Initial Target Group Research Articles

Incidence of Lyme Borreliosis in the Dutch General Practice Population: A Large-Scale Population-Based Cohort Study Across the Netherlands Between 2015 and 2019

Background: There is a need for updated incidence rates (IRs) of Lyme borreliosis (LB) in Europe, including the Netherlands. We estimated LB IRs stratified by geographic area, year, age, sex, immunocompromised status, and socioeconomic status (SES). Methods: All subjects registered in the PHARMO General Practitioner (GP) Database without prior diagnosis of LB or disseminated LB and having ≥1 year of continuous database enrolment were included. IRs and corresponding confidence intervals (CIs) of GP-recorded LB, erythema migrans (EM), and disseminated LB were estimated during the period 2015‒2019. Results: We identified 14,794 events (suspected, probable, or confirmed) with a diagnostic code for LB that included 8219 with a recorded clinical manifestation: 7985 (97%) with EM and 234 (3%) with disseminated LB. National annual LB IRs were relatively consistent, ranging from 111 (95% CI 106‒115) in 2019 to 131 (95% CI 126‒136) in 2018 per 100,000 person-years. Incidence of LB showed a bimodal age distribution, with peak IRs observed among subjects aged 5‒14 and 60‒69 years in men and women. Higher LB incidence was found in subjects who were residents of the provinces of Drenthe and Overijssel, immunocompromised, or of lower SES. Similar patterns were observed for EM and disseminated LB. Conclusions: Our findings confirm that LB incidence remains substantial throughout the Netherlands with no indication of decline in the past 5 years. Foci in two provinces and among vulnerable populations suggest potential initial target groups for preventive strategies such as vaccination.

Characterization of influenza seasonality in China, 2010-2018: Implications for seasonal influenza vaccination timing.

Optimizing the timing of influenza vaccination based on regional temporal seasonal influenza illness patterns may make seasonal influenza vaccination more effective in China. We obtained provincial weekly influenza surveillance data for 30 of 31 provinces in mainland China from the Chinese Center for Disease Control and Prevention for the years 2010-2018. Influenza epidemiological regions were constructed by clustering analysis. For each region, we calculated onset date, end date, and duration of seasonal influenza epidemics by the modified mean threshold method. To help identify initial vaccination target populations, we acquired weekly influenza surveillance data for four age groups (0-4, 5-18, 19-59, and ≥60 years) in each region and in 171 cities of wide-ranging size. We used linear regression analyses to explore the association of epidemic onset dates by age group, city, and epidemiological region and provide evidence for initial target populations for seasonal influenza vaccination. We determined that northern, mid, southwestern, southeast regions of mainland China have distinct seasonal influenza epidemic patterns. We found significant regional, temporal, and spatial heterogeneity of seasonal influenza epidemics. There were significant differences by age group and city size in the interval between epidemic onset in the city or age group and regional spread (epidemic lead time), with longer epidemic lead times for 5- to 18-year-old children and larger cities. Knowledge of influenza epidemic characteristics may help optimize local influenza vaccination timing and identify initial target groups for seasonal influenza vaccination in mainland China. Similar analyses may help inform seasonal influenza vaccination strategies in other regions and countries.

Keeping Each Other Safe: Who Checks on Their Neighbors During Weather Extremes in Summer and Winter?

Weather extremes are increasing with climate change and associated with higher morbidity and mortality. Promotion of social connections is an emerging area of research and practice for risk reduction during weather extremes. This study examines the practice of checking on neighbors during extreme summer heat and extreme winter weather. Objectives are to (1) describe the extent of neighbor checking during these extremes, and (2) examine factors associated with neighbor checking. We analyze survey data (n = 442) from a primarily low- and moderate- income study sample in a Southeastern U.S. city, using descriptive statistics and logistic regression. About 17.6% of participants checked on neighbors during extreme summer heat, and 25.2% did so during extreme winter weather. Being middle or older aged and having more adverse physical health impacts were positively associated with neighbor checking, for both extremes. For winter only, having less education was positively associated with neighbor checking. Community-based partnerships for reducing risk during weather extremes may consider people who are older or have experienced their own adverse health impacts as initial target groups for promoting neighbor checking. Future research should also examine the motivations for, details about, and impacts of neighbor checking in greater depth.

Female students receiving post-secondary education in Greece: the results of a collaborative human papillomavirus knowledge survey

ObjectivesContrary to the optimistic forecasts, existing until 2008 and despite the incorporation of the vaccine into the Greek National Immunization Program, six years later, the percentage of HPV vaccination coverage in Greece remains disappointingly low. The aim of this extended study was to investigate the knowledge, behaviour and attitude of a representative sample of the initial target group; young female students of Greek higher education institutions to Pap cervical screening, biology of HPV infection and principles of HPV vaccination. Study designCross-sectional study. MethodsOne thousand two hundred ten (1210) questionnaires were completed by young female students aged 17–24 years. The survey questionnaire sought data relating to sociodemographic characteristics, health behaviour and knowledge about HPV, as well as vaccination status. Results79.6% of the sample reported at least one annual gynaecologic examination and 92.6% were familiar with the rationale of cervical screening; however only 52.9% had undergone a Pap smear. 69.7% reported adequate knowledge about HPV and 89.3% were aware of the possible course of HPV infection. Despite most (95.9%) were aware of vaccine availability, vaccinated students represented only 33.1%. According to the multivariate analysis, vaccination status was associated with university studies (OR 1.96; 95% CI: 1.19–3.20), parental area of expertise (OR 2.77; 95% CI: 1.18–6.53, OR 2.03; 95% CI: 1.05–3.94), and adequate knowledge of the reasons for which women should undergo regular cervical screening (OR 4.23; 85% CI: 1.55–11.55). Fear of side-effects and equivocal information were the main reasons of non-vaccination (52.2% and 33.1% respectively). Finally, the majority of unvaccinated individuals showed a positive attitude towards prospective HPV vaccination, providing they received well-documented advising. ConclusionsYoung women attending Greek higher education exhibit a good level of knowledge about HPV and its correlation with cervical cancer. These data highlight the need for further sensitization of the general population.

Flaws in evaluations of social programs: illustrations from randomized controlled trials.

This article describes eight flaws that occur in impact evaluations. The eight flaws are grouped into four categories on how they affect impact estimates: statistical imprecision; biases; failure of impact estimates to measure effects of the planned treatment; and flaws that result from weakening an evaluation design. Each flaw is illustrated with examples from social experiments. Although these illustrations are from randomized controlled trials (RCTs), they can occur in any type of evaluation; we use RCTs to illustrate because people sometimes assume that RCTs might be immune to such problems. A summary table lists the flaws, indicates circumstances under which they occur, notes their potential seriousness, and suggests approaches for minimizing them. Some of the flaws result in minor hurdles, while others cause evaluations to fail-that is, the evaluation is unable to provide a valid test of the hypothesis of interest. The flaws that appear to occur most frequently are response bias resulting from attrition, failure to adequately implement the treatment as designed, and too small a sample to detect impacts. The third of these can result from insufficient marketing, too small an initial target group, disinterest on the part of the target group in participating (if the treatment is voluntary), or attrition. To a considerable degree, the flaws we discuss can be minimized. For instance, implementation failures and too small a sample can usually be avoided with sufficient planning, and response bias can often be mitigated-for example, through increased follow-up efforts in conducting surveys.

Flawed Social Experiments

This paper describes, somewhat overlapping, types of flaws that have occurred in social experiments. Each flaw is illustrated with examples from previous experiments. Some of these problems result in minor hurdles, while others cause experiments to fail — that is, the experiment is unable to provide a valid test of the hypothesis of interest. An accompanying summary table lists the flaws, indicates the circumstances under which they occur, their potential seriousness, and approaches for minimizing them. The most important of the flaws are response bias resulting from attrition; a failure to adequately implement the treatment as designed; and too small a sample to detect impacts. The third of these flaws can result from insufficient marketing, too small an initial target group, disinterest on the part of the target group in participating (if the treatment is voluntary), or attrition. To a considerable degree the flaws discussed in this article can be minimized. For instance, implementation failures and too small a sample can usually be avoided with sufficient effort and planning and response bias can often be mitigated — for example, through increased follow-up efforts in conducting surveys.

Introduction

Introduction

Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among adults 25 to 64 years of age with high-risk conditions—United States, 2010

Seasonal influenza vaccination has been routinely recommended for adults with high-risk conditions. The Advisory Committee on Immunization Practices recommended that persons 25 to 64years of age with high-risk conditions be one of the initial target groups to receive H1N1 vaccination during the 2009-2010 season. We used data from the 2009-2010 Behavioral Risk Factor Surveillance System survey. Vaccination levels of H1N1 and seasonal influenza vaccination among respondents 25 to 64 years with high-risk conditions were assessed. Multivariable logistic regression models were performed to identify factors independently associated with vaccination. Overall, 24.8% of adults 25 to 64 years of age were identified to have high-risk conditions. Among adults 25 to 64 years of age with high-risk conditions, H1N1 and seasonal vaccination coverage were 26.3% and 47.6%, respectively. Characteristics independently associated with an increased likelihood of H1N1 vaccination were as follows: higher age; Hispanic race/ethnicity; medical insurance; ability to see a doctor if needed; having a primary doctor; a routine checkup in the previous year; not being a current smoker; and having high-risk conditions other than asthma, diabetes, and heart disease. Characteristics independently associated with seasonal influenza vaccination were similar compared with factors associated with H1N1 vaccination. Immunization programs should work with provider organizations to review efforts made to reach adults with high-risk conditions during the recent pandemic and assess how and where they can increase vaccination coverage during future pandemics.

The North American Third-Party Logistics Industry in 2011: The Provider CEO Perspective

The North American Third-Party Logistics Industry in 2011: The Provider CEO Perspective

Tracking H1N1 vaccine doses administered using CDC’s Countermeasure and Response Administration system

During the influenza A (H1N1) 2009 pandemic, the Countermeasure and Response Administration (CRA) system, a Centers for Disease Control and Prevention (CDC) computer-based informatics application, monitored H1N1 vaccine uptake during the early stages of the US vaccination program, from October through the end of November 2009. CRA, which directly monitors vaccine doses administered, was developed to support the mass tracking of medical countermeasure use during public health events and to complement populationbased survey data on vaccination coverage during a pandemic influenza vaccination program. CRA provided weekly near real-time reports of H1N1 vaccine doses administered at national and state levels. On average, during any given week, 58.8 percent of the total data available to be reported was actually reported to CDC. During the 8-week mandatory reporting period, a cumulative total of 13,109,962 first-dose vaccine doses administered were reported through CRA, representing approximately 4.4 percent of the US population. Nearly 60 percent of these doses were administered to individuals aged 6 months to 24 years, an age interval that was included in the initial target groups prioritized to receive vaccine. CRA was a key component of the national surveillance system providing information on early uptake of H1N1 vaccine and monitoring program progress. These accomplishments indicate that CRA can effectively function as an immunization tool to monitor vaccine uptake during a pandemic.

Socio-demographic differences in opinions about 2009 pandemic influenza A (H1N1) and seasonal influenza vaccination and disease among adults during the 2009-2010 influenza season.

Background In April 2009, a novel influenza A virus emerged in the United States. By the end of July, influenza A (H1N1) 2009 monovalent (2009 H1N1) vaccine had been developed, licensed, and recommended by the Advisory Committee on Immunization Practices. Initial target groups for vaccination were identified and the first vaccine was publicly available in early October 2009. Objective This study examines socio‐demographic differences in opinions about 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza disease and vaccines and the association with receipt of influenza vaccinations during the 2009–2010 influenza season. Changes in opinions over the course of the pH1N1 pandemic were also examined. Methods Data from the 2009 National H1N1 Flu Survey (NHFS) were analyzed. The NHFS was a CDC‐sponsored telephone survey initiated in response to the 2009 pH1N1 pandemic to obtain weekly within‐season estimates of vaccination coverage, opinions, and other information. Results Opinions about influenza vaccine and disease varied significantly by race/ethnicity, income, and education level. In multivariable logistic regression analysis, adjusted 2009 H1N1 vaccination coverage was most strongly associated with opinions about the effectiveness of the vaccine and personal risk of disease, varying from 7 to 11% among adults who believed the vaccine to have low effectiveness and themselves at low risk of influenza, to 50–53% among those who thought vaccine effectiveness to be high and themselves at high risk of influenza. Conclusion Improving communication about personal risk and the effectiveness of influenza vaccines may improve vaccination coverage. The findings of difference in opinions could be used to target communication.

Correlates of 2009 H1N1 influenza vaccination among day care-aged children, Miami-Dade County

BackgroundThe aim of this study was to assess factors influencing 2009 H1N1 influenza vaccination among a demographically diverse group of day care-aged children. Day care children were chosen because they were an initial target group for vaccination and are at higher risk of influenza infection than children cared for at home. MethodsA cross-sectional study was conducted from March to May 2010 among parents of day care aged children in 13 day care facilities in Miami-Dade County. Data was collected by an anonymous self-administered two-page 20 question survey which consisted of demographic variables and information regarding 2009 H1N1 influenza vaccine knowledge, attitude and acceptance. Data was analyzed using SAS to conduct both bivariate and multivariate analyses. ResultsThere were 773 participants in the study. The response rate ranged from 42% to 72.2% among day care centers. A total of 172 parents (22.3%) and 225 (29.1%) children had received the 2009 H1N1 influenza vaccine. Non-Hispanic White and Black parents were more likely to vaccinate their children than Hispanic and Haitian parents. Primary reasons for non-vaccination included vaccine safety (36.7%) and side effects (27.1%). Among parents who spoke with a health care professional, 274 (61.4%) stated the health care professional recommended the vaccine. ConclusionMisperceptions about influenza vaccination among parents created a barrier to 2009 H1N1 influenza vaccination. Parents who got the vaccine, who believed the vaccine was safe and whose children had a chronic condition were more likely to immunize their children. Clear, reliable and consistent vaccine information to the public and health care providers and initiatives targeting minority groups may increase vaccination coverage among this population.

Role of network structure and network effects in diffusion of innovations

Why does diffusion of innovation sometimes propagate throughout the whole population, and why at other times does it halt in its interim process? The current paper provides a potential answer to this question by developing a simple computational model of social networks. The proposed computational approach incorporating small-world graphs enables the authors to find that diffusion of innovation is more likely to fail in a random network than in a highly clustered network of consumers. A marketing implication is that the choice of initial target groups and their network structures matter in influencing whether an innovation makes full or partial penetration, in markets where network effects plays a role.

Introducing the E-newspaper: Identifying Initial Target Groups

This article investigates how audience groups differ with respect to the adoption of new media services. The authors expand the existing framework of early adopters, which is heavily directed towards the technological aspects of a product, by including users that are more interested in the social and content-related aspects of media services. The objective is to identify and explore important audience groups that can be used as initial target groups for the introduction of the e-newspaper (a newspaper published on e-paper technology). Data was collected from in total 2976 respondents through the web sites of three Swedish newspapers.

Breast screening in the emerging world: High prevalence of breast cancer in Cairo

The Cairo Breast Screening Trial (CBST) was designed to evaluate the role of clinical breast examination as a primary screening modality in the context of primary care, as in Egypt breast cancer is usually diagnosed at an advanced stage. A specialised medical centre in Cairo (the Italian Hospital) was selected as the headquarters of the study. The initial target group was women age 35-64 living in a geographically defined area around the Italian Hospital, 4116 being contacted by social workers and invited to attend a Primary Health Centre for clinical breast examination. High rates of breast cancer were observed; 8 per 1000 at the first examination and approximately 2 per thousand among those who attended for re-screening. The initial prevalence suggests that many women in the community with early but palpable breast cancer fail to seek medical attention until their cancer is advanced. The detection rate on re-screening, and after follow-up of those who only received one or no screens, ( approximately 3/1000) is similar to expectation.

Progressive resistance training for seniors in a community setting – a process evaluation

Issue addressed: The process of implementing a progressive resistance training (PRT) program for seniors at community venues. Methods: Fifteen local recreational clubs were approached to host the program. The initial target group was community-dwelling adults over 60 years of age, specifically war widows and veterans. The process was evaluated in terms of availability and suitability of venues and trainers, enrolment rates, participant satisfaction and cost effectiveness. Results: The program was implemented at six clubs and a total of 291 new participants enrolled in the program over the first year. Fitness instructors were employed as trainers and a training workshop developed. Enrolment rates continued to increase over the year. Participant satisfaction was generally high; however, feedback indicated that participants would like more variety in the program and preferred twice per week training. However, once weekly training was financially sustainable and with several changes to design allowed the program to continue and grow at existing venues. Conclusions: The PRT program was successfully implemented at community venues and resulted in increased participation. In the format described, the program is financially sustainable but would require added funding to expand greatly beyond its current venues.

Pertussis epidemic in Oklahoma. Difficulties in preventing transmission.

From Jan 1 to Dec 31, 1983, 351 cases of pertussis were reported in Oklahoma. Overall, 59% of the cases were among children 3 months to 6 years of age, the target age group for pertussis vaccination; only 42% of the patients in this age group were appropriately immunized for age with diphtheria and tetanus toxoids and pertussis vaccine (DTP). A survey of 185 households in the neighborhoods of three cases found that only 65% of 57 children 3 months to 6 years of age were appropriately immunized for their age. Aggressive control of the outbreak was attempted in Oklahoma County with recommendations for widespread vaccination against pertussis. However, the effort failed to immunize 82% of the 931 children in the initial target group. Nonetheless, analysis of the reported cases suggested that less than one fourth of the cases were potentially preventable by a single additional dose of DTP, ie, in individuals 3 months to 6 years of age with a history of at least one prior dose of DTP who were not appropriately immunized for age. The optimal solution to outbreak control is outbreak prevention by ensuring that the maximal number of children younger than 7 years of age receive routine age-appropriate DTP vaccination.