A positive approach to parents with concerns about vaccination for the family physician

Provides an approach for primary care physicians to enable effective communication with parents who have different levels of concerns about vaccinations and awareness of currently available resources that may be used to support discussions. Summary Background Vaccine hesitancy is becoming increasingly recognised as an issue in Australia and globally, as concerns about vaccine and their safety predominate over concerns about the risk of vaccine-preventable diseases. Discussion Clear and flexible communication strategies for healthcare providers to undertake effective discussions with vaccinehesitant parents or clear referral pathways are the key to addressing concerns about vaccination in both primary and secondary care

What UK graduate employers think they want and what university business schools think they provide

This is tha authors' PDF version of an article published in International Journal of Management Concepts and Philosophy© 2009. The definitive version is available at www.inderscience.comThis paper evaluates the increasing focus on the development of students' competencies and skills for management, in university business schools. The debate suggests that deeper understandings, concerning the role of managers are being sacrificed at the hands of an instrumentalist/technicist agenda focusing on competencies and skills. The paper adds to the discussion by scrutinising and applying theory from the literatures of occupational practice, knowledge and learning. Data is presented from sixty four job advertisements stipulating the competencies and skills required of applicants and which illustrate the premium put upon personal practice knowledge. By taking a critical management perspective students can begin to understand the social context and power-based nature of management practice in the workplace. While universities may try to further fulfil the 'narrow', industry-led, competency focus, early indications suggest that universities may possess a good deal of freedom in designing pedagogies supportive of a critical agenda

The Application of Individual and Collective Rationality to e-Collaboration

This paper explains and discusses the outcomes from an action research study into on-line participation. Two, often countervailing notions of rationality are examined, firstly by deconstructing individually held, subjective constructs of trust and power and, secondly, by examining collectivist assumptions regarding the formation of online communities. We contest assumptions from the literatures, which over emphasise the importance of IT in ‘constructing’ online communities, stemming from the adoption of a wholly rationalist view of the human participants – as pursuers of knowledge, regulated and directed by rational principles

Public Discourse as Information System: the Use of SSM to Facilitate ‘Healthier’ Stakeholder Discourse

This paper explores dialogue between the diverse stakeholders affected by the introduction of the BioFuels Sales Obligation policy in New Zealand. The research will use ‘rich pictures’ within the framework of Soft Systems Methodology (SSM) to evaluate the extent to which such abstract visualization might facilitate the communication of different viewpoints. It will examine whether the act of representation might encourage individuals, organizations and interest groups to reflect upon their beliefs and assumptions thereby contributing to a healthy discourse around the subject of New Zealand biofuels

Respiratory syncytial virus: time for surveillance across all ages, with a focus on adults

Human respiratory syncytial virus (RSV), a leading cause of serious respiratory illness, can affect individuals of all ages, especially children below two years of age and adults 60 years of age and above, as well as individuals with chronic comorbidities, such as chronic pulmonary or cardiovascular conditions, and immunocompromised individuals [1,2]. In adults, clinical outcomes of RSV infection vary from mild, cold-like symptoms to more serious complications, including pneumonia, exacerbations of chronic medical conditions (e.g. asthma, chronic obstructive pulmonary disease, congestive heart failure), and can lead to death [3]. The RSV-related hospitalisation burden is especially high in older adults. A meta-analysis conducted on data from high-income countries across different continents (based on literature published between 1 January 2000 and 3 November 2021) estimated that approximately 470 000 individuals 60 years of age and above were hospitalised in 2019 due to RSV, of whom approximately 33 000 died. The pooled estimate for RSV acute respiratory infection (ARI) attack rate was 1.62% (95% CI = 0.84–3.08%), corresponding to an estimated 5.2 million RSV-associated ARI cases [2]. As RSV symptoms in adults resemble those of other common respiratory viruses (e.g. influenza), clinical diagnosis of RSV may be challenging.Circulation of the two major RSV antigenic groups (A and B) is seasonal in temperate climates, with a peak during the winter months, but has a more variable pattern in tropical climates. In addition, RSV circulation overlaps with the influenza season but usually lasts longer (16–22 vs. 6–8 weeks, respectively) [1]. Human respiratory syncytial virus circulation was impacted during the first two years of the coronavirus disease 2019 (COVID-19) pandemic, with RSV cases substantially declining after the widespread implementation of public health and social measures and re-emerging out of season when measures were gradually lifted [4].Human respiratory syncytial virus surveillance is limited, geographically heterogeneous, and does not systematically include all age groups. While the burden of RSV is highest among very young children, adults 60 years of age and above, and individuals with underlying health conditions, other populations also contribute to RSV transmission. Therefore, improved RSV surveillance systems are needed to better understand the epidemiology of RSV and inform public health measures. To identify the current challenges in RSV surveillance in adults and the ways to expand RSV surveillance systems, an advisory board among seven experts with national and international expertise in infectious diseases and surveillance was held in August 2022. The main points discussed by the group are summarised in plain language in Figure 1.<br/

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was $241 (95$191 to $291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.<br /

Feasibility of using biomarkers to examine associations between commercial cigarette smoking and glycemic levels during a smoking cessation attempt

Introduction: American Indians have a higher prevalence of type 2 diabetes mellitus (T2DM) and commercial cigarette smoking compared to other racial groups. The complex relationship between smoking, cessation, and glycemic control is not well understood. We examined the feasibility of using continuous glucose monitoring (CGM) and mobile health (mHealth) to understand the acute effects of smoking and cessation on glycemic levels.Methods: We recruited T2DM current smokers aged 21 to 75 in the Cherokee Nation Health System willing to make a cessation attempt. Patients wore 14-day FreeStyle Libre Professional CGM sensors to examine glycemic levels two weeks pre-quit and two weeks post-quit. Participants completed daily smartphone assessments using mHealth to report cigarettes, meals, exercise, tobacco, and nicotine replacement therapy. Remote carbon monoxide (CO) sensors were used to biochemically verify abstinence. Participants completed a semistructured interview at exit to describe their experiences using the technology.Results: We enrolled 13 participants and 10 made a smoking cessation attempt defined as at least a 10% reduction in cigarette consumption. Most participants who reduced cigarette consumption experienced a decrease in mean glucose. Many experienced episodes of hypoglycemia post-quit. Participants on average experienced a 13% absolute change in desired time in range in the two weeks post-quit but the direction varied by baseline HbA1c. For those who normally experienced high glucose levels, their glucose levels also decreased and for some led to an increase in time in range. Glycemic variability increased in most patients, and most recorded weight loss. Participants reported satisfaction with the technology.Conclusion: A decrease in cigarettes per day resulted in a decrease in glucose levels initially, which suggests an acute change in glucose metabolism. A more granular view of acute glycemic changes using CGM during smoking cessation could inform tailored interventions for smokers with T2DM