The 5As: A practical taxonomy for the determinants of vaccine uptake

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 107 different determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions

A Rapid Evidence Appraisal of influenza vaccination in health workers: an important policy in an area of imperfect evidence

IntroductionThe World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a ‘whole-of-system’ perspective to consider possible benefits for HWs, employers and patients.MethodsWe executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases.ResultsOf 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination.ConclusionsThe evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients

Loi et culture en pays Aborigenes ; anthropologie des resaux autochtones du Kimberley, Nord-Ouest de l'Australie

This thesis concerns Indigenous agency, socio-political and cultural systems,\ud and their reproduction by means of performances within the contemporary Australian\ud state. It examines the cultural politics of Indigeneity developed by Kimberley\ud Aboriginal people through their regional organisations. It presents an ethnographic\ud study of Indigenous modes of representation and organisation based on fieldwork\ud carried out with the Kimberley Aboriginal Law and Culture Centre, a grass-roots\ud Indigenous regional organisation federating thirty distinct groups, between 2005 and\ud 2007. As such, the thesis gives particular attention to contemporary Indigenous\ud practices of cultural representation and political action. The study aims at providing an\ud anthropological understanding of the continuing cultural and political salience of the\ud difference between Aboriginal people and Kartiyas.\ud \ud Engaging with the concept and practice of Law and Culture, initial research\ud questions have been reframed in terms of the reproduction of the Kimberley as a set of\ud Indigenous countries. Developing a relational approach, using a regional and a local\ud perspective, the thesis provides with accounts of the relational field of\ud interdependencies between the Australian State and its Indigenous habitants.\ud Experiential and historical constructions of Country, cultural logics of Indigenous ritual\ud and political agency, processes of indigenisation of the Australian modernity and\ud current models of Indigenous sustainable development in the Kimberley are\ud successively examined in order to allow for a processual and performative\ud understanding of Indigenous articulations of their subjectivity, agency and identity. The\ud thesis develops a theoretical framework discussing intercultural and ontological models\ud of Indigeneity and argues for a territorialising and performative approach to the\ud definition of Indigenous singularities, drawing on the Indigenous concepts of Country\ud and Law and Culture to frame anew notions of orality, culture and land

La Nocardiose chez les patients transplantés d'organe et de moëlle osseuse

LYON1-BU Santé (693882101) / SudocSudocFranceF

Les infections virales à manifestations cutanées chez le chien

LYON1-BU Santé (693882101) / SudocTOULOUSE-EN Vétérinaire (315552301) / SudocSudocFranceF

Loi et culture en pays aborigènes (anthropologie des réseaux autochtones du Kimberley, nord-ouest de l'Australie)

Cette thèse examine les singularités revendiquées par les autochtones du kimberley (nord-ouest de l'Australie) au travers de l'étude ethnographique des modes d'organisation et de représentations aborigènes menée entre 2005 et 2007 avec le Centre de la Loi et de la Culture Aborigènes du Kimberley (KALACC). L'analyse porte sur les pratiques autochtones contemporaines de représentation culturelle et d'action politique et cherche à comprendre d'un point de vue anthropologique la dynamique et la pertinence, tant politique que culturelle, de la différence entre Aborigènes et non-Aborigènes. A travers un dialogue critique avec le concept autochtone de "Loi et Culture" et se fondant sur une perspective à la fois locale et régionale, la thèse apporte des descriptions à différentes échelles du champ relationnel d'interdépendance liant les autochtones du Kimberley à l'Etat australien. Les constructions historiques et expérientielles des Pays autochtones, les logiques culturelles de la pratique rituelle et politique des Aborigènes du Kimberley, les processus par lesquels ils ont indigénisé la modernité australienne ainsi que leurs modèles de développement durable sont successivement examinés afin de saisir de manière performative l'articulation par les autochtones de leurs subjectivités, de leurs identités et de leur agentivité politique. Divers modèles (dialogue interculturel, singularités ontologiques) sont discutés à partir des concepts aborigènes de Loi et Culture et de Pays afin de définir les singularités autochtones en dehors de tout essentialisme et par là même reformuler les notions de culture, d'identité, d'oralité, et de territoireThis thesis concerns Indigenous agency, socio-political and cultural systems, and their reproduction by means of performances within the contemporary Australian stat. It examines the cultural politics of indigeneity developed by Kimberley Aboriginal people through their representative organisations. It presents an ethnographic study of Indigenous modes or representation and organisation based on fieldwork carried out with the Kimberley Law and Culture Centre, a grass-roots Indigenous regional organisation, between 2005 and 2007. This study aims at providing an anthropological understanding of the continuing cultural and political salience of the difference between Aboriginal people and Kartiyas, and gives particular attention to contemporary Indigenous practices of cultural representation and political action. Engaging with the concept and practice of Law and Culture, developing a relational approach, and using a multi-scale perspective, the thesis provides with ethnographic accounts of the relational field of interdependencies between the Australian State and Kimberley Indigenous people. Experiential and historical constructions of Country, cultural logics of Indigenous ritual and political agency, processes of indigeneisation of the Australian modernity and current models of Indigenous sustainable development in the Kimberley are successively examined in order to allow for a processual and performative understanding of Indigenous articulations of their subjectivity, agency and identity in Australia.PARIS-Médiathèque MQB (751132304) / SudocPARIS-Fondation MSH (751062301) / SudocSudocFranceF

Clustering of beta-lactam antibiotics to predict cross-reactivities in allergic patients.

International audiencexx