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PubMed2004

Integration of child health information systems: current state and local health department efforts.

Public health departments at the state and local levels are pursuing integration strategies to consolidate child health information systems to improve child health. Eighteen health departments were interviewed in this exploratory research study to gather information to describe their current activities related to integrating child health information systems. Results illustrate the common systems being brought together and the technical process for doing so, financing mechanisms, range of anticipated information-users and their method of access to the integrated system, and common internal and external challenges and strengths that the health departments face. The evidence suggests a trend towards more efficient and thoughtful use of the multiplicity of information systems within public health departments as programs consolidate and share data and expand electronic communication with their external partners in the health care delivery system to improve children's health.

Child↗
PubMed2006

Smallpox vaccine injury compensation program: Smallpox (Vaccinia) Vaccine Injury Table. Adoption of interim final rule as final rule with an amendment.

This document adopts the Smallpox (Vaccinia) Vaccine Injury Table (the Table) Interim Final Rule as the Final Rule with an amendment, as follows: the Final Rule clarifies that, in order for the presumption of causation to apply, the time intervals listed on the Table refer specifically to the period in which the first symptom or manifestation of onset of injury must appear following administration of the smallpox vaccine or exposure to vaccinia, and that the time intervals listed have no relevance to time of diagnosis of the injury.

Compensation and Redress↗
PubMed2006

Smallpox Vaccine Injury Compensation Program: administrative implementation. Adoption of interim final rule as final rule with amendments.

This document adopts the Smallpox Vaccine Injury Compensation Program (the Program) Administrative Implementation Interim Final Rule as the Final Rule with amendments, as follows: explains how the term "child" survivor is defined; updates the effective period of the Secretary's Declaration Regarding Administration of Smallpox Countermeasures (the Declaration); corrects an error in Sec. 102.20(d) to clarify that one of the Smallpox (Vaccinia) Vaccine Injury Table requirements to establish a covered Table injury is the first symptom or manifestation of onset of the injury in the Table time period specified; reflects the change in name from the Special Programs Bureau to the Healthcare Systems Bureau; provides the new address of the Bureau's Associate Administrator, and the new address of the Program Office; clarifies that no payments are authorized for fees or costs of personal representatives, including those of attorneys; and corrects a typographical error in Sec. 102.83(c) to make clear that the Secretary determines the timeframe for submission of required documentation.

Compensation and Redress↗
PubMed1994

Childhood immunization availability in primary care practices. Effects of programs providing free vaccines to physicians.

OBJECTIVE: To examine state immunization distribution programs, along with physician practice, training, and attitudinal factors that influence the availability of childhood immunizations in community practices. DESIGN: Multistate survey stratified by rural and urban practice. PARTICIPANTS: Family physicians in community practices in three states that offer free vaccines to physicians for use in Medicaid recipients (n = 287) and three geographically matched states that do not offer free vaccines (n = 266). RESULTS: Physicians practicing in states that offer free vaccines for use in Medicaid populations were more likely to offer immunizations to patients in their practices (92% vs 75%, respectively; P < .001). This difference persisted even after adjusting for other practice variables that are associated with immunization availability. Physicians who did not offer immunizations cited cost factors as the primary reason for not offering this service. Public health departments were used as the referral site for immunization services, but only 59% of the physicians performed follow-up to determine whether patients received immunizations. CONCLUSIONS: State immunization programs that provide vaccines free to physicians are highly associated with practice policies that increase immunization availability.

Child↗
PubMed1994

[Apoptosis (programmed cell death) in the immune system and hemopoiesis].

Apoptosis, or programmed cell death, is a series of controlled sequential events resulting in the demise of cells without evoking an inflammatory response. Although first described 20 years ago, this phenomenon evokes now renewed interest in this phenomenon, particularly in the light of our greater understanding of cellular signalling pathways and their genetic control. This is especially pertinent to haemopoiesis and overall maintenance of a functional immune system.

Animals↗
PubMed2000

Promotional model: a new direction for the National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria.

The National Programme on Immunization (NPI), which was formerly known as the Expanded Program on Immunization (EPI), and Oral Rehydration Therapy (ORT) were relaunched in 1984 after the problems of vaccine supply had been corrected. The aim of the NPI was to protect children against six childhood killer diseases and ORT to rehydrate the dehydrated child caused by diarrhoea. In order to achieve these objectives, a Partner-in-Health strategy was set up to educate, convince and motivate mothers, pregnant women and the community to accept the programme. To assess the effect of the promotional strategy, the government decided to conduct a National Immunization Coverage survey. The results showed that some states were able to reach the target while some were not. The survey also reported that 32% of the reason for immunization failure was due to lack of information and that 9% was lack of motivation. It therefore became necessary to design a promotional model for effective and rapid implementation of the programme. After an evaluation of the promotional strategy set up by the government, a pilot survey was conducted from which nine promotional elements were selected. These promotional elements were regarded as sources of information and motivation. Based on these, a promotional model was set up which stated that promotion depends on consumer information which in turn depends on the extent of interaction between the consumer and the promotional elements. The implication of the model is the need for the formation of a Public Health Organisation with a Public Health Committee at all levels of government.

Attitude to Health↗
PubMed1993

The role of apoptosis (programmed cell death) in haemopoiesis and the immune system.

Apoptosis, or programmed cell death, is a series of controlled sequential events resulting in the demise of cells without invoking an inflammatory response. It is a naturally occurring process which maintains a cellular balance during both animal development and in the mature adult. Although first described 20 years ago, there is now renewed interest in this phenomenon, particularly in the light of our greater understanding of cellular signalling pathways and their genetic control. This is especially pertinent to haemopoiesis and the overall maintenance of a functional immune system. This review broadly covers the biochemical events of apoptosis and the recognition of apoptotic cells by phagocytes. Reference is made to the selective development of T- and B-cells and to the control of inflammation. Molecular events in apoptosis are also discussed with special reference to aberrant bcl-2 gene expression in follicular B-cell lymphoma and the role of other death genes in the control of apoptosis.

Apoptosis↗
PubMed1997

Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: an exploratory study.

Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were randomly assigned to either a 13-week experiential-existential group psychotherapy (EEGP) program or a waiting list control (WLC) condition. Endocrine and immune measures were obtained before and after the intervention period. The findings of this study are that, after the 13 weeks of the experiment, patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells, CD8 cells, and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group. Importantly, this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels, suggesting that the patients' profile with regard to endocrine and immune function at the start of a program can have an important effect. If replicated on a larger scale, the current results may be relevant for the treatment of breast cancer.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[Adult vaccination update].

Vaccination, as a global concept, is the most cost-effective strategy in primary prevention of communicable diseases. One of the bigger difficulties in adult population is to reach the same vaccine coverage as in childhood vaccine programs. In order to solve this deficit, strategies established in the primary level are basic, due the fact that it's the first contact of adult population with health programs. Tertiary level could help to optimize vaccine coverage in specific groups. Active immunization in adults is established evaluating factors as age and gender, but specific circumstances associated with medical conditions, treatments or occupation could extend vaccine administration in adults.

Adult↗
PubMed2005

Activation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system during inflammation and altered programming of the neuroendocrine-immune axis during fetal and neonatal development: lessons learned from the model inflammagen, lipopolysaccharide.

The hypothalamic-pituitary-adrenal axis (HPAA) and autonomic nervous system (ANS) are both activated during inflammation as an elaborate multi-directional communication pathway designed to restore homeostasis, in part, by regulating the inflammatory and subsequent immune response. During fetal and neonatal development programming of the HPAA, ANS and possibly the immune system is influenced by signals from the surrounding environment, as part of an adaptive mechanism to enhance the survival of the offspring. It is currently hypothesized that if this programming is either misguided, or the individual's environment is drastically altered such that neuroendocrine programming becomes maladaptive, it may contribute to the pathogenesis of certain diseases. Current research, suggests that exposure to inflammatory signals during critical windows of early life development may influence the programming of various genes within the neuroendocrine-immune axis. This review will provide, (1) an overview of the HPAA and ANS pathways that are activated during inflammation, highlighting studies that have used lipopolysaccharide as a model inflammagen and, (2) evidence to support the hypothesis that inflammatory stress during fetal and neonatal development can alter programming of the neuroendocrine-immune axis, influencing stress and immune responsiveness, and possibly disease resistance later in life.

Acute-Phase Reaction↗
PubMed1995

Immunization coverage among infants enrolled in the Tennessee Medicaid program.

OBJECTIVES: To determine immunization coverage of infants receiving Medicaid in Tennessee and to identify risk factors for failure to complete recommended vaccinations by 24 months of age. DESIGN: Retrospective cohort study. SUBJECTS: A total of 33,615 children born in one of three urban Tennessee counties from 1980 through 1989 who were enrolled in Medicaid throughout their first 24 months of life. MAIN OUTCOME MEASURES: Receipt of four diphtheria-tetanus-pertussis, three oral polio, and one measles-mumps-rubella vaccines by 24 months of age (up-to-date), as recorded in computerized county immunization records and Medicaid billing files. RESULTS: Overall, 45% of infants enrolled in Medicaid in the three urban counties completed the recommended vaccinations by 24 months. The proportion of infants up-to-date peaked at 50% for those born in 1982 and 1983, and decreased to 44% for those born in 1989. The only strong independent predictors of immunization completion were number of prior births for the mother, timing of the first immunization, and county of birth. The proportion up-to-date was 56% for first-born children compared with 27% for those whose mothers had at least three prior births; 55% for those whose first immunization was on time compared with 22% for those with a delay in the first immunization; and 63%, 52%, and 37% for infants born in the three respective counties. Maternal age, education, race, and marital status predicted immunization completeness only weakly or not at all. CONCLUSIONS: Of infants born in the three counties in the 1980s who were enrolled in the Tennessee Medicaid program, fewer than half completed their recommended childhood vaccinations by 24 months of age. The large differences in immunization levels between infants enrolled in the Medicaid program in the three counties, not accounted for by differences in demographics, suggest that factors related to the health care and vaccine delivery system have important effects on achieving adequate immunization of these infants.

Child, Preschool↗
PubMed1995

Assessment of a universal, school-based hepatitis B vaccination program.

OBJECTIVE: To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992. DESIGN: Cohort study. SETTING: British Columbia, Canada. PARTICIPANTS: All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively. INTERVENTION: The vaccine used was Engerix-B, 20 micrograms, given at intervals of 0, 1, and 6 months. MAIN OUTCOME MEASURES: Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples. RESULTS: A total of 127,922 vaccine doses were administered. Initial enrollment totaled 43,358 students or 95.4% of those eligible. The series was completed by 41,594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (> or = 10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L). CONCLUSION: Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.

Adolescent↗
PubMed2004

Vaccination strategies.

By nature of their long-term deployment in challenging areas of the world, expatriate employees and their dependents are at increased risk for a number of infectious diseases. Targeted immunization strategies may decrease this risk. Expatriate employees and their dependents should be immunized before deployment, and programs should be established to provide booster immunizations if the risk is ongoing. When considering work-force productivity, work-force infectivity, and the common good, careful consideration should be given to establishing at least a basic immunization program for in-country nationals and their dependents.

Bacterial Infections↗
PubMedDate not supplied

Uptake and behavioural and attitudinal determinants of immunization in an expanded routine infant hepatitis B vaccination program in British Columbia.

INTRODUCTION: British Columbia (BC) implemented a universal infant hepatitis B (HB) immunization program in 2001. The study objective was to evaluate HB immunization coverage among the first six-month cohort of eligible infants in the province outside of the Vancouver-Richmond health region and to assess parent/guardian behavioural and attitudinal determinants of HB immunization. METHODS: A cross-sectional survey of HB immunization was conducted using a random sample of eligible infants born between 1 January-30 June 2001. HB immunization coverage data were obtained from the provincial Public Health Information System, and through a telephone survey of 487 of eligible infants' parents/guardians that was conducted between October 2002-January 2003. At this time, parents/guardians were also asked about behaviours and attitudes towards immunization, based on the Immunization Health Belief Model Scale. RESULTS: HB immunization coverage with at least one dose of HB vaccine was 89% and uptake of 3 doses of HB vaccine was 78%. HB immunization was significantly associated (p<0.001) with a recommendation for HB immunization from a health care professional. The main reason for non-HB immunization was parental concern about side effects. DISCUSSION: Seventy-eight percent of infants completed the 3-dose HB vaccination schedule. Parental behaviour regarding HB immunization of their children was strongly influenced by a supportive recommendation from either a nurse or doctor.

Attitude to Health↗