Among SSP, 98.1% (n=53) were females and 1.9% (n=1) was male. The mean age for ESP (n=68) was 41.16 years (min=27, max=72, SD=6.72). The mean age for SSP (n=54) was 38.72 years (min=26, max=55, SD =7.31). About 44.1% (n=30) of ESP were Hispanic/ Latino, and 98.1% (n=53) of SSP were Hispanic/Latino. Using backward stepwise regression analysis, in the whole sample (N=122), significant predictors of parents being in an action or maintenance stage for making sure their children received the HPV vaccination was predicted by: if child had received HPV vaccination (β=1.714, SEB=.599, p=.000) and yearly household income (β=.142, SEB=.200, p=.007) in a model accounting for 40.5% of the variance (R2=.420, AdjR2=.405). This study determined that a linguistically and culturally tailored (i.e., in English or Spanish) video on HPV and HPV vaccination of preteens and teens served as a brief online e-health intervention that was associated with significant parental movement across the stages of change (i.e., from precontemplation or contemplation stage, to preparation stage) and increased self-efficacy for three key behaviors: (1) talking to a pediatrician or family practice medical provider about the Human papillomavirus (HPV) infection and the HPV vaccination for children; (2) making sure their preteen and teen children receive the HPV vaccination; and (3) making sure their preteen and teen children receive all required doses (e.g., at least two or three doses) of the HPV vaccination. Also, 89.5% (n=17) of healthcare providers recommended the video. Qualitative data produced themes for recommending the video and improving it. Recommendations for an evaluation of the video intervention using a nationally representative sample are advanced, along with implications for widely disseminating and evaluating a new evidence-based approach codified in the video.

Attitudes and beliefs on HPV infection and vaccination II Veronika Regnerová, PharmDr. Eva Zimčíková, Ph.D. Background: Cervical cancer is the second most common type of cancer in women. The majority of cervical cancer cases are caused by human papillomavirus (HPV). Three vaccines have been approved to prevent HPV infection and related diseases. Objectives: The study aimed to analyse the knowledge and attitudes regarding HPV, cervical cancer and HPV vaccination in secondary school students in the Czech Republic. Methods: The study was carried out in May 2017 at four secondary schools. A questionnaire used for data collection comprised 15 items including questions on demographic characteristics, knowledge about cervical cancer and HPV, vaccination coverage, HPV perceived susceptibility and seriousness, and beliefs on HVP vaccination. Results: A total of 667 students participated (mean age: 16.8 y ± 1.18; 63% female); 20.5% were smokers, 24.7% God believers. Most of the students (97.0%) heard about cervical cancer and penile cancer, significant proportion (68.3%) knew HPV was the causative factor. Half of the respondents (49.9%) have heard about vaccination against HPV. Among cervical cancer risk factors HPV infection was reported in 58.1% cases followed by promiscuity (14.5%), irregular...

Orientador: Edison Iglesias de Oliveira Vidal / Resumo: Introdução: O Streptococcus Pneumoniae é o agente infeccioso mais frequentemente associado à ocorrência de pneumonia bacteriana e a vacinação é considerada a principal estratégia para a prevenção dessa doença. De acordo com o Programa Nacional de Imunização (PNI) a vacina pneumocócica polissacarídica 23-valente (Pn23) não faz parte do calendário básico de vacinação e deve ser dispensada a indivíduos a partir de 2 anos de idade desde que portadores de um conjunto de doenças e condições de alto risco para infecções pneumocócicas. A forma de operacionalização atual do PNI em relação à Pn23 se dá de modo que essa vacina não se encontra disponível nas Unidades Básicas de Saúde (UBS) e sua liberação se dá mediante solicitação aos Centros de Referência em Imunobiológicos Especiais (CRIEs), através de uma ficha de Solicitação de Imunobiológicos Especiais (SIBE). Acredita-se que tal formatação da logística de dispensação da vacina constitui um elemento limitador do acesso da população adulta à mesma. O objetivo da presente pesquisa foi avaliar a efetividade de uma intervenção piloto no município de Jahu de caráter multifatorial sobre a frequência de dispensação da Pn23 para a população adulta com indicação clínica conforme definida pelo PNI. Métodos: A intervenção foi composta por um componente caracterizado pela descentralização do fluxo de dispensação da vacina, de modo que esta passasse a estar disponível diretamente nas UBS, como é feito com as demais vacinas do calendário básico ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Streptococcus Pneumoniae is the infectious agent most commonly associated with bacterial pneumonia and vaccination against it is considered the main strategy to prevent its occurrence. According to the Brazilian National Immunization Program (NIP) the 23-valent pneumococcal polysaccharide vaccine (Pn23) is not part of the country’s basic vaccination program and is recommended only for individuals aged 2 years and older who suffer from a variety of high-risk diseases and conditions for pneumococcal infections. The current operationalization of the NIP regarding the Pn23 vaccine determines that that vaccine is not available at Primary Healthcare Units (PHU) and that its distribution to those units is conditional to the receipt of a special vaccine request form by the regional Reference Centers for Special Immunobiologic Products (RCSIP). We believed that such centralized system of distribution of the Pn23 vaccine constituted a barrier for the eligible adult population to have access the vaccine. The aim of the present study was to assess the effectiveness of a multifactorial intervention on the frequency of use of the Pn23 vaccine among adults of the municipality of Jahu with a clinical indication for the vaccine according to the NIP. Methods: The intervention consisted of the decentralization of the Pn23 vaccine distribution so that doses of that vaccine were made available at each PHU as if it were part of the country’s basic vaccination program. Additionally, t... (Complete abstract click electronic access below) / Mestre

BACKGROUND: Now considered a cornerstone of healthcare, patient-provider communication has long been studied and analyzed. Medical associations such as the Joint Commission and the American Association of Orthopaedic Surgeons (AAOS) have strongly endorsed for physicians to exercise patient-focused communication, a practice that involves showing empathy, involving patients in medical care decisions, eliciting concerns, and educating patients on treatment options (Joint Commission, 2016; AAOS, 2017). A lack of patient-provider communication has previously been identified as a significant factor in adverse medical outcomes occurring within hospitals (Khan et al., 2017). Bridging the communication disparity between patients and providers is crucial to improving overall patient outcome. Primary care providers are especially essential to improving overall patient outcome because they serve as the first point of contact for many patients accessing the healthcare system. While there is much literature on the importance of effective patient-provider communication, few studies provide technology-based tools that can enhance this establishment of communication. Human Papillomavirus is presently the most common sexually transmitted infection (STI) nationwide with 79 million Americans currently infected (CDC, 2017). Approximately 42,700 HPV-attributable cancers are diagnosed in the United States annually, and HPV is believed to be responsible for over 90% of cervical cancer cases (CDC, 2018). The Advisory Committee on Immunization Practices (ACIP) currently recommends three preventative HPV vaccines. Despite high rates of infection, HPV vaccination rates nationwide remain low as coverage of the HPV vaccine falls behind that of coverage for required vaccines like the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) (Reagan-Steiner, 2016). Previous studies have sought to address factors that affect decisions to vaccinate children. An analyzation of the National Immunization Survey of Teens has identified that parents’ belief that the HPV was not necessary as a main factor (Darden et al., 2013). As a result, there is a gap needed to be filled by providers to educate parents on the importance of the HPV vaccine. PURPOSE: The current study sought to determine the effectiveness of a web-based mobile health education program called Wheel of Wellness (WoW) on patient-provider communication, to assess the viability and impact of WoW to increase HPV vaccination rates in age eligible children (boys and girls aged 9-17) and to augment awareness about the benefits of HPV vaccination in both these children and their guardians. RESEARCH METHOD AND DESIGN: As of August 2018, twenty-seven parents of children between the ages of 9 and 17 years of age within the Pediatrics and Adolescent departments of Boston Medical Center (BMC) have been recruited. Parents enrolled in the WoW program to compile a list of concerns to be shown to a provider during their child’s appointment. Participants were asked questions to determine initial knowledge on the HPV vaccine, and their opinions on the HPV vaccine. Following their appointment, participants completed a questionnaire to assess opinions on the WoW program in facilitating communication with their provider on the HPV vaccine and related cancers. Seven physicians were interviewed to assess their views on the WoW program in facilitating communication with their patients on the HPV vaccine and related cancers. RESULTS: Initial stages of this study found that views on the effectiveness of the WoW program in facilitating patient and provider communication on the different aspects of HPV vaccination and affecting parents’ decisions to vaccinate their children were mixed by both patients and their providers. Based on the WoW feedback collected from parents, the system was widely acceptable in terms of ease in usage and with the majority of parents (92%) reporting that the WoW website is helpful for communicating their health concerns with their provider. However, the majority of providers reported having never been presented the WoW system and expressed views that WoW was inefficient as it was a parallel system to existing workflow. This study determined that of the 12 participants who had one dose of the vaccine prior to enrollment, 75% of these participants completed the HPV vaccine series during the study. CONCLUSION: Based on the initiation and completion statistics reported, this shows great potential for the use of the BNI coupled with the WoW system to help improve rates of initiation and completion of HPV vaccination going forward as the intervention may have helped encourage parents to either initiate vaccination or complete their child’s previously started series. Further studies should explore ways of empowering patients to facilitate more communication with their providers and improvements to technology to enhance provider recommendation in order to promote an increase in HPV vaccine completion. / 2021-06-17T00:00:00Z

A dissertation submitted to the Faculty of Medicine, University df the Witwatersrand in fulfilment of the requirements for the degree of Master of Science in Medicine Johannesburg 1992. / The objective of the research reported in this thesis was to describe the vaccination coverage of children aged 12 to 23 months in the Mosvold Health Ward of northern Kwa-Zulu. The Expanded Programme on Immunisation cluster sample technique was used. Simultaneous measurements of the children's weights and arm circumferences were done, and their birthplaces noted. Vaccination coverage rates were generally low; 74 to 83 per cent of the children had had BCG, 47 to 56 per cent had had three doses of DPT, 48 to 57 per cent had had three doses of polio and 47 to 56 per cent had had one dose of measles vaccine. Forty-eight per cent of the children had been born at home. Fifteen per cent had weights which Were more than two standard deviations below the median weight-for-age according to NCHS curves, 11 per cent had arm circumferences of 13,5 centimetres or less. The results are compared with other findings from else Where in southern Africa. Relevant literature on vaccination coverage improvement and the measurement thereof, is reviewed. Recommendations are made for increasing coverage rates in the Mosvold Health Ward) • / MT2017