The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were 60 days of age or older at time of discharge. This is a descriptive pilot study utilizing retrospective paper chart review. The relationships between immunization status and study variables were examined using logistic regression. Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were up to date for immunizations in accordance with AAP recommendations. Additional variables were not significant. Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status.

Background: Rotavirus disease is the leading global cause of severe diarrhea in children under 5 years. We examined the association between different rotavirus vaccines doses and severity of diarrhea. Methods: A secondary analysis of surveillance of children with acute gastroenteritis (AGE) symptoms during two seasons (January-June) in 2010 and 2011 from three pediatric hospitals in Atlanta, Georgia was conducted. Enrolled children were tested for rotavirus, using EIA (Rotaclone) and vaccination records were collected from the state immunization registry and healthcare providers. Cases were defined as any enrolled child who tested positive for rotavirus. Each enrolled child was assigned a Vesikari score to assess AGE severity. Results: 63.9% of participants had severe AGE. Cases were more likely to have severe AGE than controls (OR 3.8, 95% CI: 2.2-6.5). Receiving a mixed vaccine regimen had similar protection against severe disease to receiving only RotaTeq® or Rotarix® (Mixed: OR 0.1, 95% CI: 0.02-0.5; RotaTeq®: OR 0.1, 95% CI: 0.02-0.5; Rotarix®: OR 0.1; 95% CI 0.01-0.3). When controlling for vaccine type and demographic covariates, three doses of vaccine offered significant protection against severe disease (OR 0.3, 95% CI: 0.2-0.6). Conclusions: Receiving a mixed regimen of rotavirus vaccine is effective in preventing severe AGE. Mixed rotavirus vaccine regimens were equally efficacious to receiving a single type of vaccine in preventing severe disease. Three doses of vaccine, regardless of type, were effective in preventing severe disease but one or two doses were not.

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Rates and coverage levels of immunizations of African-American children are reduced compared to other races. Few studies have identified factors that influence vaccination decisions of African-American mothers. This study assessed the mothers' vaccination decisions using a self-administered questionnaire and a screening instrument for determining health literacy. This instrument is called Rapid Estimate of Adult Literacy in Medicine (REALM). The sample was 92 African American mothers, recruited from a large metropolitan church in Jacksonville, Florida, who had at least one child under the age of seven. A cross-sectional research design was used to administer survey instruments to identify and interpret parental barriers and decision-making regarding childhood vaccination. The results of this study showed that the there was a decrease in scores across the levels of education which indicated that education had a significant impact on the parental perception for the vaccination of their children. Interventions can now be tailored to improve the childhood immunization rates and provide a foundation for developing effective childhood vaccination educational materials for this population.

There is a growing body of research on interventions to decrease infant distress during painful procedures, and distraction is a particularly practical option. However, the effectiveness data for distraction for infant pain relief are mixed. Inconsistencies in response to distraction might be explained by unique characteristics of the infant patient. Some researchers argue that temperament is the best predictor of differences observed between individuals and also the most sensitive to novel environmental factors such as exposure to pain. This study examined whether infants’ temperament is predictive of response to immunization injection pain and whether temperament moderates the relation between a distraction intervention and infant distress. Data for this study came from two prior studies of healthy infants receiving immunizations (Cohen, 2002; Cohen et al., 2006). Participants included 252 healthy infants and toddlers who ranged from 1 to 22 months of age. Infants were randomly assigned to “typical care” condition or “distraction” condition. The period of time before, during, and after the injection was videotaped and observational coding was used to assess infant distress. Prior to the immunization, parents completed six pre-injection visual analogue scales about their child’s temperament. An oblique rotation factor analysis was conducted with the temperament data and provided two temperament factors that map onto the ‘easy/difficult’ and ‘time-to-warm-up’ dimensions documented in the literature; these two factors were used for analyses. After controlling for site and gender, regression analyses revealed that neither easy/difficult temperament (p = .098, b = .109) nor time-to-warm-up temperament (p = .572, b = -.037) was predictive of distress. There was a significant treatment condition and time-to-warm-up temperament interaction, b = .0011, SE = .0005, p = .0254, such that distraction decreased distress in infants that were slower to warm up, or warmed up neither slowly nor quickly. No other significant distraction x temperament interactions were found. Temperament was not found to impact infant distress during immunizations in this study but results speaking to whether temperament serves as a moderator of the relation between distraction and distress were mixed. Results suggest that temperament is a factor that warrants closer attention when examining how infants respond to interventions around pain.

Class of 2013 Abstract / Specific Aims: The objective of this study was to examine the availability of immunizations in community pharmacies and the out-of-pocket cost for those immunizations. Methods: Twelve community pharmacies in the Tucson area were examined and one pharmacist in each store was asked to complete a questionnaire. This questionnaire aimed to determine individual immunizations offered at each pharmacy and the out-of-pocket cost for those immunizations. Main Results: Differences in the availability and cost of immunizations were compiled for each category of community pharmacy. The categories included Supermarket/grocery store, chain, Mass merchant/big box, and independent pharmacy. Seven of the twelve (58%) pharmacies included in the analysis participated in pharmacist-based immunizations. Three out of the four (75%) supermarket based pharmacies, both chain pharmacies, and two of the four (50%) mass merchant pharmacies, provided immunizations. Neither of the independent pharmacies included in the analysis provided immunizations. The pharmacies that did not currently provide immunizations, none had plans in the future to provide immunizations. There were no other non-prescription immunizations provided at the pharmacies in the study. All seven pharmacies that provided immunization services stated they would accept insurance and only one of the chain pharmacies had a walk in clinic. Conclusion: Overall this study demonstrated that there are differences associated with cost and availability of immunization services offered between pharmacies. Further research is needed to determine what hinders community pharmacy from offering immunization services and how to develop a form of commonality between all immunizations offered.

Amish communities have persistently low childhood immunization rates. Prior to this study, reasons for low rates had not been clearly identified. Researchers have speculated that access to health care, religious factors, and fear might be reasons that Amish parents refuse childhood immunizations, but more empirical evidence was warranted.The purpose of this study was to gather that empirical evidence regarding the knowledge, attitudes, opinions, and beliefs of Amish parents residing in Ashtabula County Ohio, an additional purpose was to examine how these factors influence timely immunizations of Amish children. The theoretical framework was the PEN-3-Cultural Model, focusing on cultural influences, beliefs, and experiences in health behavior of individuals in a community. The development of a 20 question survey was guided by 4 research questions designed to evaluate any differences in Amish parents' decision to defer recommended childhood immunizations. Multivariate analysis of variance was used to evaluate the 4 research questions based on the 84 individual surveys received. Results revealed a significant link between knowledge, beliefs, and opinions toward immunization and immunization adherence. Results also revealed that age and gender had no effect on the relationship between knowledge, beliefs, attitudes, and opinions toward immunization adherence. This study contributes to positive social change by educating parents of Amish children as to why it is important to receive timely childhood immunizations; thereby, keeping their children safe from vaccine-preventable diseases.

The purpose of this study was to investigate how routine, day-to-day public health nursing (PHN) practice in one BC health authority affected health outcomes related to breastfeeding initiation and duration, infant immunizations, and household tobacco use within the population of perinatal women who were a high priority for additional and ongoing PHN services. Using administrative data from the integrated public health information system (iPHIS), outcomes for the priority population were compared to those of the general population of new mothers receiving usual PHN services. Additionally, through semi-structured interviews with PHNs, this study explored how the context of the work environment influenced PHN practice, and ultimately the achievement of those outcomes. Based on a philosophical foundation of critical realism, and a theoretical framework of critical caring, a mixed methods case study design was used to study PHN practice, as it existed day-to-day, amidst the array of ever changing organizational influences. Results from the statistical analysis of administrative data and thematic analysis of PHN interviews and organizational guiding documents, showed that priority women, who received five or more postnatal contacts from PHNs initiated breastfeeding in higher proportions than non-priority women, and continued breastfeeding to 18 months in the same proportion as non-priority mothers. Rates of breastfeeding duration for priority women were higher than expected based on current literature. Children of priority mothers were fully immunized in a slightly higher, but not significantly different proportion than children of the non-priority population, also at rates higher than expected. Although high rates of household tobacco use among this group of priority women did not appear to be influenced by PHN contact, the relationships that developed between priority women and PHNs suggest that organizational support for tobacco cessation activities may be a missed opportunity. Thematic analysis of PHN interviews and guiding documents provided background context and clarification for the kinds of organizational factors and underlying mechanisms that may have influenced the ability of PHNs to provide additional and ongoing support to priority perinatal women in achieving these three outcomes of interest. Finally, the theory of critical caring was verified and extended through the experiences and explanations of PHNs, with the addition of “navigating organizational complexity” to the original seven carative health promoting processes. / Graduate

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