Influenza immunisation coverage from 2015 to 2017: A national study of adult patients from Australian general practice

ObjectivesTo assess influenza immunisation rates and coverage in adult patients from Australian general practice and identify whether practice or patients’ characteristics are associated with vaccination uptake.DesignOpen cohort study.Setting550 Australian general practices included in the MedicineInsight database.ParticipantsPatients aged 18+ years who had at least one consultation during influenza season between 2015 and 2017. Two samples were considered: (1) ‘active’ patients (at least three consultations in any two consecutive years) and (2) ‘every year’ patients (at least one consultation per year).Main outcome measuresInfluenza vaccination rates per 1,000 consultations and coverage (% vaccinated among those who consulted) from 2015 to 2017.ResultsBetween 2015 and 2017 the influenza vaccine rate changed from 57.4 to 51.7 and 67.0 per 1,000 consultations, while correspondent values for coverage were 29.3%, 25.2% and 27.6% (in ‘active’ patients). Vaccine coverage was at least 30% higher in inner regional areas, among patients aged 65+ years or those with comorbidities. Similar associations were found among ‘every year’ patients, but average coverage across the three years was higher (41% vs 27%). Aboriginal and Torres Strait Islander people, either with or without comorbidity, showed a vaccine coverage 10–30% higher than non-Indigenous people for those aged less than 65 years (p-value for interaction < 0.001).ConclusionMedicineInsight data is a useful and low-cost method to monitor influenza immunisation coverage. Independent of the sample used, vaccination coverage among Indigenous people or patients with comorbidities could be improved. Targeted strategies for high-risk groups need to be developed.     

Tailoring immunisation service delivery in a disadvantaged community in Australia; views of health providers and parents

In 2014 the Australian immunisation target was raised from 90% to 95% of children to be fully immunised. A national priority is to identify geographic areas of low coverage and implement strategies to improve immunisation rates. Using The World Health Organization’s Tailoring Immunization Programmes (TIP) Guidelines, the aim of this study was to identify areas of low immunisation coverage for children in the Hunter New England Local Health District, New South Wales, and to gain a deeper understanding of the factors influencing immunisation in those areas in order to develop tailored strategies for increasing immunisation coverage. Data from the Australian Immunisation Register was used to identify geographic areas of low coverage. Data from interviews and focus groups with parents and service providers were used to gain a deeper understanding of the factors influencing immunisation in those areas. The regional city of Maitland in New South Wales was identified as having a persistently high number and relatively high proportion of children not fully immunised (n = 427, 15.4% in 2016). Themes from 59 stakeholder interviews and focus groups included; (i) limited engagement with health services unless the need is urgent, (ii) multi-dimensional access barriers to immunisation services in Maitland, (iii) a flexible, supportive family centred, primary health care approach, utilising strong partnerships, is most likely to be effective in increasing childhood immunisation rates in Maitland, (iv) data can be used more effectively to inform service providers about trends and individual children not fully immunised. TIP guidelines proved useful for identifying areas of low coverage and providing an understanding of determining factors and the strategies most likely to be effective. Understanding the complex problems many parents face and the access barriers that contribute to low immunisation coverage is essential in developing appropriate solutions. Finding ways to support parents and remove those barriers can contribute to higher coverage. In Maitland, targeted outreach and home visiting has been implemented in consultation with community and health service representatives to ensure that the children from socially disadvantaged populations identified do not miss out on vaccination.     

Socioeconomic inequality trends in childhood vaccination coverage in India: Findings from multiple rounds of National Family Health Survey

ObjectivesThis article examines the inequality patterns in childhood vaccination coverage at various socio-economic levels using all four rounds of nationally representative National Family Health Surveys (NFHS) in India.MethodsThe analytic sample restricted to the most recent singleton surviving children aged 12–23 months in each survey, was 11,599 in NFHS‐1 (1992–93); 10,209 in NFHS‐2 (1998–99); 9582 in NFHS‐3 (2005–06) and 49,284 in NFHS‐4 (2015–16). Complete childhood vaccination is defined as a child aged 12–23 months who received one dose of BCG (Bacille Calmette Guerin), one dose of measles, and three doses each of DPT (Diphtheria, Pertussis, Tetanus), and polio vaccine (excluding the polio vaccine given at birth) at any time before the survey—according to the vaccination card or the mother’s recall. To understand inequalities in childhood vaccination, four measures were computed for each survey rounds’ data—absolute measures of inequality, the slope index of inequality (SII), and two relative measures: the ratio between the extreme groups and the concentration index (CIX) to see the degree of disparity.ResultsThe pro-rich and pro-education inequality in childhood vaccination coverage increased between 1998–99 and 2005–06 and declined considerably thereafter. This study found that inequality in childhood vaccination coverage has been minimized at a macro level such as rural-urban, male-female, religion, ethnicity, and in select geographies, but not universally at the micro-level. Findings indicate that pro-rich and pro-education inequalities were large among specific sub-groups of population: children in rural areas, children living in the northern region of the country and among scheduled tribes—as absolute and relative inequalities remained significantly high.ConclusionThese findings recommend robust program monitoring and policy-level support at the micro level to optimize the use of existing resources across all segments of the population in the country.     

Educational Success and Adult Health: Findings from the Chicago Longitudinal Study

Growing evidence indicates that education is associated with health, yet we lack knowledge about the specific educational experiences influencing health trajectories. This study examines the role school factors play in the emergence of poor young adult health outcomes for a low-income, minority sample. The following research questions are addressed. First, what are the education-based predictors of daily tobacco smoking, frequent substance use, depression, and no health insurance coverage? Second, do later-occurring school factors explain the association between earlier school measures and the outcomes and, if so, what pathways account for this mediation effect? Data were derived from the Chicago Longitudinal Study, an investigation of a cohort of 1,539 individuals, born around 1980, who attended kindergarten programs in the Chicago Public Schools. Participants were followed prospectively from early childhood through age 24, and study measures were created from various data sources and multiple assessment waves. Findings from probit hierarchical regressions with controls for early sociodemographic covariates indicated that elementary school socioemotional classroom adjustment and high school completion were significantly and negatively associated with all four study outcomes. Participation in the Chicago Child Parent Center preschool program predicted lower rates of both daily tobacco smoking and no health insurance coverage (p?p?p?p?相似文献   

Measuring the timeliness of childhood vaccinations: Using cohort data and routine health records to evaluate quality of immunisation services

BackgroundTo achieve full benefits of vaccination programmes, high uptake and timely receipt of vaccinations are required.ObjectivesTo examine uptake and timeliness of infant and pre-school booster vaccines using cohort study data linked to health records.MethodsWe included 1782 children, born between 2000 and 2001, participating in the Millennium Cohort Study and resident in Wales, whose parents gave consent for linkage to National Community Child Health Database records at the age seven year contact. We examined age at receipt, timeliness of vaccination (early, on-time, delayed, or never), and intervals between vaccine doses, based on the recommended schedule for children at that time, of the following vaccines: primary (diphtheria, tetanus, pertussis (DTP), polio, Meningococcal C (Men C), Haemophilus influenzae type b (Hib)); first dose of measles, mumps and rubella (MMR); and pre-school childhood vaccinations (DTP, polio, MMR). We compared parental report with child health recorded MMR vaccination status at age three years.ResultsWhile 94% of children received the first dose of primary vaccines early or on time, this was lower for subsequent doses (82%, 65% and 88% for second and third doses and pre-school booster respectively). Median intervals between doses exceeded the recommended schedule for all but the first dose with marked variation between children. There was high concordance (97%) between parental reported and child health recorded MMR status.ConclusionsRoutine immunisation records provide useful information on timely receipt of vaccines and can be used to assess the quality of childhood vaccination programmes. Parental report of MMR vaccine status is reliable.     

With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions

ObjectivesTo determine the association between provincial government health and social spending and population health outcomes in Canada, separately for men and women, and account for the potential role of income inequality in modifying the association.MethodsWe used data for nine Canadian provinces, 1981 to 2017. Health outcomes and demographic data are from Statistics Canada; provincial spending data are from provincial public accounts. We model the ratio of social-to-health spending (“the ratio”) on potentially avoidable mortality (PAM), life expectancy (LE), potential years of life lost (PYLL), infant mortality, and low birth weight baby incidence. We interact the ratio with the Gini coefficient to allow for income inequality modification.ResultsWhen the Gini coefficient is equal to its average (0.294), the ratio is associated with desirable health outcomes for adult men and women. For example, among women, a 1% increase in the ratio is associated with a 0.04% decrease in PAM, a 0.05% decrease in PYLL, and a 0.002% increase in LE. When the Gini coefficient is 0.02 higher than average, the relationship between the ratio and outcomes is twice as strong as when the Gini is at its average, other than for PAM for women. Infant-related outcomes do not have a statistically significant association with the ratio.ConclusionOverall, outcomes for men and women have similar associations with the ratio. Inequality increases the return to social spending, implying that those who benefit the most from social spending reap higher benefits during periods of higher inequality.     

Are We Producing the Right Kind of Actionable Evidence for the Social Determinants of Health?

Globally, health and social inequities are growing and are created, actively maintained, and aggravated by existing policies and practices. The call for evidence-based policy making to address this injustice seems a promising strategy to facilitate a reversal of existing strategies and the design of new effective programming. Acting on evidence to address inequities requires congruence between identifying the major drivers of disparities and the study of their causes and solutions. Yet, current research on inequities tends to focus on documenting disparities among individuals or subpopulations with little focus on identifying the macro-social causes of adverse population health. Moreover, the research base falls far short of a focus on the solutions to the complex multilevel drivers of disparities. This paper focuses upon recommendations to refocus and improve the public health research evidence generated to inform and create strong evidence-based recommendations for improving population health.     

Practitioner perspectives on tackling health inequalities: Findings from an evaluation of healthy living centres in Scotland

Little is known about how health practitioners tasked with tackling health inequalities account for their own programmes and actions. This paper attempts to address this gap by drawing on data collected in the course of an evaluation of the Healthy Living Centre (HLC) programme, which was designed to address the wider determinants of health, in particular social exclusion and socioeconomic disadvantage, through targeting services at the most deprived local communities. Six Scottish HLC case studies explored in depth how HLC practitioners conceptualised ‘health inequalities’ and applied the construct to legitimate their public health and health improvement work. Practitioners drew on multiple explanations of health inequalities, sought to apply holistic approaches to service provision, and developed activities that took account of classed practices intended to overcome class-related disempowerment and stigma. They discussed the challenges of positioning services to appeal to and reach target groups and the difficulties in assessing the impact of their work on reducing health inequalities. Responses to tackling inequalities were variable across time and between HLCs, resulting from uneven learning about target groups and their changing needs, an evolving policy agenda and consideration given to the longer-term sustainability of HLC sites. Although practitioners' work to address health inequalities was limited by the programme's focus on working with disadvantaged groups, findings illustrate how classed practices are linked to the challenges of attracting and successfully engaging with such groups. Practitioner accounts highlighted the importance of gaining acceptance to overcome barriers to engagement with disadvantaged communities, the time required to achieve a satisfactory level of engagement, the proximity of service providers to clients and the adaptability of services necessary to address evolving needs.     

Parental perceptions of childhood seasonal influenza vaccination in Singapore: A cross-sectional survey

PurposeSeasonal influenza vaccination is recommended in children aged 6–59 months, but little is known about child vaccination coverage and determinants in Asian settings. We report the results of a survey of knowledge, attitudes, practices, and determinants of child influenza vaccination in Singapore.MethodsIn December 2015-March 2016, we conducted a survey of 332 parents of children aged 6 months to 5 years attending pre-schools. We assessed child influenza vaccine coverage and parental knowledge, attitudes, and practices of child influenza vaccination. We used multivariable regression and structural equation models to identify factors associated with child influenza vaccination.ResultsKnowledge about influenza, perceived benefit of vaccination, and willingness to vaccinate were high. However, only 32% of children had ever received influenza vaccine, and only 15% in the past year. Factors independently associated with child influenza vaccination included: being recommended influenza vaccine by a child’s doctor (prevalence ratio (PR) = 2.47, 95% CI: 1.75–3.48); receiving influenza vaccine information from a private general practitioner (PR = 1.47, 95% CI: 1.05–2.04); regularly receiving pre-travel influenza vaccine (PR = 1.64, 95% CI: 1.19–2.25); higher willingness to vaccinate (PR = 1.58, 95% CI:1.24–2.04 per unit increase in willingness score); and feeling well-informed about influenza vaccine (PR = 1.44, 95% CI: 1.04–1.99). Parents who obtained influenza vaccine information from television were less likely to have vaccinated their child (PR = 0.44, 95% CI: 0.23–0.85). Path analysis indicated that being recommended vaccination by a child's doctor increased willingness to vaccinate and self-efficacy (feeling well-informed about influenza vaccine). Median willingness-to-pay for a dose of influenza vaccine was SGD30 (interquartile range: SGD20-SGD50), and was higher in parents of vaccinated compared with unvaccinated children (SGD45 vs SGD30, p = 0.0012).ConclusionKnowledge and willingness to vaccinate was high in this parent population, but influenza vaccine uptake in children was low. Encouraging medical professionals to recommend vaccination of eligible children is key to improving uptake.     

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention

ObjectivesTo explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction.DesignQuasi-experimental before–after study.SettingFive low-income neighbourhoods of Barcelona during 2010–15.Participants147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months.InterventionPrimary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers.MeasurementsWe assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models.ResultsAt 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10.ConclusionThis community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.     

Animal–human connections, “one health,” and the syndemic approach to prevention

A syndemic involves two or more afflictions that, by interacting synergistically, contribute to excess burdens of disease. A syndemic approach to prevention, meanwhile, focuses on connections among health-related problems, considers those connections when developing health policies, and aligns with forces for social change. In this short report, we expand the syndemic concept to acknowledge the extent to which animal health connects with human health and, with reference to existing publications, we demonstrate the pertinence of this expanded definition for a syndemic approach to prevention. Our demonstration assumes practical importance in relation to the concept of ‘one health’, which many prominent veterinary and human health scientists have recently endorsed as a sound basis for redressing human diseases, animal diseases, and environmental degradation worldwide. While social scientists have mostly ignored animal health, few ‘one health’ proponents have emphasized social conditions or involved social scientists. By explicitly accommodating animal–human connections in our expanded conceptualization of a syndemic, we hope to help create a space in which human health, veterinary, and social scientists may learn from one another, collaborate in research, and cooperate to clear the way for innovations in prevention.     

Social Stability and Health: Exploring Multidimensional Social Disadvantage

Social stability is an understudied construct in public health that offers a useful framework for understanding social disadvantage across multiple domains. This study investigated prevalence and patterns of cooccurrence among a hypothesized set of social stability characteristics (housing, residential transition, employment, income, incarceration, and partner relationship), evaluated the possibility of underlying subgroups of social stability, and investigated the association between social stability and health outcomes. Data were from comprehensive interviews with primarily African-American low income urban women and their female social network members (n = 635) in Baltimore. Analysis included exploratory statistics, latent class analysis, and latent class regression accounting for clustered data using Stata and Mplus software. Social stability characteristics cooccurred in predictable directions, but with heterogeneity. Respondents had an average of three stability characteristics (S.D.: 1.4). Latent class analysis identified two classes of social stability: low (25%) and high (75%), with the higher class less likely to experience each of the included indicators. In controlled models, higher social stability was significantly correlated with social network characteristics and neighborhood integration. Higher social stability was independently associated with reduced risk of chronic illness (AOR: 0.54, 95% C.I.: 0.31, 0.94), mental illness history (AOR: 0.24, 95% CI: 0.15, 0.39), and current depressive symptoms (AOR: 0.35, 95% C.I.: 0.22, 0.57). The current set of social stability characteristics appears to represent a single construct with identifiable underlying subgroups and associated health disparities. Findings suggest a need for comprehensive policies and programs that address structural determinants of cooccurring social disadvantage and help to mitigate the likely spiral effect of instability experiences.     

A systems approach to improving timeliness of immunisation

Timeliness of immunisation is important in achieving a protective effect at the individual and population levels. Recent international research has highlighted the importance of organisational features of the health system in timely immunisation. This paper reports on an analysis of the availability of records of timely delivery of childhood immunisations in Indigenous primary care services and organisational features of vaccination programs in different jurisdictions in Australia. The findings demonstrate wide variation in recorded timely delivery of immunisations between health centres within and between jurisdictions. Significant deficiencies in the approach to delivery and recording of immunisations appear to be principally related to fragmented systems of delivery, recording and communication between child health and primary care services. Understanding these deficiencies presents opportunities for improving timely immunisation.     

“Never mind the logic,give me the numbers”: Former Australian health ministers' perspectives on the social determinants of health

The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure.Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long.     

Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas

OBJECTIVE: The objective of this study was to test whether the association between primary care and income inequality on all-cause, heart disease and cancer mortality at county level differs in urban (Metropolitan Statistical Area-MSA) compared with non-urban (non-MSA) areas. STUDY DESIGN: The study consisted of a cross-sectional analysis of county-level data stratified by MSA and non-MSA areas in 1990. Dependent variables included age and sex-standardized (per 100,000) all-cause, heart disease and cancer mortality. Independent variables included primary care resources, income inequality, education levels, unemployment, racial/ethnic composition and income levels. METHODS: One-way analysis of variance and multivariate ordinary least squares regression were employed for each health outcome. RESULTS: Among non-MSA counties, those in the highest income inequality category experienced 11% higher all-cause mortality, 9% higher heart disease mortality, and 9% higher cancer mortality than counties in the lowest income inequality quartile, while controlling for other health determinants. Non-MSA counties with higher primary care experienced 2% lower all-cause mortality, 4% lower heart disease mortality, and 3% lower cancer mortality than non-MSA counties with lower primary care. MSA counties with median levels of income inequality experienced approximately 6% higher all-cause mortality, 7% higher heart disease mortality, and 7% higher cancer mortality than counties in the lowest income inequality quartile. MSA counties with low primary care (less than 75th percentile) had significantly lower levels of all-cause, heart disease and cancer mortality than those counties with high primary care. CONCLUSIONS: In non-MSA counties, increasing primary physician supply could be one way to address the health needs of rural populations. In MSA counties, the association between primary care and health outcomes appears to be more complex and is likely to require intervention that focuses on multiple fronts.