Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to identify and to identify barriers to influenza vaccinations in veterans. The health belief model was utilized to organize the evidence-based practice data obtain from the literature reviews on the barriers to the influenza vaccine. An Influenza vaccination educational pamphlet was developed using data obtained from the literature reviews. No information was obtained from the veterans. The educational pamphlet listed the identified barriers and ways to overcome the barriers to the influenza vaccination. The influenza vaccination educational pamphlet will be utilized by veterans and staff in the outpatient clinic. The pamphlets will to be placed in the veteran's waiting areas, medication rooms, and lobby areas prior to the beginning of the influenza season at the end of September. The organization's outpatient quarterly influenza data report will be utilized to disseminate the results to the educational tool's effectiveness after implementation at the end of the influenza season in May. The social impact of solving this issue is the opportunity to decrease the major infrastructure demands placed on the healthcare system as well as human suffering caused by influenza.

Vaccinering är näst efter rent vatten den mest framgångsrika åtgärd som gjorts för folkhälsan i världen. Andelen föräldrar som låter vaccinera sina barn i Sverige är hög, men sjukvården har märkt av en ökning av föräldrars behov av att prata om vaccin och en ökad skepticism mot vaccinationer. Tveksamhet och motstånd till vaccination är klassificerat som en av de största riskerna mot global hälsa enligt WHO. Syftet med studien var att sammanställa tidigare forskning gällande orsaker till att föräldrar är skeptiska till att vaccinera sina barn och därmed skapa förståelse för dessa föräldrars behov i det vårdande mötet med sjuksköterskan. För att uppnå syftet gjordes en litteraturöversikt, där tio vetenskapliga artiklar med antingen kvalitativ eller kvantitativ ansats analyserades. Utifrån artiklarna identifierades fyra kategorier och tretton subkategorier. De fyra kategorierna var: oro över vaccinet, föräldrarnas livsstil och synsätt, sociala aspekter samt behovet av information. Föräldrarnas oro handlade ofta om vaccinets innehåll samt dess biverkningar. Vissa ansåg att vaccin var onödigt och onaturligt och kände osäkerhet kring vaccinets effektivitet. Personer i föräldrarnas omgivning samt sociala medier hade också stor betydelse för vaccinationsbeslutet. Vissa föräldrar upplevde en osäkerhet kring vilken information som var trovärdig. Studien visade att anledningarna till att vissa föräldrar avstår att vaccinera sina barn är av varierad art och frågan är således komplex. Studiens resultat skulle kunna ligga till grund för vidare arbete med riktlinjer för sjuksköterskan, med utgångspunkt i de bakomliggande orsakerna till vaccinations-skepticismen. Detta skulle kunna vara ett värdefullt redskap för sjuksköterskan i det vårdande mötet med föräldrarna.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18173号 / 医博第3893号 / 新制||医||1003(附属図書館) / 31031 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 木原 正博, 教授 一山 智 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Bakgrund  Forskning har visat att sjuksköterskor upplever en bristande kunskap vid hantering av stickrädda barn och hur de kan motverka utvecklingen av stickrädsla hos barn. Vaccination är ett tillfälle då sjuksköterskor bland annat ska hantera barns stickrädsla, oförmåga att hantera detta kan leda till att sjuksköterskan känner sig pressad. Vaccinationstillfällen är en stor del av barnets kontakt med sjukvård i början av livet. För att barnet i vuxenålder ska våga söka sjukvård är det viktigt att sjuksköterskan vet hur hon ska bemöta barnet på bästa sätt, hur hon kan hantera och motverka stickrädsla hos barn. Syfte Syftet var att beskriva vilka omvårdnadsåtgärder sjuksköterskan kan tillämpa för att hantera och motverka stickrädsla hos barn vid vaccination. Metod Studien är en icke-systematisk litteraturöversikt där sökningar gjorts i CINAHL och PubMed. För studien valdes 15 artiklar ut och analyserades utifrån induktivt perspektiv.                                                                                                                      Resultat Resultatet visade att centrala områdena vid omvårdnaden är kommunikation och smärtlindring. Vid kommunikationen är det viktigt att individanpassa kommunikationen efter barnets kognitiva förmåga och intresse. Det är viktigt att informera barnet om vad som ska göras och görs samt varför. Resultatet visade att smärtlindring av olika former, så som olika administrationssätt, lokalbedövning samt distraktion, är viktiga för att lindra lidande vid injektioner.  Slutsats Av studien framkom att kommunikation och smärtlindring är de två viktigaste omvårdnadsåtgärder sjuksköterskan kan tillämpa vid vaccination för att hantera och motverka stickrädsla.

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Vaccines are a scientifically proven method of preventing disease. Immunization has eradicated and continues to protect individuals from life-threatening and fatal diseases. However, as a public health measure, trust in efficacy and safety of vaccines has not been unanimous since their inception. Historically, acceptance of vaccination as a method for disease prevention has been debated since development of the smallpox vaccine. Vaccine hesitancy exists on a spectrum with the advent of each new vaccine but has been amplified in the present day COVID-19 pandemic across the United States. Higher vaccination rates have been associated with lower COVID-19 caseload, a miracle for special populations such as pregnant, pediatric, and older patients at higher risk for COVID-19 complications. This thesis seeks to explore, through a bioethical lens, the factors that contribute to the growth of today’s vaccine hesitancy movement. I highlight previous vaccine hesitancy movements and hesitancy today by examining multiple themes present in literature. I argue that describing a patient as an “Anti-Vaxxer” further ostracizes them from the healthcare institution, politicizes a healthcare issue, and generates inequitable healthcare. I use the example of Philadelphia’s own COVID-19 vaccination response through interviews with involved individuals. In terms of solutions, I propose open and persistent conversation between healthcare institutions and community, public education, and structural reform. The key concern of this thesis is to explore how to navigate a complex healthcare ecosystem regarding vaccination and strategies to ensure patient safety while maintaining the bioethical principles of autonomy and agency. / Urban Bioethics

Pulmonary tuberculosis (TB) remains one of the most infectious causes of death worldwide. Mycobacterium tuberculosis (M.tb), the causative agent of TB is transmitted via infectious aerosols, and in the majority of cases the bacteria is effectively controlled, by the host, resulting in a chronic latent infection. Currently, the only available vaccine is the Bacillus Calmette-Guérin (BCG), which despite being successful in preventing childhood disseminated forms of TB, has failed to control the adult pulmonary TB epidemic. One of the major contributing factors in the failure of the BCG is that although antigen-specific T cells are present at the time of M.tb infection, the recruitment of such T cells into the site of infection is significantly delayed. This delay, while reduced compared to non-vaccinated hosts, allows the bacteria to replicate unchecked within the lung and establish a “foothold” prior to the arrival of protective T cells and subsequent immune control. Thus, novel initiatives seek to close this “immunological gap” through increasing the level of protective T cell responses within the airway mucosa immediately following M.tb infection. We therefore investigated the impact of deliberate modulation of T cell geography following BCG vaccination on the outcome of pulmonary M.tb infection. In addition, a number of environmental factors are also thought to affect the site of M.tb infection: the respiratory mucosa. However, little is currently known about the effects of environmental exposure to allergens and other substances such as cigarette smoke on the outcome of pulmonary TB. Throughout this thesis we have investigated the mechanisms of immune protection and failure of protection against pulmonary M.tb infection within the respiratory mucosa. / Thesis / Doctor of Philosophy (Medical Science)

Receiving vaccinations is a part of growing up in the United States; however, as necessary as vaccinations are, many children find the process to be frightening and painful. A review of literature indicates that non-pharmacological interventions, such as distraction, are generally effective in reducing pain and anxiety in children receiving injections. Music has been examined as a potential distraction during pediatric medical procedures, but research findings have been mixed, due, in part, to the way in which music was used: the children were primarily instructed to merely "listen to the music." It has been noted that individuals tend to maintain their attention on music more successfully when they are asked to listen for specific elements. The present study sought to determine if a focus of attention activity (pointing at pictures) involving music would affect levels of distress and perceptions of pain in pediatric injection patients. Sixty-four 4- to 6 1/2-year old children receiving routine immunizations were randomly assigned to one of three conditions: musical story, spoken story, or standard care control. Children in the two treatment conditions listened to a recorded story on headphones and pointed at corresponding pictures before, during, and after their injections. Observational data on distress and pain were collected, in addition to the child's self-rating of pain. Participants in the musical story condition tended to be less distressed and report less pain than participants in the spoken story and control conditions, although these differences were not statistically significant. Subsequent analysis indicated that children who received more injections tended to benefit more from the music intervention, in terms of their perceived pain. Implications of the findings are discussed, along with recommendations for future research in the area.

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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.