Dissertations / Theses on the topic 'Expanded program on immunization'

The objectives of this study are: (1) To compare the effectiveness of two dosing schedules of hepatitis B vaccine in achieving compliance within the vaccines; (2) To determine the immunization requirements in U.S. pharmacy schools both at admission and before the students begin clinical clerkships; and, (3) To design an immunization program for pharmacy students at the University of the Pacific in an attempt to enhance compliance.

In 1981, President Ronald Reagan issued Executive Order 12291 which requires Federal agencies to perform benefits assessments of proposed major regulations and prohibits them from taking regulatory action unless potential benefits exceed potential costs to society. A review of welfare economics literature and applications of the CBA model to health, education, and nutrition is presented. CBA for use in the Cooperative Extension Service Expanded Food and Nutrition Education Program (EFNEP) is then systematically examined using the following criteria: 1) theoretical considerations - can the economic criterion appropriately be applied to EFNEP?; and 2) application of the CBA model - can it be made operational? Following the critique of application of CBA to EFNEP, conclusions are drawn as to the appropriate use of CBA or alternative techniques in evaluating EFNEP and similar programs.<br>Doctor of Philosophy

The Expanded Food and Nutrition Education Program (EFNEP) is one of the largest efforts of the US Department of Agriculture (USDA) to promote healthy dietary behavior practices among the low income adults and youths in the US. Although the program is shown to be effective in achieving its stated goals, the cost effectiveness of the money spent on EFNEP remains largely unknown. This dissertation analyzes the costs and effectiveness of the EFNEP, and is organized in three essays. The first essay investigates the effectiveness of the adult EFNEP and evaluates the returns to scale on the money spent in this program by utilizing an indirect production function approach. Results indicate that the program has increasing returns to scale at the National level, although a significant variation exists across the states. The second essay develops a framework for conducting the cost effectiveness analysis (CEA) for the youth EFNEP. The CEA framework is then applied to the data from Virginia youth EFNEP to estimate the cost effectiveness ratio (CER). The CER is estimated to be about $75 per behavior improvement. The third essay examines the outcomes and the attributes of the youth EFNEP program using the Rasch model type measurement model.  Findings suggest that the youth EFNEP is effective in achieving its stated program goals. In addition, the program related characteristics are found to be important attributes of effective programs. Overall, this dissertation has important policy implications for improving the (cost) effectiveness of nutrition education programs. "<br>Ph. D.

Each year approximately 7,500 low-income Virginia families are enrolled in the Expanded Food and Nutrition Education Program (EFNEP), administered through the Virginia Cooperative Extension (VCE). Chronic disease and health conditions cost society an estimated $250 billion each year in medical charges and lost productivity. It has been assumed that the numerous diet and food-related changes made by EFNEP participants will lead to a reduction in the risk of chronic disease among homemakers, and perhaps, other family members. Thus, the improved diets and behaviors resulting from EFNEP participation may result in substantial future savings in healthcare costs among participants. This study explores the possibility of potential economic benefits for the Virginia EFNEP participants. In 1996, the Virginia Cooperative Extension was awarded a grant from the Cooperative State, Research, Education, and Extension Service, United States Department of Agriculture (CSREES, USDA) to conduct a cost-benefit study of EFNEP in Virginia. Though computation of the cost-benefit ratio for the Virginia adult EFNEP includes both direct and indirect benefits, this study addressed only the assessment of the direct tangible benefits based on the savings from economic costs of avoided diseases. Existing EFNEP data for the 1996 fiscal year was used to identify optimal nutritional behaviors that can delay or prevent the onset of certain chronic diseases and health conditions. The economic costs of diseases were identified from scientific literature and translated as potential benefits. The administration costs of EFNEP were also compiled. The total direct tangible benefit for the diseases and conditions identified was estimated to be $17,770,722. Along with the indirect tangible benefits ($321,462), the total tangible benefits for the Virginia EFNEP was calculated to be $18,092,184. The direct tangible costs associated with the Virginia EFNEP in 1996 was $1,922,204. The benefit-cost ratio for the Virginia EFNEP for the 1996 fiscal year for the subset of the population practicing the optimal nutritional behaviors is calculated at $9.41/$1.00 (a $9.41 return for every $1 invested in EFNEP in Virginia). Also, a benefit of $2.45 to $1.00 was calculated when only 25% of those participants practicing optimal nutritional behaviors were assumed retain these behaviors through life. For a program of the magnitude of EFNEP, these results are very gratifying.<br>Ph. D.

Childhood obesity has increased significantly in the past decade. The same factors putting adults at risk for obesity apply to children as well. For children, the family environment may be one of the largest factors. Obesity affects both adults and children of low socioeconomic status. It also affects families living in the Appalachian region of the United States more frequently than other regions. The purpose of this study was to examine the relationships between obesity related behaviors and nutrition education among Appalachian participants in the Expanded Food and Nutrition Education Program (EFNEP). For this study eleven educators from the Appalachian region who work with the EFNEP/SNAP-Education program were interviewed by telephone. Their responses to questions were coded according to a pre-prepared answer guide. From answers provided by staff there are some areas that the EFNEP program could focus on more. Some of these areas include educating participants on budgeting and family finance, cooking skill, parenting skills and physical activity. Answers provided by participants in this study suggest that educators feel fairly successful with making changes related to healthy eating but less successful with making changes in participant’s physical activity.

Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Nuclear Science and Engineering, 2006.<br>Includes bibliographical references (p. 51-52).<br>The four biggest energy sources in the United States are coal, crude oil, natural gas, and nuclear power. While coal and nuclear power are produced domestically, more than 70% of crude oil and 20% of natural gas is imported. This places an unhealthy dependence on foreign products for our economy. Just as importantly, all of these energy sources, with the exception of nuclear power, produce large amounts of polluting emissions in the form of greenhouse gases which are responsible for environmental degradation. For these two reasons, we explore possible government policies to shift the US energy economy towards domestically-produced, environmentally-clean alternative energy sources, the most prevalent of which is nuclear power. Different forms of government support for investment in nuclear power is discussed, such as investment tax credits and production tax credits. As an instrument of public policy to affect energy imports and environmental impact, the possibility of a carbon tax (on the order of $150/tC) is considered. The effects of this carbon tax on the energy sector in the medium-term future (in the year 2020) are analyzed. Under the constraint of maintaining current natural gas demand the results show that there will be an increase in the use of nuclear power while lowering the dependence on crude oil and coal. To accomplish this, the use of natural gas is shifted from the power sector to the residential, commercial and industrial sectors due to the economic incentives to do so. From an environmental perspective, this carbon tax lowers emissions by a predicted 30% of its 2020 business-as-usual rates. Economically, the carbon tax lowers crude oil import levels by 20% and reduces the US balance of payments by over $170 billion in the year 2020.<br>by Tanzeer S. Khan.<br>S.B.

Magister Psychologiae - MPsych<br>The economic state of South Africa prior to 1994 is linked directly to the political dispensation that was operating under apartheid. Since the advent of the new democratic dispensation, the South African government has developed policies which have focused on poverty alleviation. However, given all the gains (political equality) that have been made, South Africa still remains one of the highest in the world in terms of income inequality. Income inequality is an indicator of how material resources are distributed across society. Within the context of South Africa’s income inequality is largely due to the history of colonialism and. To address this income inequality, the government initiated job creation initiatives in 1995 which was implemented by institutions such as government departments and parastatals such as the nature conservation agency under research. A qualitative methodological framework was used for this study to explore the subjective experiences of the beneficiaries involved in the Expanded Public Works Program within the nature conservation agency. For the purpose of this study purposive sampling was utilised since only specific participants from four specific reserves were selected to participate in this study. The sample for this research study comprised of 24 participants. These participants were selected from each of the 4 selected reserves. Semi-structured interviews were utilised to gain a thorough understanding of the participants’ subjective experiences. Upon completion of these interviews the information was transcribed and analysed using the interpretive phenomenological approach. Before commencement of the study, the necessary ethics approval was obtained from the Humanities and Social Sciences Research Ethics Committee at the University of the Western Cape. Participants’ rights such as anonymity, confidentiality, voluntary participation, and confidentiality were guaranteed throughout the research process.

Class of 2017 Abstract<br>Objectives: To determine whether pharmacy students were more willing to receive, administer, recommend and counsel patients about vaccinations after completing an immunization training program Methods: Anonymous and voluntary questionnaires administered on paper during a regularly scheduled class collected ratings of confidence on the willingness of first year pharmacy students to receive, administer, recommend and counsel about vaccinations prior to and after the completion of an immunization training program. Data on gender, age range, status of completion and source of the immunization training program completed was also collected. This study was approved by the University of Arizona Institutional Review Board (IRB). Results: Questionnaires were completed by 110 students at the Tucson and Phoenix campus. Students were equally willing (p=0.235) to receive all vaccinations, even if they were not required to by the UA COP, before and after the immunization training program.There was a statistically significant difference in the willingness to administer (p<0.001), to recommend (p=0.024) and to counsel (p<0.001) about vaccinations after completion of an immunization training program. Conclusions: Completing an immunization training program did not have influence on the willingness of pharmacy students to receive vaccinations. However, the results suggest pharmacy students are more willing to administer, recommend and counsel about vaccinations after the completion of an immunization training program.

Thesis (M.S. in Management) Naval Postgraduate School, December 1998.<br>"December 1998." Thesis advisor(s): Nancy C. Roberts, Francois Melese. Includes bibliographical references (p. 127-130). Also available online.

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

Immunizations are an essential part of children’s healthcare; however, the associated distress can have short- and long-term negative ramifications for children. Parents’ procedural behavior is one of the strongest predictors of children’s distress. The current study evaluated whether an interactive computer training program influenced parents’ knowledge of the impact that their behavior has on their children or their actual procedural behavior during children’s immunizations. 90 parents and their 4- to 6-year-old children receiving immunizations participated. Overall, findings suggest that using a computerized training module to enhance parent knowledge and behavior is helpful but requires improvements in some areas to optimize training.

This study was conducted to determine the impact of nutrition edu cation on participants of the Supplemental Food Program for Women, Infants and Children (WIC) and the Expanded Food and Nutrition Education Program (EFNEP). The specific objectives were to: 1) determine the impact of participation in EFNEP on iron status as assessed by hematocrit (hct) and ferritin levels; 2) determine the effect of nutrition knowledge on hct and ferritin values; and 3) determine the effect dietary behavior has on hct and ferritin levels for both WIC and EFNEP participants. Each study participant completed a 24-hour dietary recall record plus food frequency record, medical history, validated nutrition knowledge test, and finger stick blood sample prior to program enrollment or nutrition education, and again six months later. There were 42 WIC, 26 EFNEP, 23 WIC-control, and 23 EFNEP-control participants. Paired t-tests were used to find differences between preprogram and postprogram evaluation scores for the variables of nutrition knowledge score, hematocrit level, ferritin level, and levels of several nutrients. Nutrition knowledge test scores increased significantly from preprogram to postprogram for both WIC and EFNEP participants (14.2 ± 3.27 to 15.5 ± 2.89 for WIC, 14.2 ± 3.77 to 15.6 ± 2.79 for EFNEP). EFNEP participants also increased significantly in hct levels (38.5% ± 3.78 to 40.7% ± 2.13). Hematocrit levels did not change significantly for the WIC or control groups and nutrition knowledge did not increase for the control group between preprogram and postprogram evaluations. Mean intakes of vitamin A, vitamin c, calcium, and protein were above the RDA at preprogram and postprogram evaluations, yet the percentage of individual participants who consumed less than 67% of the RDA in this study was higher than in the continuing survey of Food Intake of Individuals - 1985. Improvement in nutrient intake at postprogram evaluations was encouraging. Regression analysis indicated that nutrition education classes in college, income level, and level of formal education each had a positive effect on nutrient intake and nutrition knowledge.

<p> <b>Purpose</b></p><p> The primary purpose of this research was to develop measures of diet quality and nutrition behavior to evaluate the effectiveness of the Expanded Food and Nutrition Education Program (EFNEP). EFNEP is a United States Department of Agriculture nutrition education program that works with low-income families to improve their diet quality and food-related behaviors. The research objective was to develop a reliable and valid short dietary assessment instrument that can be used nationally by EFNEP to assess diet quality behavior change among low-income adults. Short dietary assessment instruments provide cost-effective ways to evaluate federally-funded nutrition education programs and the low-income adults they serve. However, few valid instruments exist for use nationally with low-income populations.</p><p> <b>Methods</b></p><p> This research was part of a multi-state, multi-year Agricultural Experiment Station research project, NC2169: EFNEP-Related Research, Program Evaluation and Outreach. Goals of the multi-state project included developing a new EFNEP national evaluation questionnaire that would include diet quality questions. </p><p> A mixed methods observational study design, including 8 phases, was used to develop and test the dietary assessment questions. Phases 1-5 pertain to question development, and phases 6-8 relate to question testing. The research phases are listed below. 1. <b>Nutrition education curricula content analysis. </b> The content analysis determined current nutrition information taught nationally to EFNEP participants. Curricula used by the majority of EFNEP state programs served as a proxy for nutrition content taught to EFNEP participants. A tested data recording instrument captured nutrition content in the curricula. 2. <b>Dietary Guidelines expert panel (expert panel #1).</b> A panel of 6 national nutrition experts identified and prioritized the nutrition recommendations from the 2010 Dietary Guidelines for Americans deemed most critical to teach low-income adults. The study protocol used a modified Delphi Technique to build consensus among experts through structured feedback. 3. <b>EFNEP expert panel (expert panel #2).</b> Twenty-one EFNEP program administrators and other researchers from 15 states further prioritized the nutrition recommendations identified by the first expert panel to those most critical to evaluate in EFNEP. 4. <b>Literature review and question generation.</b> A literature review of published manuscripts and government and research organization websites identified validated questions that addressed the nutrition recommendations deemed critical to evaluate. Questions and response options were revised, eliminated or created to meet the needs of the EFNEP population and program. 5. <b>Content validity expert panel (expert panel #3).</b> Seven EFNEP program administrators from different US geographic regions reviewed the dietary assessment questions and response options to confirm content validity for use in a national EFNEP questionnaire. Questions and response options were revised as necessary. 6. <b>Cognitive interview testing.</b> Researchers conducted cognitive interviews with EFNEP participants (at program enrollment &ldquo;pre&rdquo; or at program completion &ldquo;post&rdquo;) in 7 states. An iterative process and scripted probing questions were used to determine ease of understanding and face validity. Interviewers in each state were trained via webinar. Interviews were audio-recorded, transcribed and analyzed pre/post to identify themes and dominant trends. Questions and response options were revised as needed. 7. <b>Reliability testing.</b> The test-retest method assessed temporal stability reliability of the questions. A total of 217 low income EFNEP-eligible women from 7 states completed the dietary assessment instrument twice, at a 1-month interval. Paired t-tests (p &le; 0.05), Spearman&rsquo;s rank order correlation coefficients (SCC) and intraclass correlation coefficients (ICC) were used to assess reliability (r > 0.5). Exploratory factor analysis was used to determine whether the questions grouped together (factor loading cut-offs > 0.5). 8. <b>Construct validity testing.</b> A total of 60 EFNEP participants were recruited from 8 states to complete the dietary assessment instrument and 3, 24-hour food recalls pre/post the EFNEP intervention. Wilcoxon signed rank test (p &ge; 0.05), SCC (r > 0.5), and Bland-Altman plots were used to assess construct validity of the questions.</p><p> <b>Results</b></p><p> <b>Phases 1-5.</b> The curricula content analysis findings revealed considerable variability in both the frequency of certain nutrition content and depth of educational instruction provided across curricula used in EFNEP. The Dietary Guidelines expert panel determined 2 overarching and 8 specific nutrition messages critical to teach low income adults.</p><p> <i>Overarching recommendations</i> &bull; Focus on nutrient-dense foods, including vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood and fish, lean meats, poultry, eggs, beans and peas, and nuts and seeds. &bull; Cook and eat more meals at home. The behaviors of portion control and how to prepare lower calorie options can be emphasized within teaching how to prepare meals at home.</p><p> <i>Specific recommendations</i> &bull; Increase vegetable and fruit intake. Eat a variety of vegetables. &bull; Consume at least half of all grains as whole grains. &bull; Increase intake of low-fat dairy or fortified soy products. &bull; Eat a variety of protein foods, including beans, legumes, nuts and seeds, eggs, seafood, and lean meats and poultry. &bull; Develop skills in reading the Nutrition Facts panel to identify portion size and calorie intake for packaged foods. &bull; Prepare, serve, and consume smaller portions of food and beverages. &bull; Reduce intake of foods such as chips and crackers and sweets such as cookies, cakes, pie, muffins, doughnuts, and pastries. &bull; Limit the intake of sugar-sweetened beverages.</p><p> Using the Dietary Guidelines panel findings, the EFNEP expert panel prioritized 6 diet quality content areas to evaluate in EFNEP.</p><p> <i>Nutrition behaviors to evaluate in EFNEP</i> &bull; Cook and eat more meals at home. &bull; Increase fruit intake. &bull; Increase vegetable intake. &bull; Eat a wider variety of vegetables. &bull; Increase intake of dairy of fortified soy products. &bull; Limit the intake of sugar-sweetened beverages.</p><p> The literature review produced an average of 40 questions (range 19-71) per diet quality content area and 46 response scales. Questions were eliminated or revised to yield 22 questions with 1-2 response scales per question. Content validity expert panel feedback resulted in 20 revised questions for cognitive interview testing.</p><p> <b>Phases 6-8.</b> A total of 111 cognitive interviews in 3 rounds of interviews/question revisions were completed with EFNEP participants in 7 states. Cognitive interviews yielded a 14-item dietary assessment instrument covering the 6 nutrition content areas. Reliability testing results showed all questions had at the least moderate correlations (SCC > 0.40) and fair agreement (ICC > 0.41), with at least half the questions indicating strong (SCC > 0.60) and moderate (ICC > 0.61) correlations (<i>P</i> &lt; 0.001). The majority of questions (12/14) grouped together to align with the 6 nutrition content areas to evaluate in EFNEP (factor loadings >0.50).</p><p> For construct validity testing, data were collected from EFNEP participants in 8 states (n = 60 pre, 30 post). Food recall data were collected an average of 14 days after participants completed the instrument (range 6-32 days). Results demonstrated significant differences (Wilcoxon signed rank test p = &lt; 0.05) and low or no correlations both pre (SCC = 0.01 &ndash; 0.44) and post (SCC = 0.01 &ndash; 0.44) between the instrument and 24-hour food recall data. The Bland-Altman method was not pursued due to the lack of significant correlations. The researchers concluded that incompatible methods along with measurement error from multiple sources contributed to the lack of association between the instrument and 24-hour food recall data.</p><p> <b>Conclusions and Implications</b></p><p> This research resulted in nationally-tested reliable and valid dietary assessment instrument for low-income adults that can be used to evaluate EFNEP&rsquo;s effectiveness at improving diet quality among participants. The mixed-methods approach established temporal stability reliability and content, face, and factor validity of the dietary assessment instrument. Questions were developed to meet program objectives and tested with the target EFNEP population in multiple states, which confirmed their appropriateness for evaluating behavior change for this national nutrition education program. This research has implications that extend beyond EFNEP, as other nutrition education programs serving low-income adults may adopt the methods used to develop their own validated evaluation questionnaire. Nutrition education programs or interventions may also adopt the validated instrument to evaluate their programs.</p><p> Future research directions include testing the dietary assessment instrument questions for sensitivity to change and/or with a compatible comparison tool to establish construct or convergent validity. For example, a modified 7-day food record tailored to the needs of low-income participants and the behaviors captured in the instrument may be an appropriate comparison measure to assess convergent validity of the dietary assessment questions.</p><p>

Dietary improvement was assessed using 24-hour food recall in a sample of 180 homemakers who had completed six to 18 months of instruction in the Virginia Expanded Food and Nutrition Education Program (EFNEP) to determine whether they retained dietary improvement six to 36 months after leaving the program. These homemakers provided additional information on Perceived Educational Gains and Program Benefits received from participating in EFNEP. Family factors were explored which were believed to be related to dietary change - Family Composition, Family Resource Assistance, Household Roles and Responsibilities, Family Support, and Family Diet Control. Diet Scores increased significantly (p<.01) from program Entry to Exit; greatest increases were in average daily servings from milk and fruit-vegetable groups. Slight but significant (p<.01) regression occurred in average Diet Score and servings of milk from Exit to Follow-up. Homemakers with higher Diet Scores at program Entry had higher scores at program Exit and Follow-up, and higher Program Benefit Scores. Length of time in program was not significantly associated with Dietary Improvement or Retention. High average Educational Gain and Program Benefit Scores at Follow-up were evidence that EFNEP was successful from the perspective of homemakers served. Family Composition was not associated with Dietary Improvement. Family Support emerged as the only family measure related to diet; higher Family Support Scores were associated not only with greater Perceived Educational Gains and Program Benefits, but also with higher Diet Scores at program completion and follow-up. Results of the study confirmed the Virginia EFNEP to be effective in improving diets of homemakers and sustaining these changes, and suggested a key role for family support in influencing dietary outcome and program success from the view of participants.<br>Ph. D.

Master of Public Health<br>Department of Food, Nutrition, Dietetics, and Health<br>Sandra B. Procter<br>There have been major shifts in the dietary patterns of people in the United States in the last four decades. People eat fast food more frequently, eating more convenience food products, and highly processed food. On the other hand, the practice of cooking from raw ingredients or cooking from scratch has been declining. The lack of cooking skills is one of the barriers of cooking from raw ingredients. Cooking skills are one of the important determinants of food choice. People who have higher cooking skills tend to choose healthier food options. There are many programs that aim to increase cooking skills and nutrition knowledge. One of them is done by EFNEP. Over the years, EFNEP has been helping the low socioeconomic population to reach nutritional well-being. Evaluation is an important component of EFNEP. There are evaluation tools in EFNEP including behavioral checklist and dietary recall that are administered pre and post program. However, these tools do not specifically measure participants’ cooking skills. A proposed short self-reported questionnaire is designed to measure cooking skills of EFNEP participants in Kansas. The questionnaire comprises of seven questions and has been tested to a representative group.

Das zunehmende Durschnittsalter unserer Gesellschaft und der Mangel an Spenderorganen stellen bedeutende Herausforderungen für die Organtransplantation dar. Organe, die früher als "marginal" galten, werden heute routinemässig transplantiert. Gleichzeitig mit der Zunahme älterer Patienten auf der Warteliste steigt das Interesse an der Entwicklung von speziellen Allokations-Strategien. Basierend auf dem Konzept der Abstimmung des metabolischen Bedarfs des älteren Empfängers und der Kapazität der älteren Spenderniere entwickelte Eurotransplant daher das Eurotransplant Senior Program (ESP), welches im Januar 1999 gestartet wurde. Im Rahmen dieses Programms werden Nieren von über 65 Jahre alten Spendern lokal auf eine selektierte Gruppe über 65 Jahre alter, nicht immunisierter Empfänger übertragen. Das Ziel dieser 5-Jahres Analyse war es herauszufinden, ob das ESP erfolgreich seine Ziele erreicht hat, Organe von älteren Spendern optimal zu nutzen und die Zeit auf der Warteliste für ältere Empfänger zu verkürzen. Als Basis dienten Daten des Eurotransplant Information Systems (ENIS). Zusätzliche Informationen wurden für die ESP Patienten und zwei Kontrollgruppen mit entweder annähernd vergleichbarem Alter des Spenders (Kontrolle 1) oder des Empfängers (Kontrolle 2) erfasst. Insgesamt zeigt diese Auswertung, dass die Ziele des ESP erreicht wurden. Die Verfügbarkeit von älteren Spenderorganen wurde von 162 (10%) im Jahre 1998 auf 239 (fast 15%) im Jahre 2004 gesteigert. Die Wartezeit für ältere Empfänger verkürzte sich signifikant im Vergleich zu vor der Einführung des ESP und weiter im Verlauf der ersten 5 Jahre auf deutlich unter 4 Jahre, während sich die Wartezeit für Patienten in den Kontrollen die über ETKAS transplantiert wurden um bis zu einem Jahr verlängerte. Die kalte Ischämiezeit für ESP Patienten war signifikant kürzer mit etwa 12 im Vergleich zu ca. 17 Stunden für beide Kontrollen.Das Patienten- und Transplantatüberleben der Empfänger von Organen von über 65-jähriger Spendern wurde durch die ESP-Allokation, trotz 5-10% höherer Abstossungraten, nich negativ beeinflusst. Die Analyse der unabhängigen Risikofaktoren für akute Abstoßungsreaktionen weist darauf hin, dass ein verbessertes HLA matching unter Beibehaltung kurzer Ischämiezeiten möglicherweise von Vorteil wäre.<br>The aging society and the shortage of organs impose significant challenges to organ transplantation. As a result, organs previously considered marginal are now routinely used. At the same time, an increase in the number of elderly patients on renal transplant waiting lists has heightened interest in the development of special allocation strategies for these patients. As a result, Eurotransplant started the Eurotransplant Senior Program (ESP) in January 1999, an allocation scheme based on the concept of matching the metabolic demand of the recipient and the excretory capacity of the donor. The program obtaines kidneys from donors over 65 years and locally allocates them to a selected group of non-immunized patients in the same age group. The main objective of this evaluation was to find out if the allocation scheme is effective in using kidneys from elderly donors and if it shortens the waiting time for elderly patients. The Eurotransplant database was used as a starting point, and data added to the database by collecting additional information on the ESP patients, and on two control groups. The controls were observed over the same time period as the ESP patients, and matched them for either donor age (Control 1) or recipient age (Control 2). Overall, this 5-year analysis of the ESP shows that the objectives of the program have been met. The availability of elderly donors increased from 169 (10%) in 1998 to 239 (almost 15%) in 2004. The waiting time for elderly recipients transplanted within the ESP was successfully reduced compared to the waiting time before introduction of ESP and is now below 4 years, while waiting time in both control groups has increased by up to one year. The cold ischemia time for ESP patients was significantly shorter, with a mean of approximately 12 hours compared with over 17 hours in both control groups. Graft and patient survival in recipients of organs from donors age over 65 were not negatively impacted by the ESP allocation despite 5-10% higher acute rejection rates.Based on an analysis of independent risk factors the use of HLA matching instead of waiting time should be considered as an allocation criterion while maintaining a short cold ischemia time.

The purpose of this study was to explore the incentives and barriers perceived by low-income women of child-bearing age related to their participation in nutrition education programs. The specific programs of concern in this study are the Expanded Food and Nutrition Education Program (EFNEP) and the Food Stamp Nutrition Education (FSNE) program. This qualitative study sought to hear the voices of the women so that nutrition programs can be made more successful in reaching this population. Personal interviews were conducted with 23 women in their homes or appropriate local sites, and transcripts were analyzed to identify categories and themes. People of low socioeconomic status and those with the least education have higher rates of obesity and overweight and suffer disproportionately from poor health. Women receiving Temporary Assistance to Needy Families (TANF) also receive Medicaid. Medicaid costs have escalated due to the obesity rate, which is currently estimated at 64% of the adult population. In addition, 30% of American children are experiencing obesity or are overweight. It is important for parents to understand the causes of obesity and the effects of the chronic diseases related to obesity. Prevention programs are more cost effective than medical treatment of the diseases associated with obesity, and proper nutrition can reduce the incidence of chronic diseases. Findings of this study suggest that isolation is the main impediment to participating in nutrition education programs. Missing from the interviewed women's circumstances are social capital, human capital, and economic capital. Social capital relates to the connections and relationships that are important in life. Human capital involves the knowledge and skills acquired through life experiences. Economic capital refers to individual wealth or economic resources available to an individual or community. Nutrition education programs should be refined to incorporate opportunities for socialization that will develop trust and reciprocity, as well as nutrition knowledge. Based on the results of this study, Virginia Cooperative Extension programs will be adapted to incorporate weight control and cooking classes with nutritious recipes. The learning environment will be safe, learner-centered, and fun. New marketing tools that are more appealing to the prospective clients will be developed.<br>Ed. D.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-17T15:40:10Z No. of bitstreams: 2 Dissertação - Wider Carlos Bernardes de Moura - 2016.pdf: 1656116 bytes, checksum: 507ddc7778f24f76d1103d1aefc0d664 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)<br>Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-17T15:43:26Z (GMT) No. of bitstreams: 2 Dissertação - Wider Carlos Bernardes de Moura - 2016.pdf: 1656116 bytes, checksum: 507ddc7778f24f76d1103d1aefc0d664 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)<br>Made available in DSpace on 2016-08-17T15:43:26Z (GMT). No. of bitstreams: 2 Dissertação - Wider Carlos Bernardes de Moura - 2016.pdf: 1656116 bytes, checksum: 507ddc7778f24f76d1103d1aefc0d664 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-06-13<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES<br>Introduction: vaccines are important technologies in health and have been used for decades to prevent a series of high morbidity diseases through vaccination of children, adolescents, adults and seniors. Knowledge of the immunization program costs is important for health managers in strategic planning, decision making and incremental costs estimates the introduction of new vaccines and budgetary impact of the same, supporting cost-effectiveness studies. Objectives: estimate the cost of the National Immunization Program (NIP) in Brazil, the federal considering the 2013 base year and analyze the acquisition of immunobiologics used in Brazil considering quantitative and cost in the 2004-2015 period. Methods: two studies were carried out. A retrospective descriptive study program cost for the NIP cost analysis at the federal level, and the period considered from January to December 2013. A restrospective study ecological descriptive type, historical series of quantity and immunobiologics costs purchased by NIP between the periods of 2004-2015. For both analyzes were considered the SUS perspective. The following cost components were considered: inputs (immunobiologics, syringes and needles), human resources, transportation, building infrastructure and services, office equipment, transfers to the Cold Chain and other (social mobilization, training, publications and research). For historical trend analysis, vaccines and serums /Immunoglobulins were considered. The analysis was stratified by national and international production; purchasing mechanism; and conventional routine schedule vaccines and vaccines introduced from 2006. Results: the total NIP costs at federal level in 2013 was R$1,467,100,454.81, of which R$1,304,032,414.00 (88.9%) to inputs for the routine and campaigns R$78,282,799.95 (5.3%) and transport R$3,210,769.92 (0.2%) with human resources and R$81,574,470.94 (5.6%) with the other components (building infrastructure, equipment, financial transfers and others). A total of 2,910,669,114 doses of immunobiologics was acquired by the NIP in the 2004-2015 period, at a cost of R$15,473,789,880. Conclusion: Federal costs of the NIP are significant, mainly due to costs of vaccine purchase and transportation. With the introduction of new vaccines in the immunization schedule, the PNI costs increase significantly, justifying the adoption of transfer strategy technologies for production of new vaccines and self-sufficiency in the production of immunobiologics adopted by MS.<br>Introdução: as vacinas são importantes tecnologias em saúde e vem sendo utilizadas há várias décadas em crianças, adolescentes, gestantes adultos e idosos para prevenir uma série de doenças de alta morbidade. O conhecimento dos custos de programa de imunizações é importante para os gestores de saúde no planejamento de estratégias, na tomada de decisões e para estimativas de custos incrementais na introdução de novas vacinas e de impacto orçamentário das mesmas, subsidiando estudos de custo-efetividade. Objetivos: estimar o custo do Programa Nacional de Imunizações (PNI) no Brasil, na esfera federal considerando o ano base de 2013 e analisar as aquisições de imunobiológicos utilizadas no Brasil considerando quantitativo e custos no período de 2004-2015. Métodos: foram realizados dois estudos. Um estudo descritivo retrospectivo de custo de programa para a análise de custos do PNI no nível federal, sendo o período considerado de janeiro a dezembro de 2013; e um estudo retrospectivo do tipo ecológico descritivo de série histórica da quantidade e custos de imunobiológicos comprados pelo PNI entre o período de 2004-2015. Para ambas as análises, foi considerada a perspectiva do SUS. Foram considerados os seguintes componentes de custo: insumos (imunobiológicos, seringas e agulhas), recursos humanos, transporte, infraestrutura predial e serviços, equipamentos de escritório, repasses para a rede de frio e outros (mobilização social, treinamento, publicações e pesquisas). A análise de série temporal considerou vacinas e soros/imunoglobulinas e foi estratificada por produção nacional e internacional; mecanismo de compra; e vacinas convencionais do calendário de rotina e vacinas introduzidas a partir de 2006. Resultados: o total de custos do PNI pelo nível federal em 2013 foi de R$1.467.100.454,81, sendo R$1.304.032.414,00 (88,9%) para insumos (imunobiológicos, seringas e agulhas) R$78.282.799,95 (5,3%) com transportes, R$3.210.769,92 (0,2%) com recursos humanos e R$81.574.470,94 (5,6%) com os demais componentes (infraestrutura predial, equipamentos, repasses para a rede de frio e outros). Um total de 2.910.669.114 doses de imunobiológicos foi adquirido pelo PNI no período de 2004-2015, a um custo de R$15.473.789.880. Conclusão: os custos federais do PNI são significativos, sobretudo em função de custos com compra e transporte de vacinas. Com a introdução de novas vacinas no calendário vacinal, os custos do PNI aumentaram significativamente, justificando a adoção de estratégia de transferência de tecnologias para produção de novas vacinas e promovendo a autossuficiência nacional na produção de imunobiológicos.

Objective: Evaluate how a social marketing approach compares to traditional nutrition education curriculum for promoting behavioral changes related to eating and food. Design: Nonequivalent comparison group, entry-exit design. Participants from 12 Kentucky counties assigned either comparison or pilot group. Comparison group received traditional nutrition education curriculum and pilot group received the social marketing program, Cook Together, Eat Together (CTET) curriculum. EFNEP’s Behavior Checklist and 24-Hour Dietary Recall were administered at entry and exit of the 8-week programs. Participants: Females (18-72 years of age) from families eligible to receive SNAP benefits (n=64 comparison group participants, n=60 pilot group participants). Intervention: Comparison group completed an 8-week standard lesson and pilot group completed CTET program in varying time frames (1-8 weeks). Main Outcome Measures: Eating behavior changes between entry and exit for comparison versus pilot. Analysis: Quantitative data were analyzed using independent and paired t-tests with significance of P≤ 0.05 and 0.10. Results: Groups were demographically similar. Both had significant differences in entry and exit scores for Behavior Checklist and 24-Hour Recall (P≤ 0.05). Conclusion and Implications: Positive behavior change was observed in both comparison and pilot groups. A social marketing program proves to be a promising approach to nutrition education.

Mathematical models provide unique insights to real-world problems. Within the context of infectious diseases, models are used to explore the dynamics of infections and control mechanisms. Human papillomavirus (HPV) globally infects about 630 million people, many of these infections develop into cancers and genital warts. Vaccines are available to protect against the most prevalent and devastating strains of HPV. The introduction of this vaccine as part of a national immunization program in Canada is a complex decision for policy-makers in which mathematical models can play a key role. We use the current recommendations provided by the World Health Organization to explore the integral role mathematical models have in the decision to incorporate the HPV vaccine within a national immunization program. We then provide a review of the literature discussing the role of mathematical models in the decision to include a vaccine in a national immunization program within the context of the HPV vaccine. Next, we evaluate the current standing of mathematical models used within the context of HPV immunization, to highlight the types of models used, underlying assumptions and general recommendations made about these immunization programs. Then, we create and analyze a model to explore the possibility of bettering the current HPV vaccine strategy in Canada. We focus on the effects of the grade of vaccination and the number of doses required to eradicate the targeted strains of HPV.

Made available in DSpace on 2011-05-04T12:36:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2010<br>Hoje em dia, uma série de vacinas são capazes de proteger as pessoas, reduzindo drasticamente a incidência de doenças. Para gerenciar as ações de imunização em saúde pública, o Programa Nacional de Imunizações foi criado em 1973. Através dos seus mecanismos de trabalho, tais como, fornecimento de vacinas para toda a população, financiada pelo Governo Federal, sem custos diretos para os vacinados; armazenamento, transporte e suprimento de vacinas em redes de frio adequadas; sistemas de informações confiáveis, o Programa Nacional de Imunizações tem êxito em seus objetivos por controlar várias doenças evitáveis pela imunização. No entanto, sabemos que a ocorrência de eventos adversos pode surgir após a administração desses produtos imunizantes EAPV. Para monitorar e controlar EAPV, a Vigilância Epidemiológica de Eventos Adversos Pós-Vacinação foi criado pelo Programa Nacional de Imunização, em 1992. Este serviço foi estruturado para reconhecer e identificar os casos de EAPV, subsidiar pesquisas, e assessorar os profissionais de saúde na vigilância de casos, entre outros objetivos que contribuem para o controle de vacinas, saúde e bem-estar da população. Para fazer o controle de eventos adversos, a Vigilância Epidemiológica de EAPV usa um formulário de notificação, manual de monitoramento com informações e instruções para notificar e investigar casos de EAPV e fornecer dados para o sistema de informação. Este último é fundamental para acompanhar os casos suspeitos e confirmados de EAPV, identificando os casos graves, os surtos e controlar os lotes de vacinas que podem causar eventos adversos à população vacinada. Desde 1998, o Programa Nacional de Imunizações tem administrado o Sistema de Informações de Eventos Adversos Pós-Vacinação, desenvolvido pela equipe técnica do Departamento de Informática do Ministério da Saúde DATASUS. Com base nas diretrizes e critérios para avaliação de sistemas de vigilância do Centers for Disease Control and Prevention (CDC) - Atlanta / EUA, várias falhas e erros foram apontadas no sistema, onde surgiu a proposta de um novo sistema de informação para melhorar a eficácia da Vigilância Epidemiológica de Eventos Adversos Pós-Vacinação. O sistema foi revisto de acordo com a padronização da Terminologia de Reações Adversas (WHO-ART) e o Dicionário Médico de Atividades Reguladoras (MedDRA) da Rede Uppsala Monitoring Centre(UMC). O novo sistema de informações proposto nesta dissertação pode beneficiar de Vigilância Epidemiológica de Eventos Adversos Pós-Vacinação facilitando o fluxo de dados de EAPV, ampliando o acesso às informações aos diversos profissionais de saúdee fabricantes de vacinas, atualizando e facilitando a operação, enquanto mantém a segurança e privacidade da informação. Esta proposta inclui um novo formulário de notificação com base no atual formato em uso nas unidades de saúde no país, além das fichas de notificação dos sistemas de vigilância do Canadá e EUA. O Centro de Vigilância Epidemiológica da Secretária de Estado da Saúde de São Paulo, também contribuiu com o seu modelo de formulário.<br>Nowadays, a number of vaccines are able to protect people, reducing dramatically the incidence of diseases. To manage the immunizing actions in public health, the Brazilian National Immunization Program was created in 1973. Through its working mechanisms, such as, providing vaccines for the whole population, funded the Federal Government, without direct cost for vaccinees; storage, transportation and supply of vaccines in appropriate cold chain settings; reliable information systems, the National Immunization Program has succeed in its goal to control many diseases preventable by immunization. However, we know that the occurrence of adverse events may follow the administration of immunizing products – AEFI. To monitor and control AEFI, the Epidemiological Surveillance of Adverse Events Following Immunization was created by National Immunization Program in 1992. This service was structured to recognize and identify AEFI cases, subsidize research work, and support health professionals in surveillance, and other objectives that contribute to vaccines control, health and welfare of the population. To control adverse events, AEFI’s Epidemiological Surveillance use a notification form, monitoring manual with information and instructions to report and investigate AEFI’s cases and supply data to the information system. The latter is critical to follow up suspected and confirmed cases of AEFI, identifying severe cases, outbreaks and monitor vaccine lots that may cause adverse events to the vaccinated population. Since 1998, the National Immunization Program has managed the Adverse Events Following Immunization’s Informations System, developed by the technical staff in the Ministry of Health Department - DATASUS. Based on the guidelines and criteria for evaluation of the Surveillance Systems for the Centers for Disease Control and Prevention (CDC) – Atlanta / USA, several flaws and errors in systems were pointed out, and a proposal for a new information system was conceived to improve the effectiveness of the Epidemiological Surveillance of Adverse Events Following Immunization. The system was revised according to the standardization of Adverse Reactions Terminology (WHO-ART) and Medical Dictionary of Regulatory Activities (MedDRA) of the Network Uppsala Monitoring Center (UMC). The new informations system proposed in this dissertation may benefit the Epidemiological Surveillance of Adverse Events Following Immunization by expediting the flow of AEFI’s data, expanding the access to information to various health professionals, and to vaccine manufacturers, updating and facilitating operation, while mantaining security and privacy. This proposal include a new notification form based on the current format in use in the health units in the country besides the notification forms of Surveillance Systems in Canada and USA. The Epidemiological Surveillance Center of State Secretary for Health in São Paulo, also contributed to its model of form.

Submitted by IVANA REGINA GONÇALVES null (nanaenf82@hotmail.com) on 2016-12-13T18:58:31Z No. of bitstreams: 1 Tese Ivana Goncalves.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5)<br>Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-12-15T14:52:37Z (GMT) No. of bitstreams: 1 goncalves_ir_dr_bot.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5)<br>Made available in DSpace on 2016-12-15T14:52:37Z (GMT). No. of bitstreams: 1 goncalves_ir_dr_bot.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5) Previous issue date: 2016-11-18<br>O programa de uso da imunoglobulina palivizumabe teve início em 2007 no Estado de São Paulo e em 2013 estendeu-se nacionalmente, sendo destinado a crianças com maior risco para a infecção pelo Virus Sincicial Respiratório (VSR). Desde seu início, o programa permanece sem avaliação sistemática. O objetivo dessa pesquisa foi avaliar o programa de uso da imunoglobulina palivizumabe no Estado de São Paulo. Foram avaliados os 16 locais de aplicação: cinco Centros de Referência para Imunobiológicos Especiais (CRIE) e 11 postos de aplicação existentes no Estado de São Paulo, seguindo o referencial de avaliação proposto por Donabedian. Dados de estrutura e processo foram obtidos por entrevista com os responsáveis pela aplicação da imunoglobulina; para avaliação de resultado foram entrevistadas as mães das crianças do programa, visando identificar a associação entre falha na tomada do palivizumabe e a necessidade de hospitalização em Unidade de Terapia Intensiva por doença ou sintomatologia respiratória no período de sazonalidade do VSR. Participaram desta pesquisa 693 crianças/responsáveis (85,1% da população elegível), que ingressaram no programa entre março e agosto de 2014, sendo a coleta de dados realizada entre março e setembro do mesmo ano. Para análise de resultado foi utilizado o odds ratio pontual e intervalar com intervalo de confiança de 95%, considerando-se associações estatisticamente significativas se p < 0,05. Para avaliação de estrutura foram consideradas 30 variáveis relacionadas a condições preconizadas pelas políticas públicas de saúde e para o processo elencaram-se 10 variáveis relativas aos cuidados com a aplicação e conservação da imunoglobulina e sala de aplicação, sendo em ambos os casos o serviço classificado de acordo com o percentual de desconformidade em: adequado (até 10%), parcialmente adequado (de 10 a 20%) e inadequado (superior a 20%). Apenas dois locais de aplicação (P7 e P9), tiveram estrutura e processo considerados adequados. Apesar de terem estrutura classificada como adequada, nove locais tiveram processo parcialmente adequado (C2, C3, C4, P3 e P10) ou inadequado (C1, P2, P5 e P8). As principais falhas de estrutura foram relativas à climatização, disponibilidade de medicamentos e materiais para uso em caso de choque anafilático, sala exclusiva para aplicação de imunobiológicos e protocolo de uso da palivizumabe disponível e, no caso do processo, a não aplicação da imunoglobulina em crianças hospitalizadas, falta de supervisão do médico durante a aplicação, falha na temperatura de conservação do produto e não aplicação no mês anterior à sazonalidade. De acordo com os resultados, pode-se verificar que o risco de hospitalização em Unidade de Terapia Intensiva por doença/sintomatologia respiratória foi diretamente proporcional ao número de falhas (p=0,007; OR=1,29, IC=1,07-1,56). Conclui-se que a avaliação da estrutura do programa de uso da imunoglobulina palivizumabe no Estado de São Paulo é, em geral, mais favorável que o processo. Os resultados evidenciaram aumento médio da chance de internação por doença/sintomatologia respiratória de 29% a cada falha no recebimento das doses.<br>The palivizumab immunoglobulin health program was introduced in 2007 in São Paulo State and it was initiated nationally in 2013, aiming at being administered to highly risk children for respiratory syncytial virus infections. Since its beginning, such a program has remained with no systematic evaluation. The objetive of the present research was evaluate the palivizumab immunoglobulin health program in São Paulo State. For doing so, 16 places of palivizumab application in São Paulo State were considered: five of which are reference centers for special immunobiologicals and other 11 places of application. The theoretical framework adopted for the evaluation was the one proposed by Donabedian. Structural and processual data on the program was obtained by interviewing each worker responsible for the immunoglobulin in each application place. As for the evaluation of the program outcomes, the childrens mothers/responsible were also interviewed with the aim of identifying the association between palivizumab dose failure and respiratory-related hospitalizations in the seasonality period of respiratory syncytial virus. A total of 693 children/responsibles (85.1% of the eligible individuals) composed the research, all of which made part of the program in the period March-August of 2014, being the data collection performed between March and September of the same year. The data was analysed by the punctual and intervalar odds ratio, with a confidence interval of 95% and a statistical significance fixed at 5%. To the evaluation of program structure, 30 variables preconized by the public health policies were considerated; regarding the program process, 10 variables related to the immunoglobulin care of application and conservation and room of application were considered. Structure and process were both classificated as its nonconformity rate in: adequate (less than 10%), partially adequate (from 10% to 20%) and inadequate (greater than 20%). Only in two of the application places (P7 and P9) structure and process were found to be inadequate. Despite having an adequate structure, in nine places the process was found to be either partially adequate (C2, C3, C4, P3 and P10) or inadequate (C1, P2, P5 and P8). The main structural failures were the ones related to: climate control, availability of materials and medicines used in anaphylactic shock, exclusive room for immunobiological application and palivizumab usage protocol availability and, regarding the process, the absence of application in hospitalized children, absence of medical care during the immunoglobulin administration, inappropriate temperature for immunoglobulin conservation and absence of application prior to the respiratory syncytial virus seasonality. According to the results, the hospitalization risk in intensive care unit due to respiratory disease and related-symptoms was directly proportional to the number of dose failures (p=0.007; OR=1.29, IC=1.07-1.56). As a conclusion for the evalution, the structure of the São Paulo State palivizumab immunoglobulin health program is in general more favorable than the process. As for the results, they an average increasing of 29% in respiratory-related hospitalizations in intensive unit to each dose failure in palivizumab adminstration.

Orientador: Cristina Maria Garcia de Lima Parada Parada<br>Resumo: O programa de uso da imunoglobulina palivizumabe teve início em 2007 no Estado de São Paulo e em 2013 estendeu-se nacionalmente, sendo destinado a crianças com maior risco para a infecção pelo Virus Sincicial Respiratório (VSR). Desde seu início, o programa permanece sem avaliação sistemática. O objetivo dessa pesquisa foi avaliar o programa de uso da imunoglobulina palivizumabe no Estado de São Paulo. Foram avaliados os 16 locais de aplicação: cinco Centros de Referência para Imunobiológicos Especiais (CRIE) e 11 postos de aplicação existentes no Estado de São Paulo, seguindo o referencial de avaliação proposto por Donabedian. Dados de estrutura e processo foram obtidos por entrevista com os responsáveis pela aplicação da imunoglobulina; para avaliação de resultado foram entrevistadas as mães das crianças do programa, visando identificar a associação entre falha na tomada do palivizumabe e a necessidade de hospitalização em Unidade de Terapia Intensiva por doença ou sintomatologia respiratória no período de sazonalidade do VSR. Participaram desta pesquisa 693 crianças/responsáveis (85,1% da população elegível), que ingressaram no programa entre março e agosto de 2014, sendo a coleta de dados realizada entre março e setembro do mesmo ano. Para análise de resultado foi utilizado o odds ratio pontual e intervalar com intervalo de confiança de 95%, considerando-se associações estatisticamente significativas se p < 0,05. Para avaliação de estrutura foram consideradas 30 variáveis... (Resumo completo, clicar acesso eletrônico abaixo)<br>Doutor

M. Tech. (Department of Hospitality, Tourism and PR Management, Faculty of Human Sciences), Vaal University of Technology<br>The purpose of this study was to determine the contribution of the National School Nutrition Programme (NSNP) has made on the total nutrient intake of Kagiso learners. This was done by investigating the nutrient intake of school children participating in the NSNP (experimental group) and comparing this to the nutrient intake of learners participating in the tuck-shop or lunch box (control group) from one school. The research methodology was undertaken in two phases, namely phase one; planning and phase two; data collection and analysis. The following measuring methods were applied; socio-demographics, household food insecurity assessment scale, anthropometry measurements, food frequency questionnaires (FFQ), 24-hour recall and the observation of the NSNP during the school lunch breaks. Anthropometry measurements were analysed according to the World Health Organization standards (WHO 2008), socio-demographics, and household food insecurity assessment scale and FFQ were captured on an Excel spreadsheet by the researcher and analysed using the Statistical Package for Social Sciences (SPSS) version 22.0 for descriptive statistics such as frequencies, standard deviations and confidence intervals. An expediency sample of 160 primary school children aged 6-13 years, including girls (n=84) and boys (n=76) and 106 caregivers were recruited into the study. The results showed that majority of caregivers (59%) completed secondary level education, followed by 39% with primary level or college completion (2%). The employment rate in the Kagiso households of the sampled group was low with 20% of caregivers being unemployed. Out of the 76% of the employed caregivers, 26% were permanently employed and 51% were temporarily employed with contract work and piece jobs. The highest monthly income (42%) was between R1000-R3000 and the lowest (38%) was less than R1000 with only R101-R200 to spend on food per week. The food insecurity status of Kagiso learners showed that 44% of school children were food secure, and 56% were food insecure – of these, 29% experienced hunger. Heightfor-age, weight-for-age and BMI-for-age were measured for all of the 160 children. The group was categorized as follows; school children participating in the NSNP (n=59) and children using the tuck-shop foods (n=35) and lunch box (n=66). The nutritional status of Kagiso learners from the sampled group showed that more boys were stunted (13%) and wasted (12%) while of the girls, 30% were at risk of being overweight, with only 2% reported to be overweight. The majority of boys reported to be stunted and wasted were from the NSNP group and the girls reported to be overweight or at risk of being overweight were from the tuck-shop group. Thus, the learners from the lunchbox had optimum growth status when compared to the other two groups. The respondents consumed a mainly high carbohydrate diet with a low consumption of vegetable and fruits. The results from the Food Variety Score (FVS) revealed a low individual mean (2.25±1.57) in the legume and nuts group, followed by a medium individual mean (7.9±2.81) in the fruits and other juices group, 7.16±2.68 in the vegetable group, and lastly, the highest individual mean (9.26±3.04) in the cereal, roots and tubers diversity. The results from the top 20 popular food items ranked as follows; maize meal stiff (1st), maize meal porridge (5th), white rice (6th), white bread (7th) brown bread (9th), potato fries (12th), breakfast cereal (13th) and samp and beans (14th). Cabbage (15th) and pumpkin (20th) were the most popular vegetables and there were no fruits within the top 20 popular list of food items. The Nutrient Adequacy Ratio (NAR) of the NSNP (n=59) meals was below the 1/3 (33.3%) and 30% dietary requirements for lunch meals. This was very evident regarding vitamin A (16.85%), energy kilojoules (23.78%), calcium (18%), folate (26.72%), zinc (15.71%), dietary fiber (25.71%) and iodine (4.65%). Iron (38.98%) was slightly above the 1/3 and 30% dietary intake, but there were a high percentage (61%) of respondents who did not meet the EARs of 5.9mg for iron. The results revealed an inadequate contribution by the NSNP to the nutrient intake of Kagiso learners. The poor intake of folate, vitamin A and dietary fiber in this sampled group is linked to the low consumption of vegetable and fruits. Results from this observational study showed that a majority of respondents do not participate in the NSNP when they do not have their own eating utensils. Respondents also revealed that the NSNP meals caused allergies such as skin rash while some mentioned diarrhea as the cause of not eating meals from the NSNP. Hence, a larger percentage (41%) of school children preferred to participate in the lunch box rather than in the NSNP (37%). The high prevalence of inadequate nutrient intake and the poor nutritional status of Kagiso learners in the sampled group, is an indication that strict monitoring of dietary measures needs to be implemented and continuously evaluated to ensure that positive nutritional results are obtained by the NSNP across South Africa

INTRODUÇÃO: Os Centros de Referência para Imunobiológicos Especiais (CRIEs) são unidades de vacinação públicas e gratuitas que disponibilizam vacinas e imunoglobulinas não disponíveis na rotina do Programa Nacional de Imunizações (PNI), para indivíduos que necessitam de imunobiológicos específicos, mediante prescrição médica. Também realizam atendimento de pessoas com eventos adversos pós-vacinação (EAPV). É um subprograma do PNI, criado em 1993. OBJETIVO: Avaliar a implantação dos CRIEs quanto ao cumprimento de diretrizes e regulamentações formais. MÉTODOS: Foi realizada uma avaliação de programa do tipo pesquisa avaliativa e para isso, desenvolvido um questionário on-line, contendo 170 questões, envolvendo as dimensões \"estrutura\", \"recursos humanos\" e \"atividades desenvolvidas\". Os responsáveis pelos 42 CRIEs existentes em 2011 participaram do estudo. A fim de agrupar serviços com características semelhantes, foi aplicado o método de agrupamento para dados binários, utilizando a Distância Euclidiana Quadrática (pelo método do vizinho mais distante - complete linkage). RESULTADOS: Foi evidenciada uma grande diversidade entre os serviços nas três dimensões analisadas. Treze CRIEs (31%) estavam localizados em instituição universitária; 29 (69%) possuíam o mínimo de salas preconizado; 29 (69%) relataram insuficiência de equipamentos para armazenamento de imunobiológicos; 22 (52%) não realizavam manutenção preventiva da rede de frio; 30 (71%) possuíam gerador elétrico; 24 (57%) tinham fonte de oxigênio. O número de funcionários variou de três a 21; quatro serviços não tinham enfermeiros e nove não tinham médicos; 23 (55%) possuíam médico em período maior ou igual à metade do expediente; 27 (64%) tinham recursos humanos treinados para atender emergências. O número de doses de imunobiológicos administrados aumentou 66% de 2006 a 2010. Trinta e cinco serviços (83%) funcionavam 40 horas semanais ou mais. Acerca do atendimento de EAPV, 28 (67%) CRIEs contavam com retaguarda laboratorial, 36 (86%) com retaguarda hospitalar e 36 (86%) com retaguarda de especialistas. A análise estatística resultou em cinco \"perfis\" de serviços, denominados de acordo com suas características. 1) \"Melhor estrutura\": 12 CRIEs com a maior porcentagem de serviços com o mínimo de salas preconizado, câmaras de vacinas, manutenção preventiva da rede de frio e fonte de oxigênio. 2) \"Dispensador de imunobiológicos\": 6 CRIEs que mais dispensavam do que aplicavam imunógenos; nenhum serviço tinha médico mais da metade do expediente; nenhum serviço possuía câmaras de vacinas. 3) \"Implantação incipiente\": 5 CRIEs com estrutura mais precária, com baixos índices de câmaras de vacinas, manutenção preventiva e fonte de oxigênio; nenhum possuía computador. 4) \"Sala de vacinas\": 13 CRIEs, todos faziam imunização de rotina e a maioria participava de campanhas de vacinação. 5) \"Ensino e pesquisa\": 6 serviços, todos inseridos em hospitais de ensino, desenvolviam pesquisas e recebiam estagiários. Quase todos possuíam médicos em mais da metade do expediente e tinham manutenção preventiva da rede de frio. CONCLUSÃO: Diante da variabilidade de situações, a avaliação de implantação dos CRIEs foi avaliada por perfil: \"melhor estrutura\" e \"ensino e pesquisa\" foram considerados implantados; \"dispensador de imunobiológicos\" e \"sala de vacinas\", parcialmente implantados; \"implantação incipiente\", não implantados<br>INTRODUCTION: The Reference Centers for Special Immunobiologicals (Centros de Referência para Imunobiológicos Especiais, CRIEs) are public vaccination clinics that provide vaccines and immunoglobulins not routinely available in the National Immunization Program (NIP) to persons with special needs, free of charge, by medical prescription. These centers also provide medical assistance for persons with adverse events following immunization (AEFI). The CRIEs were established in 1993, by the Brazilian NIP. OBJECTIVE: To evaluate the implementation of CRIEs on its compliance to formal policies and regulations. METHODS: This is a program evaluation, type \"evaluative research\". We developed an on-line questionnaire, with 170 questions, involving the dimensions: \"structure\", \"human resources\" and \"developed activities\". The persons in charge of the 42 CRIEs in activity in 2011 were invited to participate in this study. A statistical analysis was performed to group services with similar characteristics, applying the binary data\'s grouping method, by using the Quadratic Euclidean Distance (by the method of the farthest neighbor - complete linkage). RESULTS: A great diversity was observed among services, in the three dimensions. Thirteen (31%) CRIEs were in university premises; 29 (69%) had the minimum recommended spaces; 29 (69%) reported insufficiency of equipment for immunobiologicals storage; 22 (52%) did not conduct preventive maintenance of the cold chain; 30 (71%) had power generator; 24 (57%) had oxygen supply. The number of professionals varied from three to 21; four services did not have nurses and nine did not have doctors; 23 (55%) had doctors for at least half of working hours; 27 (64%) had human resources trained in emergency. The number of administered doses of immunobiologicals increased 66% from 2006 to 2010. Thirtyfive (83%) CRIEs were open at least 40 hours/week. Regarding care to AEFI, 28 (67%) CRIEs had laboratory support, 36 (86%) had hospital reference, and 36 (86%) had reference experts. The statistical analysis showed five service profiles, nominated according to their characteristics. 1) \"Best structure\": 12 CRIEs with the best index of the minimal recommended spaces, vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply. 2) \"Distribution centers\": 6 CRIEs that, mainly, delivered immunobiologicals to be administered in other services; none with a physician for at least half of the opening hours; none with vaccine storage chamber. 3) \"Incipient implementation\": 5 CRIEs with an overall poorer infrastructure; only some had vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply; none of them had computer. 4) \"Vaccination Room\": These 13 CRIEs administered routine immunization; most of them participated in immunization campaigns. 5) \"Teaching and research\": 6 CRIEs in teaching hospitals, performed research and received trainees; almost all of them had physicians for at least half of the working hours and preventive maintenance of the cold chain. CONCLUSION. Considering the services\' diversity, the implementation of CRIES was evaluated according to the different profiles: \"Best structure\" and \"Teaching and research\" were considered implemented; \"Distribution centers\" and \"Vaccination Rooms\", partially implemented; and \"Incipient implementation\", not implemented

This thesis explores the various meanings and implications of transparency in architecture and in learning environments in particular. Architectural transparency, achieved through choice of materials and principles of formal composition, creates a diversity of relationships and can facilitate visual, conceptual, and functional clarity as well as offering simultaneous perception of different spaces. It offers a range of phenomenological qualities and so provides an opportunity to explore and complicate such dichotomies as translucency and opacity, openness and closure, and public space and private space. While celebrated throughout modern and contemporary architecture, transparency raises issues of privacy and safety even as it breaks down hierarchies and social boundaries. The research-based design of transparency in a school building necessitates careful planning to achieve a balance between the access to views, natural light, fresh air, and social interaction that transparency may bring and the continuing obligation to provide a safe, secure environment for schoolchildren.

Submitted in fulfilment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015<br>Brief background: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. In South Africa the programme remained fragmented because of the system of apartheid until 1995 when the national EPI was formed through the unification of all immunisation services in the country. Since then there have been significant advances in immunisation service delivery in South Africa. Amongst the revisions that were made in 2009 was the change of the EPI schedule. Aim of the study The aim of the study was to investigate the factors that influence the uptake of the revised EPI for children between the ages of 6 to 12 years at Umlazi Township, KwaZulu-Natal in order to improve immunisation coverage. Methodology A descriptive quantitative design was used to conduct the study. A total of ten primary health care clinics were included in the study. Data was collected from child caregivers and health care workers using self-directed questionnaires. Results: It was worth noting that although the results of the study revealed that the EPI coverage for children between the ages 6 to 12 years remained low in Umlazi Township, however, the programme was well-implemented. Several factors that influenced the uptake of the immunisations were identified and these factors could be used to strengthen the EPI programme in Umlazi. Factors that had a negative influence on the uptake of immunisations were also identified and these factors could be used to develop strategies address the challenges.

PURPOSE: The purpose of the study was to explore the perception of the R48 trained professional nurses with regard to implementation of the EPI in Tshwane District Gauteng Province. METHODOLOGY: A qualitative research design was followed. Data were collected through in-depth qualitative interviews from a purposive sample of eight (8) R48 trained professional nurses. Eight steps of Tech’s inductive, descriptive open coding technique was followed. FINDINGS: The study established that EPI programme is important in R48 training. The implementation of integrated approach was viewed as beneficial leading to the reduction of diseases. The successful implementation would be more beneficial if it is consistently coupled with support from programme managers and regular in-service on up-dates of new vaccines and technologies are introduced within the programme<br>Health Studies<br>M.A. (Nursing Science)

The study sought to determine the meaning and interpretation by facility managers and nurses on utilisation of expanded programme on immunisation and integrated management of childhood illnesses (EPI and IMCI) programmes for follow-up and antibody testing of HIV-exposed infants (HEI) at 18 months. Also to understand the factors within the health systems that influence the follow-up and antibody testing. The study setting selected was six facilities in Steve Tshwete subdistrict in Nkangala district of Mpumalanga province in South Africa. The study used a hermeneutic phenomenology using in-depth interviews for collecting data from 4 facility managers and 12 nurses. The major themes that emerged from the interviews were referral, defaulting, integration, stigma, and off-site ART initiation within the health system. These were found to influence the utilisation of HEI and IMCI services for follow-up and management of HEI. It was also found that the importance of integrating the management of HEI into the EPI and IMCI cannot be overemphasised. It was concluded that the Health Department needs to be vigilant and use all available resources to manage HEI to meet the MDG 4 of prevention of infant mortality<br>Health Studies<br>M.A. (Nursing Science)

The purpose of this study was to evaluate the effectiveness of a hepatitis A vaccine requirement targeted at childcare center attendees aged 2--5 in Maricopa County, Arizona. Assessment of vaccine coverage shows that 13.4% of all children aged 2--5 years and 51.9% of children attending childcare have received at least one dose of hepatitis A vaccine. In addition, almost 85% of physicians surveyed agreed with the requirement. Incidence rates, for the overall population and the targeted age group, decreased following implementation A case-control study conducted prior to implementation found individuals with hepatitis A were 6 times more likely to have worked in or attended a childcare center compared to their matched controls. In addition, 40% of hepatitis A cases in the population were attributable to attending or working in a childcare center A case-control study was conducted post-implementation. Cases were individuals reported to surveillance staff between 8/1/99 and 4/30/00. Cases were included if they met the Centers for Disease Control hepatitis A surveillance case definition. Each case (n = 72) was matched to two controls (n = 144) based on age and neighborhood Cases were more likely to have had contact with a hepatitis A case (OR = 9.55, CI: 2.09, 43.67) compared to their matched controls in the unadjusted analysis. In addition, individuals with direct contact with a childcare center (OR = 0.223, CI: 0.049, 1.021) or greater than 12 years of education (OR = 0.149, CI: 0.055, 0.40) were protected against disease In the multivariate analysis, contact with a hepatitis A case (OR = 23.28, CI: 2.09, 28.35) was still significantly associated with disease. In addition, protective effects of education (OR = 0.146, CI: 0.045--0.476) and direct childcare center contact (OR = 0.065, CI: 0.004, 0.935) both remained significant. Over 12% (PAR = 12.5, CI: 3.12, 21.88) of the hepatitis A cases in the population were attributable to contact with a case The results of this study suggest the vaccination requirement has had some impact on the epidemiology of hepatitis A in Maricopa County. The risk associated with childcare centers seen in the 1997 study has either become protective or no longer significantly associated with hepatitis A disease<br>acase@tulane.edu

碩士<br>國立臺灣大學<br>預防醫學研究所<br>93<br>Background: Rubella vaccination has been started since 1986 in Taiwan, the vaccination policy have changed many times. At present, children in Taiwan receive routine MMR vaccine at 15 months old and then receive a booster dose at primary school entry. Susceptible women of child-bearing age also receive MMR vaccine. Objectives: This study is carried out to examine age-specific seroprevalence of antibodies against rubella and to elucidate associated factors for seropositivity in northern Taiwan. Study design: A cross-sectional study was conducted to survey school girls aged 7∼9 years (1995∼1997 cohorts), 11∼13 years (1991∼1993 cohorts), 15∼17 years (1987∼1989 cohorts), and 19∼22 years (1982∼1985 cohorts) in Taipei County. Child bearing women aged 25∼33 years (1971∼1979 cohorts) and women older than 34 years old who came to Taipei Hospital for pre-marital, pre-labor examination, and other health examinations were also included. Rubella seropositivity was defined as serum rubella IgG antibody level ≧ 10 IU/ml by enzyme immunoassay. Participants are given an informed consent and a questionnaire detailing socioeconomic status, education level, race of mother, number of siblings, and history of rubella infection and rubella vaccination. For women older than 25 years old, ethnicity, marital status, and parity were also asked. Possible predictors of rubella seropositivity and differences in seroprevalence for each age group were calculated by multiple logistic regression. Vaccination coverage rate was also investigated. Results: Total 1144 cases were recruited. The geometric mean rubella specific IgG antibody value was found be 76.1± 61.7 IU/ml. Rubella seropositivity rates were 282/287 (98.3 %) positive in persons aged 7∼9 years, 234/235 (99.6%) in aged 11∼13 years, 179/185 (96.8%) in aged 15∼17 years, 110/119 (92.4%) in aged 19∼22 years, and 197/242 (81.4%) in aged 25∼33 years, in aged 34∼44 years 68/76 (89.5%). Seropositivity decreased with age and was the lowest in the 25∼33-year-old age group. For child bearing age women (25∼44 years old), 51 out of 53 (96.2%) seronegative women were foreigners. Age, maternal low education level, foreign mother, and no vaccination at 15 months old were correlated with seronegativity in students (p < 0.05). In addition to previous predictors, foreigners, not married, low parity, and low family income were associated with seronegativity in women. Vaccine coverage rate in students was 99.6%. Comparing with United States and Italy, rubella seropositivity rates and vaccine coverage rate are higher in Taiwan. Conclusion: The vaccine program has promoted effectively immunity. However, to eliminate rubella and chronic rubella syndrome, more effort should be made to vaccinate susceptible foreign brides and old age reproductive Taiwanese women.

Measles immunization coverage in Namibia has not yet reached the WHO target of 90% in all provinces and districts, particularly in Luderitz district. The study aimed to determine the factors associated with the uptake of measles immunization among children in Luderitz district. A quantitative cross-sectional study was conducted among 150 parents/caregivers and their children who visited Luderitz clinic during July 2019 to August 2019. A developed questionnaire collected data on the several factors including child-related ,health service related and the perception of parents/caregivers. Data was analysed using STATA 14. Measles immunization uptake was 61% and significantly associated with child’s age (p=0.001) and gender (p=0.003), parents/caregivers age (p≤0.0001), gender (p=0.021), marital status (p≤0.0001) and employment status (p=0.009). Barriers to measles immunization were mainly inconvenient vaccination time (44%) and forgetfulness (25%) while suggested cues to action, were sending the reminders (30%), providing immunization the whole day (40%) and health education and promotion.<br>Health Studies<br>M.A. (Nursing Science)