Modern immunization’s role in health systems is threefold: it is simultaneously a pharmaceutical product, a personal health care intervention, and a public health measure, each constituting a distinct, yet overlapping set of governance arrangements. This thesis examines immunization policy change and governance at the federal-provincial interface over the last decade (1997-2008) in Canada, situated against broader trends in public policy and public health. The research is based upon a case study design and a discursive approach to policy analysis, using documentary sources, supplemented with archival information, direct observations, and decision-maker informants. Over time, structures and instruments used to deal with immunization at the federal-provincial interface have undergone adaptation. New decision-making structures include the Public Health Agency of Canada and the Pan-Canadian Public Health Network; new instruments include the National Immunization Strategy, accompanied by targeted federal funding. Consistent with other sectors, however, the decade also witnessed an ongoing emphasis on fiscal prudence, risk-based regulation, and informal networks to accomplish policy goals. This thesis concludes that effective federal governance and lasting policy change for immunization requires resolution of two major tensions in the policy ideas underlying national processes. First, the interpretation of federal authority over matters of national concern remains ambiguous. While the National Immunization Strategy reflected dominant ideas around equitable access to vaccines and a broad conception of the federal sharing community, persistent gaps, particularly linking national-level decisions, financing, and delivery, have reinforced the existing notion of the appropriate degree of federal influence for immunization, rather than expanding it. Second, an increasing focus on personal security dimensions of immunization amid structural changes intended to address public security concerns is in tension with a situation that predisposes the state to avoid an unjust application of compulsory measures rather than to protect from harm those individuals who consent freely to immunization. Immunization in Canada requires a new paradigm that expands the notion of the state’s role in prevention as it applies to immunization, that addresses specific needs for protection in the life of the individual, and that reasserts the importance of strong, substantive, and sustained federal contributions to matters of national concern.

This dissertation considers the economics of public health in the context of respiratory disease, a leading cause of morbidity and mortality. The pervasive nature of respiratory illness represents a significant reduction to health and longevity, but private actions to prevent illness may not consider the full-scale benefit of societal health improvement. In this thesis, I consider two determinants of respiratory illness: (1) the spread of influenza disease and (2) air pollution. In both cases, public policy aims to attenuate the effects of these factors by incentivizing or mandating preventative action. Because such interventions come at a cost, it is important to consider the magnitude of benefits associated with these actions. I consider each determinant in turn. First, I provide causal evidence on the health and economic consequences of an ongoing broad-scope vaccination program. The Ontario Influenza Immunization Campaign expanded the scope of vaccine coverage leading to a 20-percent increase in vaccination. Using the timing of this campaign and exogenous variation in vaccine quality, I link higher vaccination rates to decreases in lost-work-time, hospitalization, and death. Results indicate that, when vaccine quality is high, the program leads to higher gains for Ontario relative to other provinces and in short, an ounce of prevention is worth a pound of cure. Second, I provide evidence of the impact of air pollution on respiratory health. Recent changes in standards for air pollution are highly contentious and represent stringent constraints on economic activity. Evidence from this dissertation directly informs this debate. By linking daily pollution to hospital admissions for municipalities across Ontario, I study the impact of air pollution at levels below those historically considered. Results indicate that particulate matter has a significant effect on respiratory health of children but that ozone and carbon monoxide have little effect on respiratory hospitalizations for all age groups.

While the majority of school-aged children associate immunizations with low levels of anxiety, fear, and pain, there is a small subset for whom needles are highly distressing (Humphrey, et al., 1992). Poorly managed, these individuals may come to avoid medical treatment (Ollendick, King, & Muris, 2002). Using Lazarus and Folkmans (1984) transactional theory of coping and Reid and colleagues (1998) development and validation of the Pain Coping Questionnaire as frameworks, the present program of research elaborated on existing knowledge about how children cope with needles. As part of Studies 1 (N = 176) and 2 (N = 302), a Coping with Needles Questionnaire (CNQ) was developed and validated; both two- and three-subscale versions of the questionnaire were examined. The resulting CNQ was composed of and scored as two separate subscales: problem-focused and emotion-focused coping. Construct validity testing demonstrated that emotion-focused coping was robustly associated with more negative experience with needles (i.e., higher anxiety, fear, pain, and lower self-efficacy). There was no main effect of problem-focused coping but it tended to moderate the negative effect of emotion-focused coping when the two interacted. Study 3 (N = 78) was designed to investigate (1) the percentage of participants who are high on only one type of coping (i.e., dominant copers) and (2) how coping responses change over time in response to repeated presentations of the same stressor. Presently there are gaps in the existing literature regarding these two targeted areas of investigation. Results of this investigation indicated that most children engage in high amounts of both problem- and emotion-focused coping when initially queried about their experience with an immunization, with approximately 30% showing a pattern of coping dominance. When participants were followed and queried about a second experience with immunization, it was found that most of them engaged in low amounts of both types of coping. This pattern of change in the distribution of coping over time was not consistent with learning effects. In other words, participants did not seem to improve their coping with experience. However, lack of a clearly positive type of coping and a six-month time-lag may have inhibited the potential for learning to occur. The utility of the CNQ for screening purposes and implications of these findings for interventions are discussed.

Globalization has brought health concerns to the forefront. Moreover, governments, policymakers, and health officials are paying more attention to these health concerns. With the increased cross-national interaction, diseases have more pathways to spread than ever. As countries attempt to ensure access to care and control health expenditure, monitoring and improving the quality of health care is a pressing issue. This paper uses linear regressions to analyze the relationship between prevention and public health expenditure and the rate of measles immunizations in member countries of the Organisation of Economic Co-operation and Development (OECD). There is a weak negative relationship between the expenditure and rates of measles immunizations for both private and public expenditure data, suggesting that the higher the expenditure the lower the rates of measles immunizations. Several possible reasons for this phenomenon is discussed in conjunction with the role of health educators as it relates to the use of theory based interventions to improve rates of measles immunizations.

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Thesis (M.A.)--York University, 2008. Graduate Programme in Higher Education. / Typescript. Includes bibliographical references (leaves 33-37). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR45942

Thesis (M.A.)--East Carolina University, 2009. / Presented to the faculty of the Department of Health Education and Promotion. Advisor: Sharon M. Knight. Title from PDF t.p. (viewed May 4, 2010). Includes bibliographical references.

Thesis (M.A.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains v, 41 p. Vita. Includes abstract. Includes bibliographical references (p. 23-28).

The World Health Organization (WHO) recommends childhood immunization as one of the necessary preventive health measures to reduce the chance of contracting infectious diseases in children. Despite the proven benefits, immunization is associated with pain and management of immunization-induced pain has been neglected in current local practice. Administration of oral sucrose is found to be an effective pain-relieving intervention during routine immunizations as evidenced by seven systematic reviews. This simple intervention is encouraged to be carried out during routine immunizations in community settings such as Maternal and Child Health Centres in Hong Kong. Evidence-based practice guidelines and implementation plans are set up in carrying out the new practice. Stakeholders are identified with communication strategies noted. In addition, pilot testing and evaluation are also necessary to improve the new practice. It is expected that the implementation of the intervention can bring about obvious positive outcomes for infants, parents, nurses and the health care system by means of reducing infants’ pain and distress during routine immunizations. / published_or_final_version / Nursing Studies / Master / Master of Nursing

One thousand Holstein-Friesian heifer calves were studied to evaluate the effects of colostrum-derived 24 to 48 h serum Ig concentrations on growth and survival. The rate of growth increased as 24 to 48 h serum Ig concentrations increased. Calves born to first-calf heifers had higher 24 to 48 h serum Ig concentrations and gained weight at a higher rate of gain than heifers born to 3-year-old and older cows. The concentration of serum Ig at 24 to 48 h in the dairy heifer is a significant source of variation affecting average daily gain through the first 180 d of life. Seasonal factors were also significant in influencing rate of gain from birth to 6 months. Age of dam was a significant source of variation in calf weight gains, but only for the first 35 d of life. Approximately 28% of the calves absorbed less than 12 mg/ml of maternally-derived antibody. Heifers in this category suffered a death loss of 6.78% compared to only a 2.59% loss for heifers absorbing greater than 40 mg/ml Ig. Both season and age of dam were significant in affecting the concentration of 24 to 48 h serum Ig acquired. Forty-nine percent of the variation in 35 d serum Ig can be attributed to the variation found at 24 to 48 h. The data presented here indicate that proper management of factors influencing the absorption of colostral immunoglobulins by the neonatal dairy heifer would enhance the replacement rearing program.