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Gooding GD, Protudjer JL, Gabrielli S, Mulé P, Shand G, Zhang X, McCusker C, Noya FJ, Harvey M, Chalifour M, Sicard C, Abrams E, Amiel JA, Ngo TT, Bonnici A, MacDonald N, Ben-Shoshan M. COVID vaccine evaluation of barriers and resources among families of children with diagnosed allergies. Front Allergy 2023; 4:1101247. [PMID: 37216150 PMCID: PMC10198258 DOI: 10.3389/falgy.2023.1101247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2023] Open
Abstract
Background We aimed to determine vaccine hesitancy and the main barriers associated with the 2019 novel coronavirus, SARS-CoV-2 (COVID-19) vaccination among families of children diagnosed with food/drug/environmental allergies. Methods Between May and June 2021, we approached 146 families seen at the outpatient allergy clinic at the Montreal Children's Hospital and a community allergy practice were invited to complete an anonymous online survey on COVID-19 and vaccination attitudes and behaviour. Uni and multivariable logistic regressions were compared to estimate factors associated with vaccine hesitancy. Results Among all patients, 24.1% reported vaccine hesitancy. The large majority of parents (95.2%) believed that vaccines work. The most common barrier to vaccination was fear of adverse side effects (57.0%). One-third of participants (31.5%) reported that a history of food, venom and drug allergy was a contraindication for COVID-19 vaccination. Fifty-nine (60.8%) participants stated that the dissemination of additional information would increase their willingness to be vaccinated. Most (96.9%) parents reported that their children's vaccinations were up to date. Hesitant families were more likely to be parents of children aged 6-10 years, be of Asian descent, report that mRNA vaccines are riskier than traditional vaccines, and report that the vaccine should not be given if the child has a history of allergic reaction to vaccines. Conclusion Vaccine hesitancy exists mainly among certain ethnic groups and families with young children. Allergies to food, venom and drug allergy are commonly perceived as contraindications for COVID-19 vaccination. Knowledge translation activities addressing parental concerns will help increase vaccination rates.
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Affiliation(s)
- Gregory D. Gooding
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer L. Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Pasquale Mulé
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Greg Shand
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Francisco J. Noya
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Maria Harvey
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Mélodie Chalifour
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine Sicard
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elissa Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jacques-Alexandre Amiel
- Department of Pharmacy, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Thanh-Thao Ngo
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andre Bonnici
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Noni MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
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Uttekar S, MacDonald N, Orenstein WA, Danchin M, Blaser V, Thomson A, Menning L, Shimp L, Rath B, Limaye R, Esangbedo D, Abeyesekera S, Malue Nielsen S, Mackay S, Purnat T, Duraisamy K, Karthickeyan V, Siddique A, Thacker N. Empowering Health Workers to Build Public Trust in Vaccination: Experience from the International Pediatric Association's Online Vaccine Trust Course, 2020-2021. Vaccine 2023; 41:435-443. [PMID: 36470688 DOI: 10.1016/j.vaccine.2022.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The quality of interactions between health workers (HWs) and caregivers is key in vaccine acceptance. To optimize this, HWs need knowledge about best vaccine communication practices in person and on social media. Most pre-service curricula do not include such approaches. COVID-19 necessitated the International Pediatric Association (IPA) to shift from in-person train the trainer workshops to developing an online Vaccine Trust Course to address these gaps. METHOD The seven-module, 8-hour Vaccine Trust Course was offered online in seven languages and promoted globally. Course outcomes for participants between September 1, 2020 and September 30, 2021 were assessed using enrollment, participation, and completion data; pre-and post-training surveys of attitudes, knowledge, and practice skills; and follow-up practice surveys 3 months post course completion. RESULTS Of the 4,926 participants across 137 countries who registered; 2,381 (48.3 %) started the course, with 1,217 (51.1 %) completing. The majority were 25 - 39 years (57 %), female (57 %), and in pediatrics (70 %); 31 % came from India. 62 % of completers rated course structure/design as excellent, 36 % as good. Over 80 % rated the content as the most valuable aspect. Three months post training, 61 % HWs reported increased empathy towards caregivers, confidence while counseling and increased vaccine acceptance amongst their patients. 21 % identified the course as the only factor in these positive changes. CONCLUSION Shifting from face-to-face to online training due to the COVID-19 pandemic helped increase the global reach of HWs course engagement and uptake. Trained HWs reported increased empathy towards caregivers and confidence while counseling and increased patient vaccine acceptance.
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Affiliation(s)
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | | | - Margie Danchin
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; The University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vince Blaser
- Sabin Vaccine Institute, Washington, DC 20037, United States
| | | | | | - Lora Shimp
- John Snow, Inc., 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, United States
| | - Barbara Rath
- Vaccine Safety Initiative, Berlin, Germany; Université de Bourgogne Franche Comté, 32 Av. de l'Observatoire, 25000 Besançon, France
| | - Rupali Limaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E5521, Baltimore, MD 21205, United States
| | | | | | - Siff Malue Nielsen
- World Health Organization Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark
| | | | - Tina Purnat
- World Health Organization, Geneva, Switzerland
| | | | | | - Aninda Siddique
- University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1, Canada
| | - Naveen Thacker
- International Pediatric Association, Gandhidham, Gujarat, India; Deep Child Hospital and Research Centre, Plot No. 208, Sector 1A, Gandhidham, Gujarat, India.
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Vijayasingham L, Heidari S, Munro J, Omer S, MacDonald N. Resolving sex and gender bias in COVID-19 vaccines R&D and beyond. Hum Vaccin Immunother 2022; 18:2035142. [PMID: 35143380 PMCID: PMC9009935 DOI: 10.1080/21645515.2022.2035142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The influence of sex and gender in immune response and vaccine outcomes is established in many disease areas, including in COVID-19. Yet, there are notable gaps in the consideration of sex and gender in the analysis and reporting of COVID-19 vaccines clinical trial data. The push for stronger sex and gender integration in vaccines science should be championed by all researchers and stakeholders across the R&D and access ecosystem - not just gender experts. This requires joint action on the tactical framing of customized value propositions (based on stakeholder motivations), the stronger enforcement of existing regulation, tools, and commitments, and aligning the overall agenda to parallel calls on intersectionality, equity diversity and inclusion.
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Affiliation(s)
- Lavanya Vijayasingham
- Gender and Health Hub, United Nations University- International Institute for Global Health, Kuala Lumpur, Malaysia
- CONTACT Lavanya Vijayasingham Gender and Health Hub, United Nations University- International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jean Munro
- Gender Equality, GAVI Vaccine Alliance, Geneva, Switzerland
| | - Saad Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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Taddio A, Ilersich ANT, Bucci L, McMurtry CM, Gudzak V, Ipp M, Zita T, Tharmarajah S, MacDonald N. Letting kids play their CARDs (Comfort, Ask, Relax, Distract) to help cope with needle-related fear and pain: Results from user testing. Vaccine 2022; 40:7667-7675. [PMID: 36372667 DOI: 10.1016/j.vaccine.2022.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022]
Abstract
This study examined perceptions of children and parents about a new web-based CARD (Comfort, Ask, Relax, Distract) game that teaches children how to cope with needle-related pain and fear. A convenience sample of 15 child-parent dyads (children, 6-12 years) participated. Children played the game on a handheld device while being virtually monitored. Activity tracking revealed most children engaged with multiple components. Children reported they understood the game, it was easy to play, they learned coping strategies and believed they could implement them. Children reported lower fear of needles after playing. Parents liked the simplicity and variety of game activities. Most children and parents reported they would use the game or its coping strategies for future needles and would recommend the game. In summary, children and parents found the CARD web game acceptable and appropriate. Future studies can evaluate its effectiveness when integrated into upcoming needle procedures like COVID-19 vaccinations.
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada.
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph; Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
| | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Moshe Ipp
- Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Tina Zita
- Peel District School Board, Mississauga, Canada.
| | - Shenthuraan Tharmarajah
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Noni MacDonald
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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5
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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6
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Dubé E, Labbé F, Malo B, Manca T, Aylsworth L, Driedger SM, Graham J, Greyson D, MacDonald N, Meyer SB, Parsons Leigh J, Sadarangani M, Wilson S, MacDonald SE. " I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2088970. [PMID: 35767434 PMCID: PMC9621068 DOI: 10.1080/21645515.2022.2088970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients. METHODS Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted. RESULTS Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program. CONCLUSIONS While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Wilson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Marshall D, Krupp S, Khoury R, MacDonald N, Tokarski G, Makowski C, Miller J, Manteuffel J. 16 The Impact of an Emergency Department Alternatives to Opiates (ALTO) Program on Opiate Administration. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Dochez C, Duclos P, MacDonald N, Steffen C, Lambert PH. Advanced vaccinology training globally: Update and impact of the COVID-19 crisis. Vaccine 2022; 40:5683-5690. [PMID: 36030127 PMCID: PMC9393177 DOI: 10.1016/j.vaccine.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
A total of 33 advanced vaccinology courses were in existence in 2021. Some vaccinology courses were not sustained since 2018. The number of vaccinology courses has been increasing during the last few years, with courses offered in each WHO region. The COVID-19 pandemic resulted in the cancellation or postponement of some vaccinology courses. Due to the COVID-19 pandemic, an increased number of courses are using an online or hybrid format.
The rapid development of innovations and new technologies, the focus on the life-course approach to immunization and equity, and the prevalent hesitancy towards vaccines requires immunization staff to be well-trained and updated regularly in order to deliver quality immunization services to the public. The need for advanced vaccinology training is therefore paramount. In preparation for a second Global Workshop on Advanced Vaccinology Training that took place in March 2022, this paper presents the results of a survey aiming to provide a thorough update of a landscape analysis on advanced vaccinology courses conducted in 2018 and a look at the impact of the COVID-19 crisis. Thirty-three course organizers responded to a survey to provide information on their respective course. Of those, 17 courses are short courses, 11 post-graduate courses and 5 are Master level courses. Most courses are organized on an annual basis. Even though some courses were not sustained overtime, the number of courses has been increasing during the last few years, and at least one vaccinology course is now being offered in each WHO region. Although the training capacity has increased tremendously, the need still exceeds the capacity and many courses have way more applicants than they can select. The most frequent challenges reported included sustainable funding and identifying faculty. The COVID-19 pandemic impacted the delivery of several vaccinology courses, which have been postponed or reformatted to an online or hybrid training event. An e-portal of the global collaboration has been established to facilitate communication between the different courses and to assist future course participants to identify the most suitable course for their needs.
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Affiliation(s)
- Carine Dochez
- University of Antwerp, Network for Education and Support in Immunisation, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Philippe Duclos
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | | | - Paul-Henri Lambert
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
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Dubé E, Gagnon D, MacDonald N. Between persuasion and compulsion: The case of COVID-19 vaccination in Canada. Vaccine 2022; 40:3923-3926. [PMID: 35637068 PMCID: PMC9134169 DOI: 10.1016/j.vaccine.2022.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
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McIntyre PB, Aggarwal R, Jani I, Jawad J, Kochhar S, MacDonald N, Madhi SA, Mohsni E, Mulholland K, Neuzil KM, Nohynek H, Olayinka F, Pitisuttithum P, Pollard AJ, Cravioto A. COVID-19 vaccine strategies must focus on severe disease and global equity. Lancet 2022; 399:406-410. [PMID: 34922639 PMCID: PMC8676417 DOI: 10.1016/s0140-6736(21)02835-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Peter B McIntyre
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Sonali Kochhar
- Department of Global Health, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
| | - Noni MacDonald
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Shabir A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kim Mulholland
- Department of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Folake Olayinka
- STAR Fellows Department, Public Health Institute, Washington DC, USA
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine and the Vaccine Trial Centre, Mahidol University, Nakhon Pathom, Bangkok
| | | | - Alejandro Cravioto
- Department of Public Health, National Autonomous University of Mexico, Mexico City, Mexico
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11
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Getachew B, Solomon S, Ramet BT, Mezgebu T, Ewnetu DB, MacDonald N. Feeding Experiences of HIV-Exposed Preterm Infants Among Mothers Living with HIV in Addis Ababa, Ethiopia: A Qualitative Study. HIV AIDS (Auckl) 2021; 13:973-981. [PMID: 34754246 PMCID: PMC8572019 DOI: 10.2147/hiv.s333537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
Introduction Providing adequate nutrition to preterm infants who are born to HIV-positive mothers is more challenging due to the mother’s underlying health and nutrition status. The understanding of these issues and active participation of the mothers have a significant role in giving continuous care for HIV-exposed preterm infant. Hence, this study aimed to explore the experience of HIV-positive mothers’ feeding practice of their preterm infants, and health workers to identify barriers and facilitators of feeding HIV-exposed preterm infants. Methods A phenomenological qualitative study design was conducted in Addis Ababa, Ethiopia, between May 1, 2016 and March 31, 2017. Mothers who gave birth to HIV-exposed preterm infants at the study sites’ follow-up clinic were traced and invited by the healthcare providers to voluntarily participate in this study. Fifteen in-depth interviews with mothers of HIV-exposed preterm infants and seven key informant interviews with health professionals and policymakers were carried out. The interviews were transcribed and translated and then manually analyzed thematically. Results The health education given during antenatal care (ANC) did not consider the feeding practice needs for HIV-exposed preterm infants. Child health status, desire to have a healthy infant, financial constraints and family support were among the influential factors in the feeding practice of HIV-exposed preterm infants mentioned by the study participants. HIV-exposed preterm infant feeding procedure neither has a guideline nor is clearly mentioned in the national HIV guidelines. Conclusion The desire to have a healthy infant was a major facilitator for feeding of HIV-exposed premature infants. However, financial constraints majorly limited the option to be only exclusive breastfeeding. This became even more problematic for the mother if the premature infant became ill and could not breastfeed well.
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Affiliation(s)
| | - Semaria Solomon
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Tirumebet Mezgebu
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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12
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Cull K, Bowles SK, MacDonald N, McNeil S, Taylor B, Slayter K, Steenbeek A, Taddio A, Bucci LM, Isenor JE. Patient perspectives of pain mitigation strategies for adult vaccine injections. Can J Pain 2021. [DOI: 10.1080/24740527.2021.1967113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kathryn Cull
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan K. Bowles
- Department of Pharmacy, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly McNeil
- Division of Infectious Diseases, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Beth Taylor
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathryn Slayter
- Department of Pharmacy, IWK Health, Halifax, Nova Scotia, Canada
| | - Audrey Steenbeek
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lucie M. Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
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Abaasa CN, Rukundo GZ, Ayesiga S, Atukunda SP, Campisi S, O'Hearn S, MacDonald N. Healthcare providers and caregivers' perspectives on factors responsible for persistent malnutrition of under 5 children in Buhweju district, South Western Uganda; a phenomenological qualitative study. BMC Public Health 2021; 21:1495. [PMID: 34344341 PMCID: PMC8330056 DOI: 10.1186/s12889-021-11432-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Unacceptably high levels of childhood malnutrition have been registered in all regions of Uganda over the years. Buhweju district alone contributed 46% prevalence of childhood malnutrition to the 47.8% estimated national prevalence for the whole of western Uganda in 2014. This study assessed health provider and caregiver opinions on factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Methods In this phenomenological qualitative study, we conducted two key informant interviews and six focus group discussions with Village Health Team members and care takers of under five children in Engaju and Nyakishana sub-counties respectively.to explore their opinions on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5. Results Historical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Conclusion Persistent malnutrition in under five children is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services. Thus literacy education for mothers and young adolescent boys and girls through engaging local leaders, local nongovernmental organizations and Companies operating in the district to contribute to social services provision would limit the domestic violence and increase sensitization on male responsibilities in the children care in Buhweju district. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11432-1.
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Affiliation(s)
- Catherine N Abaasa
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Savino Ayesiga
- Department of Anatomy, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Susan Campisi
- Hospital for Sick Children, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Shawna O'Hearn
- Global Health, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Noni MacDonald
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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14
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Heidari S, Durrheim DN, Faden R, Kochhar S, MacDonald N, Olayinka F, Goodman TS. Time for action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind. BMJ Glob Health 2021; 6:e006854. [PMID: 34389628 PMCID: PMC8366282 DOI: 10.1136/bmjgh-2021-006854] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Shirin Heidari
- Gender, Equity and Human Rights Unit, World Health Organization, Geneva, Switzerland
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - David N Durrheim
- Public Health Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
| | - Ruth Faden
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonali Kochhar
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Global Health, Global Healthcare Consulting, New Delhi, India
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Noni MacDonald
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Department of Pediatrics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
| | - Folake Olayinka
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
- Public Health Institute/STAR, Washington, DC, USA
| | - Tracey S Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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15
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Castillo E, Patey A, MacDonald N. Vaccination in pregnancy: Challenges and evidence-based solutions. Best Pract Res Clin Obstet Gynaecol 2021; 76:83-95. [PMID: 34090801 DOI: 10.1016/j.bpobgyn.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 01/31/2023]
Abstract
Vaccination in pregnancy (VIP) is dually beneficial - it protects the mother and the baby from tetanus, influenza, and pertussis. VIP uptake is low in many countries. Vaccine hesitancy, defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccination despite the availability of vaccination services" is one of WHO's ten threats to global health per 2019. According to extensive research, mostly from high-income countries (HIC) and limited to tetanus, influenza and pertussis vaccines, lack of provider recommendations, safety concerns, and limitations in access are the main barriers to VIP. Health care provider recommendation is the leading facilitator for VIP across various socioeconomic status groups. Data on strategies to overcome patient, provider, and system barriers to VIP are inconsistent, contradictory, or lacking. Patient-focused research on evidence-based strategies to overcome provider and system barriers is needed. Furthermore, VIP programs require embedded continuous quality improvement to ensure sustainability.
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Affiliation(s)
- Eliana Castillo
- Department of Medicine, University of Calgary, Canada; Department of Obstetrics and Gynaecology University of Calgary, Canada.
| | - Andrea Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Canada; Faculty of Health Sciences, Queen's University, Canada
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Dutton J, Zardab M, De Braal VJF, Hariharan D, MacDonald N, Hallworth S, Hutchins R, Bhattacharya S, Abraham A, Kocher HM, Yip VS. The accuracy of pre-operative (P)-POSSUM scoring and cardiopulmonary exercise testing in predicting morbidity and mortality after pancreatic and liver surgery: A systematic review. Ann Med Surg (Lond) 2020; 62:1-9. [PMID: 33489107 PMCID: PMC7804364 DOI: 10.1016/j.amsu.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiopulmonary exercise-testing (CPET) and the (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity ((P)-POSSUM) are used as pre-operative risk stratification and audit tools in general surgery, however, both have been demonstrated to have limitations in major hepatopancreatobiliary (HPB) surgery. Materials and methods The aim of this review is to determine if CPET and (P)-POSSUM scoring systems accurately predict morbidity and mortality. Eligible articles were identified with an electronic database search. Analysis according to surgery type and tool used was performed. Results Twenty-five studies were included in the final review. POSSUM predicted morbidity demonstrated weighted O/E ratios of 0.75(95%CI0.57–0.97) in hepatic surgery and 0.85(95%CI0.8–0.9) in pancreatic surgery. P-POSSUM predicted mortality in pancreatic surgery demonstrated an O/E ratio of 0.75(95%CI0.27–2.13) and 0.94(95%CI0.57–1.55) in hepatic surgery. In both pancreatic and hepatic surgery an anaerobic threshold(AT) of between 9 0.5–11.5 ml/kg/min was predictive of post-operative complications, and in pancreatic surgery ventilatory equivalence of carbon dioxide(˙VE/˙VCO2) was predictive of 30-day mortality. Conclusion POSSUM demonstrates an overall lack of predictive fit for morbidity, whilst CPET variables provide some predictive power for post-operative outcomes. Development of a new HPB specific risk prediction tool would be beneficial; the combination of parameters from POSSUM and CPET, alongside HPB specific markers could overcome current limitations. Current pre-operative scoring for pancreatic and liver surgery is inaccurate. In pancreatic and liver surgery anaerobic threshold scores were predictive of complications. In pancreatic surgery ventilatory equivalence of carbon dioxide was predictive of mortality. P-POSSUM is inaccurate for predicting mortality and morbidity in pancreatic surgery.
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Affiliation(s)
| | | | | | | | - N MacDonald
- Department of Anaesthesia, The Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1BB, UK
| | - S Hallworth
- Department of Anaesthesia, The Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1BB, UK
| | | | | | | | | | - V S Yip
- Barts and London HPB Centre, UK
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17
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Taddio A, Bucci L, McMurtry CM, MacDonald N, Badali M. Introducing a practical tool to reduce fear and anxiety during COVID-19. Can Pharm J (Ott) 2020; 154:26-29. [PMID: 33598056 DOI: 10.1177/1715163520975424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa
| | | | - Noni MacDonald
- the Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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18
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MacDonald N, Harmon SHE, Faour D, Graham J, Steffen C, Henaff L, Shendale S. Mandatory immunization: Empirical examination of governance instruments in 28 Global NITAG Network (GNN) countries. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the Global Vaccine Action Plan 2017 Assessment Report, WHO's SAGE noted need to understand ways in which legislation and regulation are used to advance or undermine immunization. The NITAG Environmental Scan Project sought to address this in a pilot study.
Methods
Data was collected via a secure online survey of GNN members (40 countries Sept 2018). Respondents reporting a mandatory element were asked: (1) what vaccinations were required by law; and (2) what population groups were subject to mandates; (3) what grounds, if any, were available for requesting exemptions.
Results
28 (70%) countries responded, representing every WHO region and World Bank income level. While mandatory immunization programs / elements within broader NIPs were relatively common, jurisdictions varied with respect to immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We observed some loose associations with geography and income level. Children were the most common population group subject to mandates at some stage of childhood development (28/28); healthcare workers were second (8/15 (53%)). Sanctions for failure to immunize varied broadly, ranging from no penalty, to loss of access to social services e.g. admission to school, monetary fines, and incarceration. A variance between countries as to how strictly immunization mandates are enforced was noted.
Conclusions
A variety of approaches existed ranging from Narrow/Permissive to Broad/ Inclusive in scope with enforcement mapping loosely to this continuum from Loose/Permissive to Tight/Coercive. Jurisdictions with few/no vaccines mandated, and few/no target groups identified, Loose approach is expected; for those closer to Broad approach, Tighter controls expected. Coercive measures may be 'positive' (vaccination as a gateway to public services, with possible work-arounds), or 'negative' (failure to vaccinate = penalties).
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Affiliation(s)
- N MacDonald
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - S H E Harmon
- Faculty of Law and Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - D Faour
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - J Graham
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - C Steffen
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - L Henaff
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - S Shendale
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
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19
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Logeman C, Taddio A, McMurtry CM, Bucci L, MacDonald N, Chalmers G, Gudzak V, Shah V, Coldham J, Little C, Samborn T, Dribnenki C, Snider J. Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School. Children (Basel) 2020; 7:E126. [PMID: 32899632 PMCID: PMC7552616 DOI: 10.3390/children7090126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre-post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
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Affiliation(s)
- Charlotte Logeman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada;
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, ON K1Z 8R9, Canada;
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada;
| | - Garth Chalmers
- University of Toronto Schools, Toronto, ON M5S 2R7, Canada;
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Joanne Coldham
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cheri Little
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Tracy Samborn
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cindy Dribnenki
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Joanne Snider
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
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MacDonald N, Mohsni E, Al-Mazrou Y, Kim Andrus J, Arora N, Elden S, Madrid MY, Martin R, Mahmoud Mustafa A, Rees H, Salisbury D, Zhao Q, Jones I, Steffen CA, Hombach J, O'Brien KL, Cravioto A. Global vaccine action plan lessons learned I: Recommendations for the next decade. Vaccine 2020; 38:5364-5371. [PMID: 32563607 PMCID: PMC7342005 DOI: 10.1016/j.vaccine.2020.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
The Global Vaccine Action Plan 2011-2020 (GVAP) was developed to realize the ambitions of the Decade of Vaccines - that all individuals and communities enjoy lives free from vaccine-preventable diseases. It included a comprehensive monitoring and evaluation/accountability framework to assess progress towards global targets with recommendations for corrective actions. While many of the GVAP targets are very unlikely to be met by the end of 2020, substantial progress has nevertheless been made, establishing a strong foundation for a successor global immunization strategy, the Immunization Agenda 2030 (IA2030). The Strategic Advisory Group of Experts on immunization has made a series of recommendations to ensure that the lessons learned from GVAP inform the development and implementation of IA2030.
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Affiliation(s)
- Noni MacDonald
- SAGE Decade of Vaccines Working Group; Professor of Paediatrics, Dalhousie University, IWK Health Centre, Canada. Chair of the SAGE Decade of Vaccines Working Group.
| | - Ezzeddine Mohsni
- SAGE Decade of Vaccines Working Group; Senior Technical Adviser in Global Health Development/Eastern Mediterranean Public Health Network
| | - Yagob Al-Mazrou
- SAGE Decade of Vaccines Working Group; Secretary General - Health Services Council of the Kingdom of Saudi Arabia, Saudi Arabia
| | - Jon Kim Andrus
- SAGE Decade of Vaccines Working Group; Adjunct Professor and Director, Division of Vaccines and Immunization, Center for Global Health, University of Colorado, USA
| | - Narendra Arora
- SAGE Decade of Vaccines Working Group; Executive director, International Clinical Epidemiology Network, India
| | - Susan Elden
- SAGE Decade of Vaccines Working Group; Health Adviser, Department for International Development, London, UK
| | - Marie-Yvette Madrid
- SAGE Decade of Vaccines Working Group; Independent Consultant, Geneva, Switzerland
| | - Rebecca Martin
- SAGE Decade of Vaccines Working Group; Director of the Center for Global Health, US CDC, USA
| | - Amani Mahmoud Mustafa
- SAGE Decade of Vaccines Working Group; Project Manager, Sudan Public Health Training Initiative, Carter Center, Sudan
| | - Helen Rees
- SAGE Decade of Vaccines Working Group; Executive Director, Wits Reproductive Health and HIV Institute, Personal Professor, Ob/Gyn Codirector, African Leadership in Vaccinology Excellence, University of Witwatersrand, South Africa
| | - David Salisbury
- SAGE Decade of Vaccines Working Group; Associate Fellow, Centre on Global Health Security, Chatham House, London, UK
| | - Qinjian Zhao
- SAGE Decade of Vaccines Working Group; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ian Jones
- Jinja Publishing Ltd, Bishop's Stortford, UK
| | - Christoph A Steffen
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Alejandro Cravioto
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Chair, Strategic Advisory Group of Experts on Immunization (SAGE)
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21
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Cherian T, Hwang A, Mantel C, Veira C, Malvolti S, MacDonald N, Steffen C, Jones I, Hinman A. Global Vaccine Action Plan lessons learned III: Monitoring and evaluation/accountability framework. Vaccine 2020; 38:5379-5383. [PMID: 32430149 PMCID: PMC7342004 DOI: 10.1016/j.vaccine.2020.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Monitoring & Evaluation/Accountability (M&E/A) framework of the Global Vaccine Action Plan (GVAP) was used to report progress annually to the World Health Assembly (WHA). METHODS Stakeholder feedback was obtained through five reviews consisting of surveys and semi-structured interviews conducted from 2017 to 2019. Participants consisted of individuals involved in the development and implementation of GVAP or its M&E/A process, national immunization managers, academics, representatives of non-governmental organizations, and civil society organizations. RESULTS The feedback was mixed and contradictory for some components, though most participants reported that the M&E/A process was a highlight of GVAP and a step in the right direction. Several of the goals and targets were considered aspirational and unrealistic for many countries. There were mixed responses on whether it promoted accountability, especially at the country level. DISCUSSION The mixed and contradictory views on the M&E/A processes and its impact suggested a failure of communication about its scope and intent. Though the process, especially the annual reporting to the WHA, kept immunization high on the global agenda, it failed to fully meet the expectations in promoting accountability. Engaging with countries to capture the local context in setting global goals and targets and promoting local M&E/A processes will be important to achieve accountability in the next decade.
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Affiliation(s)
- Thomas Cherian
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Angela Hwang
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland; Angela Hwang Consulting, P.O. Box 6601, Albany, CA 94706, USA.
| | - Carsten Mantel
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Chantal Veira
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, USA.
| | - Stefano Malvolti
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Noni MacDonald
- Dalhousie University, IWK Health Centre, Halifax, Canada
| | - Christoph Steffen
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | - Ian Jones
- Jinja Publishing Ltd, Bishop's Stortford, United Kingdom
| | - Alan Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, USA.
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Martin A, Albrechtsons D, MacDonald N, Aumeerally N, Wong T. Becoming parents again: Challenges affecting grandparent primary caregivers raising their grandchildren. Paediatr Child Health 2020; 26:e166-e171. [PMID: 34131461 DOI: 10.1093/pch/pxaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background A growing number of Canadian children live in the care of their grandparents, called skip-generation families. Reasons for this include teen pregnancy, death of a parent, mental/physical illnesses, and addictions. These grandparents and grandchildren are at increased risk of physical and mental illness, yet have few resources available to them. Objective Our study aims to describe the lived experiences of skip-generation families to better identify their needs. Methods We conducted semistructured interviews of grandparent primary caregivers from ten households in our community to chronicle their experiences raising their grandchildren. Participants were recruited by paediatricians using convenience sampling. Interviews were recorded, transcribed, and coded using Atlas Ti software, and classified into themes by consensus. Results Five primary themes emerged from the interviews: (1) Changes in family dynamics, (2) Psychosocial impact on grandchild and grandparent, (3) Lack of resources for grandparent caregivers, (4) The challenges of parenting later in life, and (5) Resilience inspired by the love of family. Many participants (n=10) described feeling unsupported after assuming care of their grandchildren and identified a need for additional counselling services, financial support and respite care. All (n=11) highlighted that caring for their grandchildren changed their lives in positive ways. Conclusion When grandparents are prioritized as primary caregivers for their grandchildren, our study suggests they receive insufficient community resources to meet their emotional, respite and financial needs. Further research involving this population in Canada is required. Paediatricians can play an essential role in recognizing these vulnerable families and advocating for additional supports and services.
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Affiliation(s)
- Ashley Martin
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - Daniel Albrechtsons
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - Noni MacDonald
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - Nadia Aumeerally
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - Tania Wong
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
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Bulemela J, Mapunda H, Snelgrove-Clarke E, MacDonald N, Bortolussi R. Supporting breastfeeding: Tanzanian men's knowledge and attitude towards exclusive breastfeeding. Int Breastfeed J 2019; 14:52. [PMID: 31889975 PMCID: PMC6933626 DOI: 10.1186/s13006-019-0244-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive breastfeeding (EBF) is one of the key strategies to ensure infants and young children survive and grow. However, a 2010 study showed that it was only practiced by 50% of Tanzanian women. That study also found that men were rarely supportive; either at home or in the health facilities, due to their personal beliefs or to traditional beliefs and culture of the community. In a report six years later the rate of EBF has decreased to 30%, in one region. Methods In this qualitative study, we used focus groups to assess the knowledge and attitudes of 35 men from three villages on the benefits of EBF, the disadvantages of not breastfeeding, and how they can support their partners' breastfeeding. In addition, we assessed how they felt about spending time at home, if they considered handling the infant to be rewarding and whether they helped the mother with home chores. Differences in village infrastructure and characteristics were noted. Results Five themes were identified, including traditional roles, and feelings of exclusion/inclusion and resistance. Men felt they needed better information on EBF. They wished that their partners could breastfeed for a longer time, since they realized it improved infant growth and prevented disease; however, they did not have time to remain with the infant at home. Poverty required the men to work for long periods outside the home. As well, the men were not involved with the Reproductive Child Health Clinic (RCHC) except at the time of delivery or for mandatory HIV testing, however, they wanted to be educated together with their partners at the RCHC. Conclusion Most men in this study understood that the EBF period was important, and that it broadened their relationship with their partner. EBF, however, could be a challenge for couples because of poverty. Nevertheless, many men wanted to help and to become more involved.
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Affiliation(s)
- Janeth Bulemela
- Tanzanian Training Centre for International Health (TTCIH), Ifakara, Tanzania.,2St Francis Referral Hospital, Ifakara, Tanzania.,St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Heka Mapunda
- Tanzanian Training Centre for International Health (TTCIH), Ifakara, Tanzania
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Manteuffel J, Shayya S, Sabagha N, MacDonald N, Griebe K, Doyal M, Hedroug Y, France J, El-Khoury C, Theoharris T. 317 Sustainable Naloxone Education and Distribution From an Urban Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto M5S 3M2, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax B3H 4R2, Canada
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Dowell AC, Menning L, MacDonald N, Turner N. An evolution in thinking to support the post 2020 global vaccine strategy: The application of complexity and implementation science. Vaccine 2019; 37:4236-4240. [PMID: 31235372 DOI: 10.1016/j.vaccine.2019.05.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony C Dowell
- Department of Primary Health Care and General Practice, University of Otago-Wellington, New Zealand.
| | - Lisa Menning
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Nikki Turner
- Director Immunisation Advisory Centre, University of Auckland, New Zealand
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Duclos P, Martinez L, MacDonald N, Asturias E, Nohynek H, Lambert PH. Global vaccinology training: Report from an ADVAC workshop. Vaccine 2019; 37:2871-2881. [PMID: 30898392 DOI: 10.1016/j.vaccine.2019.02.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
At a workshop on 7-8 November 2018 the leaders of 26 advanced vaccinology courses met to carry out an extensive review of the existing courses worldwide, in order to identify education gaps and future needs and discuss potential collaboration. The main conclusions of the workshop concerned: opportunities for strengthening and expanding the global coverage of vaccinology training; evaluation of vaccinology courses; updating knowledge after the course; how to facilitate post-course 'cascade' training; developing and sharing best practices; the application of online and innovative approaches in adult education; and how to reduce costs and facilitate wider access to vaccinology training. The importance of collaboration and information exchange through networks of alumni and between courses was stressed. A web platform to provide information about existing courses for potential applicants is needed. Lack of sustainable funding is a constraint for vaccinology training and needs to be addressed.
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Affiliation(s)
- Philippe Duclos
- University of Geneva, Centre de Vaccinologie, 1 rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Lindsay Martinez
- Independent consultant, 13 Chemin Maurice Ravel, CH-1290 Versoix, Switzerland.
| | - Noni MacDonald
- Dalhousie University, Division Pediatric Infections, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Edwin Asturias
- University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 310, 80045 Aurora, United States.
| | - Hanna Nohynek
- National Institute for Health and Welfare Department of Vaccines and Immune Protection, 166 Mannerheimintie, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Paul-Henri Lambert
- University of Geneva, Centre de Vaccinologie, 1 rue Michel Servet, 1211 Geneva 4, Switzerland.
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Desai S, MacDonald N. Les maladies évitables par la vaccination : un aperçu des maladies peu fréquentes pour le professionnel de la santé de première ligne. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shalini Desai
- Société canadienne de pédiatrie, comité des maladies infectieuses et d’immunisation, Ottawa (Ontario)
| | - Noni MacDonald
- Société canadienne de pédiatrie, comité des maladies infectieuses et d’immunisation, Ottawa (Ontario)
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Abstract
This practice point provides quick information for front-line health care providers on vaccine-preventable diseases which, given the success of immunization programs in Canada, are now uncommon or rarely seen. These infections can still occur in children and youth from Canada and elsewhere, and their clinical identification has important public health implications. Knowledge of signs and symptoms, immunizing travellers and newcomers to Canada, awareness of outbreaks in-community and elsewhere, and early consultation with an expert in infectious diseases and public health authorities in suspected cases, are key preventive care measures.
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Affiliation(s)
- Shalini Desai
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
| | - Noni MacDonald
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
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Freedman T, Taddio A, Alderman L, McDowall T, deVlaming-Kot C, McMurtry CM, MacDonald N, Alfieri-Maiolo A, Stephens D, Wong H, Boon H. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on student symptoms. Paediatr Child Health 2019; 24:S42-S53. [PMID: 30948922 PMCID: PMC6438866 DOI: 10.1093/pch/pxz020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many students are afraid of receiving vaccinations at school. We implemented a novel, multifaceted knowledge translation intervention incorporating evidence-based vaccination coping strategies-The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-and evaluated impact on student attitudes, knowledge, coping strategies used, and symptoms during school-based vaccinations. METHODS Mixed methods. Ten schools participated in a controlled clinical trial: five experimental and five control. Experimental School (ES) students completed a knowledge and attitudes survey during an in-class CARD™ educational session prior to school vaccinations and selected coping strategies for upcoming vaccinations. Control School (CS) students received the usual vaccine education lesson, which did not include information about or selection of coping strategies. At all schools and during both vaccination clinic visits (fall and spring), injecting nurses recorded specific coping strategies used, and students independently rated their fear, pain, and dizziness during vaccinations. Focus groups were conducted at five schools after all clinics were completed (three ES, two CS). RESULTS ES students had higher knowledge (P<0.001), less fear (P=0.03), and greater willingness to be vaccinated (P=0.001) after the in-class education session. Students rated the education as understandable, sufficient, useful, and that it prepared them for vaccinations. During school vaccination clinics, ES students selected more coping interventions than CS students. There were fewer students with high levels of fear (P=0.008) and dizziness (P=0.04) in the ES group. In round 2, fewer students (P=0.02) in the ES group returned to the clinic postvaccination because they were feeling unwell. ES students participating in focus groups scored higher on their knowledge test (P<0.001) compared with CS students and reported learning and benefitting from CARD™. DISCUSSION This small-scale implementation study provides preliminary evidence of the effectiveness of CARD™ in improving vaccination experiences for students at school. Future research is recommended that examines CARD™ in different settings to confirm these results.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | | | | | | | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Taddio A, Alderman L, Freedman T, McDowall T, McMurtry CM, MacDonald N, deVlaming-Kot C, Alfieri-Maiolo A. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery. Paediatr Child Health 2019; 24:S54-S67. [PMID: 30948923 PMCID: PMC6438865 DOI: 10.1093/pch/pxz021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We conducted a small-scale implementation study that integrated The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. METHODS Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. RESULTS Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARD™. Experimental group nurses were able to integrate CARD™ within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARD™ built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. CONCLUSION CARD™ is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Taddio A, Freedman T, Wong H, McMurtry CM, MacDonald N, Ilersich ANT, Ilersich ALT, McDowall T. Stakeholder feedback on The CARD™ System to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S29-S34. [PMID: 30948920 PMCID: PMC6438868 DOI: 10.1093/pch/pxz018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE School-based vaccination programs can be a source of distress for many students due to the pain from the needle injection and related fears. We created a multifaceted Knowledge Translation (KT) intervention to address vaccination and pain, fear, and fainting called The CARD™ System. The objectives were to document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear. METHODS Quantitative and qualitative methods were used. Students, school staff, public health nurses, and parents participated in separate focus groups whereby they independently completed a knowledge and attitudes survey and provided structured and qualitative feedback on key KT tools of the multifaceted KT intervention. They then repeated the knowledge and attitudes survey. RESULTS Altogether, 22 students (grade 6 and 7), 16 school staff (principals, grade 7 and 8 teachers, resource teachers, secretaries), 10 nurses (injecting, charge, and school nurses), and 3 parents participated. Knowledge test scores increased post-KT tool review: 8.5 (2.1) versus 7.3 (1.9); P<0.001. Attitudes were more positive about the individual nature of pain and fear experience during vaccination. Student fear scores were lower post-tool review: 5.1 (2.9) versus 4.6 (3.0); P<0.001. The majority of the participants reported they understood all the information, the amount was just right and that the information was useful. DISCUSSION The KT tools were demonstrated to be acceptable and to improve knowledge. Future research is warranted to determine their impact on student experience during school vaccinations.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | | | | | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Freedman T, Taddio A, McMurtry CM, Wong H, MacDonald N, McDowall T, deVlaming-Kot C, Alderman L. Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S19-S28. [PMID: 30948919 PMCID: PMC6438867 DOI: 10.1093/pch/pxz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Pain, fear, and fainting management during school-based vaccinations is suboptimal. The objective was to examine stakeholder perceptions of barriers and facilitators to better practices. Method: Six semi-structured focus groups were conducted in Niagara Region, Ontario: two parent groups (n=7); one grade 7 to 8 student group (n=9); two nurse groups (n=12); and one school staff group (n=6). Participants shared perceptions about school vaccination clinics and the implementation of specific strategies and tools. Focus groups were audio recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis. RESULTS Feedback from stakeholders was categorized into four domains of CFIR: intervention characteristics, inner setting, outer setting, and characteristics of individuals. Intervention characteristics included: vaccine educational materials, vaccination accommodations, distraction techniques, topical anaesthetics, and food. Inner setting factors included: school vaccination procedures, relationships between school staff and nurses, assessment and documentation of student fear, and factors that contribute to a chaotic vaccination clinic. Outer setting factors were: the social environment and addressing parent and student needs. Stakeholder roles were discussed in characteristics of individuals. CONCLUSION This study identified elements that can facilitate and challenge pain and fear mitigation tools and strategies; these elements should be considered in the development of a Knowledge Translation (KT) intervention to improve the school vaccination experience.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Taddio A, Ilersich ANT, Ilersich ALT, Schmidt C, Chalmers G, Wilson E, McMurtry CM, MacDonald N, Bucci LM, Freedman T, Wong H. Piloting The CARD™ System for education of students about vaccination: Does it improve the vaccination experience at school? Paediatr Child Health 2019; 24:S35-S41. [PMID: 30948921 PMCID: PMC6438862 DOI: 10.1093/pch/pxz019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Many students are fearful of vaccine injection-associated pain. In prior research, we created Knowledge Translation (KT) tools to address school vaccinations and associated pain, fear, and fainting. The objectives of this pilot implementation project were to determine the acceptability and impact of these KT tools on student knowledge, attitudes, and perceptions of their vaccination experience. METHODS Pre-post mixed methods design. Students in an independent school in the Greater Toronto Area, Ontario, participated in two separate focus groups before and after school vaccinations. In both sessions, they independently completed a knowledge and attitudes survey, reviewed three KT tools (two videos and one pamphlet) and then repeated the knowledge and attitudes survey. They provided structured and qualitative feedback about the KT tools and described the impact of the education on the vaccination experience. RESULTS Altogether, 11 grade 7 students participated. Knowledge scores were higher post-tool review compared to baseline in the first focus group. There was no significant difference in fear scores and attitudes about getting vaccinated. Qualitative feedback was categorized into two themes: intervention characteristics and characteristics of the school environment. Students reported the KT tools helped them to prepare for vaccination. They used the information on vaccination day to reduce their own fear and pain and to assist peers. They believed all students should view the KT tools. Students reported that teachers and nurses did not do enough to make vaccinations a positive experience. For example, they did not provide a private setting as an option for vaccination and prevented them from using some coping strategies recommended in the KT tools. DISCUSSION This study provides preliminary evidence of the acceptability and positive impact of the KT tools on students' vaccination experiences. Future research is recommended that involves inclusion of all students and adults in the KT intervention.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | | | | | | | | | - Evelyn Wilson
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| | | | | | | | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Taddio A, McMurtry CM, Bucci LM, MacDonald N, Ilersich ANT, Ilersich ALT, Alfieri-Maiolo A, deVlaming-Kot C, Alderman L. Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System. Paediatr Child Health 2019; 24:S3-S18. [PMID: 30948918 PMCID: PMC6438869 DOI: 10.1093/pch/pxz025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background Students experience fear, pain, and fainting during vaccinations at school. While evidence-based interventions exist, no Knowledge Translation (KT) interventions have been developed to mitigate these symptoms. A multidisciplinary team—the Pain Pain Go Away Team—was assembled to address this knowledge-to-care gap. This manuscript provides an overview of the methodology, knowledge products, and impact of an evidence-based KT program developed and implemented to improve the vaccination experience at school. Methods We adapted knowledge and assessed the barriers to knowledge use via focus group interviews with key stakeholder groups involved in school-based vaccinations: students, nurses, school staff, and parents. Next, we developed project-specific goals and data collection tools and collected baseline data. We then created a multifaceted KT intervention called The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract) to provide a framework for planning and delivering vaccinations using a student-centred approach. Selected KT tools from this framework were reviewed in additional focus groups held in all stakeholder groups. The multifaceted KT intervention was then finalized and implemented in stages in two projects including grade 7 students undergoing school vaccinations and impact on student outcomes (e.g., symptoms of fear, pain, dizziness) and process outcomes (e.g., utilization of interventions that reduce student symptoms, vaccination rate) were assessed. Results Participants reported that improving the vaccination experience is important. Based on participant feedback, an evidence-based multifaceted KT intervention called The CARD™ System was developed that addresses user needs and preferences. Selected KT tools of this intervention were demonstrated to be acceptable and to improve knowledge and attitudes about vaccination in the stakeholder groups. In two separate implementation projects, CARD™ helped grade 7 students prepare for vaccinations and positively impacted on their vaccination experiences. CARD™ improved vaccination experiences for other stakeholder groups as well. There was no evidence of an impact on school vaccination rates. Conclusion We developed and implemented a promising multifaceted KT intervention called The CARD™ System to address vaccination-associated pain, fear, and fainting. Future research is recommended to determine impact in students of different ages and in different geographical regions and clinical contexts.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.,The Hospital for Sick Children, Toronto, Ontario
| | | | | | | | | | | | | | | | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Greyson D, Rafferty E, Slater L, MacDonald N, Bettinger JA, Dubé È, MacDonald SE. Systematic review searches must be systematic, comprehensive, and transparent: a critique of Perman et al. BMC Public Health 2019; 19:153. [PMID: 30717742 PMCID: PMC6362565 DOI: 10.1186/s12889-018-6275-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/28/2018] [Indexed: 11/10/2022] Open
Abstract
A high quality systematic review search has three core attributes; it is systematic, comprehensive, and transparent. The current over-emphasis on the primacy of systematic reviews over other forms of literature review in health research, however, runs the risk of encouraging publication of reviews whose searches do not meet these three criteria under the guise of being systematic reviews. This correspondence comes in response to Perman S, Turner S, Ramsay AIG, Baim-Lance A, Utley M, Fulop NJ. School-based vaccination programmes: a systematic review of the evidence on organization and delivery in high income countries. 2017; BMC Public Health 17:252, which we assert did not meet these three important quality criteria for systematic reviews, thereby leading to potentially unreliable conclusions. Our aims herein are to emphasize the importance of maintaining a high degree of rigour in the conduct and publication of systematic reviews that may be used by clinicians and policy-makers to guide or alter practice or policy, and to highlight and discuss key evidence omitted in the published review in order to contextualize the findings for readers. By consulting a research librarian, we identified limitations in the search terms, the number and type of databases, and the screening methods used by Perman et al. Using a revised Ovid MEDLINE search strategy, we identified an additional 1016 records in that source alone, and highlighted relevant literature on the organization and delivery of school-based immunization program that was omitted as a result. We argue that a number of the literature gaps noted by Perman et al. may well be addressed by existing literature found through a more systematic and comprehensive search and screening strategy. We commend both the journal and the authors, however, for their transparency in supplying information about the search strategy and providing open access to peer reviewer and editor's comments, which enabled us to understand the reasons for the limitations of that review.
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Affiliation(s)
- Devon Greyson
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute & Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ellen Rafferty
- 5-308 Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Linda Slater
- John W. Scott Health Science Library, University of Alberta, Edmonton, AB, Canada
| | - Noni MacDonald
- Department Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute & Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ève Dubé
- Institut national de santé publique du Québec, QC, Québec, Canada
| | - Shannon E MacDonald
- 5-308 Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
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Abstract
The approach to i.v. fluid therapy for hypovolaemia may significantly influence outcomes for patients who experience a systemic inflammatory response after sepsis, trauma, or major surgery. Currently, there is no single i.v. fluid agent that meets all the criteria for the ideal treatment for hypovolaemia. The physician must choose the best available agent(s) for each patient, and then decide when and how much to administer. Findings from large randomized trials suggest that some colloid-based fluids, particularly starch-based colloids, may be harmful in some situations, but it is unclear whether they should be withdrawn from use completely. Meanwhile, crystalloid fluids, such as saline 0.9% and Ringer's lactate, are more frequently used, but debate continues over which preparation is preferable. Perhaps most importantly, it remains unclear how to select the optimal dose of fluid in different patients and different clinical scenarios. There is good reason to believe that both inadequate and excessive i.v. fluid administration may lead to poor outcomes, including increased risk of infection and organ dysfunction, for hypovolaemic patients. In this review, we summarize the current knowledge on this topic and identify some key pitfalls and some areas of agreed best practice.
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Affiliation(s)
- N MacDonald
- Department of Perioperative and Pain Medicine, Barts Health NHS Trust, London E1 1BB, UK
| | - R M Pearse
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2018; 118:424-429. [PMID: 28186223 DOI: 10.1093/bja/aew466] [Citation(s) in RCA: 427] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background The 100 mm visual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 sd , standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions Analgesic interventions that provide a change of 10 for the 100 mm pain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D B Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - W Galagher
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - D Boyd
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - C Chew
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - N MacDonald
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Dennis
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
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39
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Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018; 17:989-1004. [DOI: 10.1080/14760584.2018.1541406] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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40
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Abbott TEF, Gooneratne M, McNeill J, Lee A, Levett DZH, Grocott MPW, Swart M, MacDonald N. Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study. Br J Anaesth 2017; 120:475-483. [PMID: 29452804 DOI: 10.1016/j.bja.2017.11.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET. METHODS We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO2 peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement. RESULTS Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO2 peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO2 peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO2 peak was moderate [0.73 (0.64-0.80)]. CONCLUSIONS Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
| | | | | | - A Lee
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D Z H Levett
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M P W Grocott
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M Swart
- South Devon Healthcare NHS Trust, Torbay, UK
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41
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MacDonald N, Dubé E, Butler R. Vaccine hesitancy terminology: A response to Bedford et al. Vaccine 2017; 37:3947-3948. [PMID: 29180029 DOI: 10.1016/j.vaccine.2017.11.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Noni MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Centre de recherche du CHU - Université Laval, Québec, Canada.
| | - Robb Butler
- Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
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Filliter JH, Dodds L, MacDonald N, Shea S, Dubé E, Smith IM, Campbell LA. The next vaccine-autism question: Are school-aged youth with autism spectrum disorder undervaccinated and, if so, why? Paediatr Child Health 2017; 22:285-287. [PMID: 29479236 DOI: 10.1093/pch/pxx083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Over the past two decades, the words 'autism' and 'vaccination' have often been linked and mired in controversy. In this commentary, we raise a different question about autism spectrum disorder (ASD) and vaccines: Are school-aged youth with ASD undervaccinated and, if so, why? There are several reasons why youth with ASD might be undervaccinated, including: belief in a vaccine-ASD link, challenges faced by youth with ASD when seeking health care and vaccine hesitancy factors that affect the general population. Possible undervaccination in this group is concerning given the prevalence of ASD and the key role of vaccinations in preventing infectious diseases. More research is needed to establish definitively whether youth with ASD are undervaccinated and to understand facilitators and barriers to vaccination for this population. This would help public health officials to develop and implement targeted policy and practice changes to increase vaccination uptake in youth with ASD, thereby increasing immunization equity.
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Affiliation(s)
- Jillian H Filliter
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia.,IWK Health Centre, Halifax, Nova Scotia
| | - Linda Dodds
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,IWK Health Centre, Halifax, Nova Scotia.,Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Nova Scotia
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,IWK Health Centre, Halifax, Nova Scotia
| | - Sarah Shea
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,IWK Health Centre, Halifax, Nova Scotia
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec, Québec.,Département d'Anthropologie, Université Laval, Québec, Québec
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia.,IWK Health Centre, Halifax, Nova Scotia
| | - Leslie Anne Campbell
- IWK Health Centre, Halifax, Nova Scotia.,Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia
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Affiliation(s)
- Rachel Han
- Department of Family Medicine, University of Calgary, Hospital, Calgary, AB, Canada
| | - Tim Mailman
- Department of Infectious Diseases, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Noni MacDonald
- Department of Infectious Diseases, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Smith
- Department of Infectious Diseases, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
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44
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MacDonald N, Ahmad T, Mohr O, Kirk-Bayley J, Moppett I, Hinds C, Pearse R. Dynamic preload markers to predict fluid responsiveness during and after major gastrointestinal surgery: an observational substudy of the OPTIMISE trial. Br J Anaesth 2015; 114:598-604. [DOI: 10.1093/bja/aeu398] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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Sutton DG, McVey S, Gentle D, Hince AJ, MacDonald N, McCallum S. CT chest abdomen pelvis doses in Scotland: has the DRL had its day? Br J Radiol 2014; 87:20140157. [PMID: 24971617 DOI: 10.1259/bjr.20140157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This article reports on a pilot study designed to collect dose data representative of current CT chest abdomen pelvis (CAP) practice in Scotland, make any immediately obvious interventions and to identify if the current UK diagnostic reference level (DRL) of 940 mGy cm is still appropriate. The aims are to identify if a Scotland-wide picture archiving and communication system (PACS)-based dose audit of a number of CT examinations is likely to have value in terms of optimization of patient doses and to comment on the significance of the results in terms of future optimization strategies. METHODS Dose audit of CT CAP examinations at 32 different scanner sites across Scotland using accepted data collection and analysis methods. The minimum sample size was 30. RESULTS RESULTS indicate that CT CAP doses are lower than those previously reported (median, 800 mGy cm, 75th percentile 840 mGy cm) but follow a distribution that is not in keeping with the concept of DRLs as presently understood or implemented. CONCLUSION There is value in a PACS-based dose audit project to provide serial snapshots of patient doses as optimization efforts take place and to revise current knowledge about CT doses. In our opinion, the results call into question whether DRLs or the concept of "achievable dose" are suitable for devising optimization strategies once a certain degree of optimization has taken place. ADVANCES IN KNOWLEDGE The results reported here suggest that it may be time to take a different approach to optimization, concentrating on tools that are more refined than the DRL, which may have become more of a compliance tool than an aid to optimization.
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Affiliation(s)
- D G Sutton
- 1 Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
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Taddio A, Ipp M, Apppleton M, Chambers C, Halperin S, Lockett D, MacDonald N, Mousmanis P, Ridell RP, Rieder M, Scott J, Shah V. 197: Implementing Best Practices for Vaccination Pain Management. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Bortolussi R, MacDonald N, Moraca S, Grant E. 9: Assessing Healthcare Needs and Research Barriers for Community Focused Interdisciplinary Health Research Capacity Building Using a Microresearch Model in East Africa. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Affiliation(s)
- Mark C Steinhoff
- Global Child Health Center, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Noni MacDonald
- Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Dina Pfeifer
- Vaccine-preventable Diseases and Immunization, WHO, Regional Office for Europe, Copenhagen, Denmark
| | - Louis J Muglia
- Center for Prevention of Preterm Birth, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Gagnon B, Agulnik JS, Gioulbasanis I, Kasymjanova G, Morris D, MacDonald N. Montreal prognostic score: estimating survival of patients with non-small cell lung cancer using clinical biomarkers. Br J Cancer 2013; 109:2066-71. [PMID: 24064979 PMCID: PMC3798950 DOI: 10.1038/bjc.2013.515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 01/03/2023] Open
Abstract
Background: For evidence-based medical practice, well-defined risk scoring systems are essential to identify patients with a poor prognosis. The objective of this study was to develop a prognostic score, the Montreal prognostic score (MPS), to improve prognostication of patients with incurable non-small cell lung cancer (NSCLC) in everyday practice. Methods: A training cohort (TC) and a confirmatory cohort (CC) of newly diagnosed patients with NSCLC planning to receive chemotherapy were used to develop the MPS. Stage and clinically available biomarkers were entered into a Cox model and risk weights were estimated. C-statistics were used to test the accuracy. Results: The TC consisted of 258 patients and the CC consisted of 433 patients. Montreal prognostic score classified patients into three distinct groups with median survivals of 2.5 months (95% confidence interval (CI): 1.8, 4.2), 8.2 months (95% CI: 7.0, 9.4) and 18.2 months (95% CI: 14.0, 27.5), respectively (log-rank, P<0.001). Overall, the C-statistics were 0.691 (95% CI: 0.685, 0.697) for the TC and 0.665 (95% CI: 0.661, 0.670) for the CC. Conclusion: The MPS, by classifying patients into three well-defined prognostic groups, provides valuable information, which physicians could use to better inform their patients about treatment options, especially the best timing to involve palliative care teams.
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Affiliation(s)
- B Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Centre de Recherché du Le Centre Hospitalier Universitaire de Québec, 9 rue McMahon, Local 1899-6, Quebec, Quebec City, Quebec QC G1R 2J6, Canada
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50
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Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, de Gier RPE, de Jong TPVM, Fasching G, Fetter W, Gahr M, Graugaard C, Greisen G, Gunnarsdottir A, Hartmann W, Havranek P, Hitchcock R, Huddart S, Janson S, Jaszczak P, Kupferschmid C, Lahdes-Vasama T, Lindahl H, MacDonald N, Markestad T, Märtson M, Nordhov SM, Pälve H, Petersons A, Quinn F, Qvist N, Rosmundsson T, Saxen H, Söder O, Stehr M, von Loewenich VCH, Wallander J, Wijnen R. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision. Pediatrics 2013; 131:796-800. [PMID: 23509170 DOI: 10.1542/peds.2012-2896] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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