Background Owing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria. Methods We conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures. Results Of 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ 2 = 106.32, p -value < .001), practicing hand hygiene (χ 2 = 162.24, p -value < .001), physical distancing (χ 2 = 60.84, p -value < .001) and vaccination uptake (χ 2 = 46.85, p -value < .001). Conclusions This study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

Background Quantifying the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in indoor settings is crucial for developing effective non-vaccine prevention strategies and policies. However, summary evidence on the transmission risks in settings other than households, schools, elderly care, and health care facilities is limited. We conducted a systematic review to estimate the secondary attack rates (SARs) of SARS-CoV-2 and the factors modifying transmission risk in community indoor settings.Methods We searched Medline, Scopus, Web of Science, WHO COVID-19 Research Database, MedrXiv, and BiorXiv from 1 January 2020 to 20 February 2023. We included articles with original data for estimating SARS-CoV-2 SARs. We estimated the overall and setting-specific SARs using the inverse variance method for random-effects meta-analyses.Results We included 34 studies with data on 577 index cases, 898 secondary cases, and 9173 contacts. The pooled SAR for community indoor settings was 20.4% (95% confidence interval [CI], 12.0%-32.5%). The setting-specific SARs were highest for singing events (SAR, 44.9%; 95% CI, 14.5%-79.7%), indoor meetings and entertainment venues (SAR, 31.9%; 95% CI, 10.4%-65.3%), and fitness centers (SAR, 28.9%; 95% CI, 9.9%-60.1%). We found no difference in SARs by index case, viral, and setting-specific characteristics.Conclusions The risk of SARS-CoV-2 transmission was highest in indoor settings where singing and exercising occurred. Effective mitigation measures such as assessing and improving ventilation should be considered to reduce the risk of transmission in high-risk settings. Future studies should systematically assess and report the host, viral, and setting-specific characteristics that may modify the transmission risks of SARS-CoV-2 and other respiratory viruses in indoor environments. We conducted a systematic review and meta-analysis to estimate the risk of SARS-CoV-2 transmission in community indoor settings. We found that risk was greatest in settings where singing and exercising occurred and recommend implementing effective mitigation measures in these settings.

To address the high burden of diabetes, China has managed to strengthen diabetes care during the past decade. This study aimed to examine trends and disparities in the coverage of diabetes care among diabetes patients aged 45 years and older following China's healthcare reform. We used data from the 2011-12 baseline survey and 2015-16 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). The prevalence of three diabetes care indicators were compared between the two periods and by participants' characteristics. Logistic regressions and random-effect logit model were used to investigate the socioeconomic and geographic disparities in diabetes care indicators and assess whether there was a significant improvement in these disparities from 2011-12 to 2015-16. We found the prevalence of diabetes among adults aged 45 years and above increased from 16.37% in 2011-12 to 20.33% in 2015-16 in China. Between the 2011-12 and 2015-16 surveys, the proportions of diabetes patients who received health education increased from 31.68% to 35.63%, diabetes-related examination from 32.21% to 41.32%, and diabetes treatment from 30.8% to 36.6%. Disparities in the coverage of diabetes care still existed; while geographic disparities improved significantly during the study period, individual socioeconomic disparities persisted. To address disparities in diabetes care, more effort needs to be directed to improve the primary care system to ensure the quality and timely delivery of diabetes care. Tailored programs should be carried out with more attention given to underserved groups with less educational attainment and lower economic status.

Background: The Chinese elderly face a significant threat from seasonal influenza, owing to the consis-tently low vaccination coverage. This study investigated the prevalence and determinants of influenza vaccination hesitancy among the Chinese elderly.Methods: In 2019, 3849 elderly individuals from 10 provinces in China were recruited in a cross-sectional survey. Multinomial logistic regression was applied to investigate the determinants of influenza vaccina-tion hesitancy.Results: Among the elderly respondents, 37.18% expressed some degree of hesitancy towards influenza vaccination: 19.28% were hesitant, and 17.90% refused influenza vaccination, including 19.28% acceptors with doubts and 17.90% refusers. Only 39.10% of the respondents considered themselves as the priority group for influenza vaccination, and 13.93% reported receiving a recommendation for vaccination from healthcare workers. Respondents with higher education levels and from urban areas had significantly higher odds of vaccine hesitancy than their counterparts. Confidence in the safety of vaccines was neg-atively associated with vaccine hesitancy, but confidence in vaccine efficacy had no such association. Respondents who perceived themselves as highly susceptible to influenza (AOR = 0.85; 95 %CI = 0.77-0.93) and those aware of the elderly as a priority group for influenza vaccination (AOR = 0.51; 95 %CI = 0.41-0.64) had a significantly lower odds of being refusers.Conclusion: This study found a high prevalence of hesitancy towards influenza vaccination among the Chinese elderly, especially well-educated and urban-dwelling respondents. The government should address vaccine hesitancy through culturally appropriate communication, subsidies for vaccination, and actively promoting vaccines through primary care professionals. (c) 2022 Published by Elsevier Ltd.

Influenza vaccination coverage has generally been low in mainland China. However, few studies have attempted to measure influenza vaccination coverage among internal migrants in China who are at an increased risk of influenza infections. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among internal migrants in Shanghai, China. We conducted a cross-sectional online survey among a sample of migrants residing in Shanghai during November 1-20, 2020, to investigate vaccination uptake during the 2019-20 and early 2020-21 flu seasons (September to November 2020). Multivariable logistic regression was used to examine the factors associated with influenza vaccination uptake for the two flu seasons. About a quarter, 26.3%, and 24.4% of respondents reported receiving an influenza vaccination during the 2019-20 and early 2020-2021 flu seasons, respectively. Respondents who were divorced or widowed, had more household members (2 or ≥ 3), and considered themselves in good health were more likely to receive an influenza vaccine, regardless of the season. Respondents who perceived that they were highly susceptible to influenza and COVID-19 and those who reported ever consulting a medical professional about COVID-19 were more likely to have received a flu vaccination in the early 2020-21 flu season. The uptake of influenza vaccination among internal migrants in Shanghai was suboptimal. We found a range of factors linked to influenza vaccination uptake, pointing to the need for more in-depth evaluations on the underlying reasons driving the vaccination uptake among vulnerable populations in China, especially during the COVID-19 pandemic.

Background Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Evidence on the willingness and uptake of the COVID-19 testing is scarce, and the willingness and uptake of vaccination may change as the pandemic evolves. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China. Methods A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate factors associated with the willingness and uptake of the two measures. Results In early 2021, about half (52.45%) of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) of the respondents were willing to receive testing. About two-thirds (63.28%) of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. Conclusions By early 2021, Chinese adults expressed almost universal willingness of COVID-19 testing and over half of adults have been tested, while the willingness and uptake of COVID-19 vaccination were relatively low at the low-risk period of the COVID-19 pandemic. Maintaining willingness of COVID-19 vaccination is critical and necessary, especially when the pandemic evolved into a low-risk period.

Access to vaccination information could influence public attitudes towards vaccination. This study investigated the number and types of vaccination-related information sources, and estimated their associations with vaccine confidence and hesitancy in China. In January 2019, we conducted a cross-sectional survey in China, and 2122 caregivers with children <6 years completed self-administered questionnaires. Logistic regressions were used to assess associations between caregivers' primary information sources and vaccine confidence/hesitancy. A majority (72%) of caregivers had multiple sources of vaccination-related information. The proportions of caregivers reporting professional sources, media, and peers as primary information sources were 81%, 63%, and 26%. Internal migrants were less likely to get information from professional sources; more educated and wealthier caregivers reported more information sources and were more likely to get information from media and peers. Caregivers who reported professional information sources had significantly higher odds of being confident about the safety of vaccines and lower odds of being hesitant toward vaccination than those who did not. Caregivers who reported the media as a primary information source had significantly higher odds of being hesitant toward vaccination than those who did not. To address vaccine hesitancy, it is essential to promote universal access to professional vaccination-related information sources, and to use the media to disseminate evidence-based information and clarify misinformation. Health communication should target internal migrants, and more educated and wealthier caregivers.

Background: Following the COVID-19 pandemic, global interest in influenza vaccines and pneumonia vaccines has increased significantly. We aimed to examine public interest in and actual market circulation of influenza and pneumonia vaccines before and after the initial outbreak of COVID-19 and estimate the coverage and determinants of influenza and pneumonia vaccination uptake following the COVID-19 pandemic. Methods: We obtained search volume data for vaccines using the Baidu search index and collected the numbers of vaccines issued from the National Institutes for Food and Drug Control. We also conducted a cross-sectional survey among 3346 adult residents to evaluate the coverage and determinants of influenza and pneumonia vaccination uptake in the Yangtze River delta, China, from 29 January to 4 February 2021. Results: Public searches and the number of vaccines issued for the influenza vaccines and pneumonia vaccines obviously increased after the initial outbreak of COVID-19. In the total sample, 12.5% were vaccinated against influenza, and 21.5% had at least one family member vaccinated against pneumonia. A minority of participants perceived that they were highly or very highly susceptible to influenza (15.9%) and COVID-19 (6.7%). A range of socio-economic factors and perceived susceptibility to COVID-19 were associated with influenza and pneumonia vaccination uptake. Conclusions: Public interest in and issued volumes of influenza and pneumonia vaccines increased nationally following the COVID-19 pandemic. Perceptions of high susceptibility to COVID-19 were associated with the uptake of the influenza and pneumonia vaccines. Targeted interventions were needed to improve vaccination coverage.

To investigate parenting and children’s emotional and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of random, representative sample of residents with children aged 3–17 years in mid-March, 2020 in China. 1655 parents were surveyed with 80.1% response rate. During the epidemic, half (49%) of children had stress symptoms and 10% had emotional problems; children had higher screen time, less exercise and worse sleep than before. Socially disadvantaged children were more vulnerable to the epidemic. Children whose parents communicated about the epidemic more frequently, who had irritable parents and experienced worse parent-child closeness had higher probabilities of emotional problems, stress symptoms and worse lifestyles. Improve parenting skills and communication quality is necessary during the epidemic.

Understanding the public’s attitude towards COVID-19 vaccination and their acceptance could help facilitate the COVID-19 rollout. This study aimed to assess the acceptance and willingness to pay (WTP) for the COVID-19 vaccine among migrants in Shanghai, China. A cross-sectional study was conducted among 2126 migrants in Shanghai for the period 1–20 November 2020. Convenience sampling was used to recruit respondents in workplaces with large numbers of migrant workers. Multivariable (ordered) logistic regressions were used to examine factors associated with acceptance and WTP of the COVID-19 vaccine. Most (89.1%) migrants would accept COVID-19 vaccination. Over 90.0% perceived the COVID-19 vaccine as important, while only 75.0% and 77.7% perceived vaccines safe and effective. Socio-demographic factors were not significantly associated with vaccine acceptance, but confidence in the importance (OR 8.71, 95% CI 5.89–12.89), safety (OR 1.80, 95% CI 1.24–2.61) and effectiveness (OR 2.66, 95% CI 1.83–3.87) of COVID-19 vaccine was significantly positively associated with vaccine acceptance. The top reasons for vaccine hesitancy were lack of vaccine information and confidence. The proportion of those definitely willing to get the COVID-19 vaccine was 20% lower if paid by themselves than free vaccination. Migrants were willing to pay a median amount of USD 46 for the COVID-19 vaccine. Results show that a high acceptance of the COVID-19 vaccine was universal among migrants in Shanghai. Concerns about vaccine safety, effectiveness and high costs of the COVID-19 vaccine may hinder their uptake. Effective health communication to build confidence in the COVID-19 vaccine and subsidies toward the costs of these vaccines are needed to improve uptake.

Background Understanding how people’s emotions influence their health decisions and behaviours at a population level is fundamental to designing effective communication strategies and public health interventions for infectious disease outbreaks. This review identifies relevant research to assess the role of emotional determinants and their impact on public responses to the risk of infectious disease outbreaks, specifically in relation to the uptake of public health interventions. Methods A comprehensive systematic review was conducted exploring the differences in public responses by emotion, infection, outcome and region. A basic consensus approach was followed in which emotional stimuli were categorised as being either pleasant or unpleasant, and predisposing people to bivalent behaviour (i.e., approach or withdrawal). All primary research studies published in five global databases between 1988-2019 were eligible for inclusion. Binomial tests (against a test proportion of 0.5 or 50% for each study outcome) were performed using the direction of effect observed in each study, i.e., either favouring or not favouring intervention uptake. Results A total of 75 studies from 28 different nations were eligible for inclusion in the review. A total of 97 correlations were made between 12 emotions, 10 infectious diseases, and the uptake of seven types of public health interventions. Unpleasant emotions were evoked much more often than pleasant following public health risk communications, with fear and anxiety being the most common. Overall, moderate anxiety-related emotions (worry, anxiety, stress, concern) seemed to be much more significant motivators for public action compared to extreme unpleasant emotions (fear, panic, hopelessness, shame), which had a statistically significantly negative effect on the uptake of public health interventions in several cases. Pleasant emotions (empathy, hope) also showed promise as motivators for public health intervention uptake, but more research is needed to corroborate this. Conclusions The results of this review show that the public’s emotional responses to epidemics in the past 30 years have played a clear role in determining how successful the rollout of public health interventions has been. Emotions need to be considered in crisis communications, and these research findings can help inform communications strategies in the evolving context of the COVID-19 pandemic and future infectious disease outbreaks.

To investigate associations between parent–child relationships, children’s externalizing and internalizing symptoms, and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of a random, representative sample of residents with children aged 3–17 years during mid-March 2020 in Wuhan and Shanghai, China. A total of 1655 parents and children were surveyed with a response rate of 80.1% in the survey. During the epidemic, the frequency of children enquiring about the epidemic (AOR = 1.46, 95% CI: 1.04, 2.06), parents explaining the epidemic to them (AOR = 2.87, 95% CI: 1.80, 4.58), parents expressing negative emotions in front of them (AOR = 2.62; 95% CI = 2.08–3.30), and parents with more irritable attitudes (AOR = 1.93; 95% CI = 1.33–2.81) were significantly associated with children’s externalizing symptoms. For internalizing symptoms, significant associations were found with worse parent–child closeness (AOR = 2.93; 95% CI = 1.80–4.79), the frequency of parents expressing negative emotions in front of them (AOR = 2.64; 95% CI = 1.68, 4.12), and more irritable attitudes (AOR = 2.24; 95% CI = 1.42–3.55). We also found that each indicator of parent–child relationships had the significantly similar associations with children’s lifestyle behaviors. These findings suggest that improving parents’ attitudes towards their children and parent–child closeness during the epidemic, especially among parents with lower educational levels, are important to ensure the wellbeing of children.

Maternal vaccination is an important strategy to reduce maternal and newborn mortality and morbidity. Yet, vaccination uptake is suboptimal in many countries, including France. This mixed-method study aimed to identify factors influencing maternal vaccination, exploring pregnant women's perceptions, confidence, and decision-making processes in France. Maternal vaccination uptake was positively associated with awareness of maternal vaccines, confidence in vaccine effectiveness and receiving a recommendation from a healthcare professional. A trusting relationship with healthcare professionals was observed as crucial for women during pregnancy. Even if women considered themselves as sole decision-makers, healthcare professionals' role in decision-making was viewed as substantial. Pregnancy can be a complex time for assessing risks, which was evident in the strong emotional reactions to maternal vaccination and anxieties about safety. As new maternal vaccines are developed, it is crucial to consider women's values, risk perceptions and emotions in the development of strategies to support acceptance of maternal vaccination.

Abstract Background In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore. Methods We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12–23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children’s vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) “5As” taxonomy for the determinants of vaccine uptake. Results In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53–76%) and 77% (95% CI: 58–88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07–0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04–0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination. Conclusions Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.

BACKGROUND:The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake.METHODS:We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type.FINDINGS:We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited.CONCLUSIONS:The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.

INTRODUCTION:Vaccine hesitancy is cited as one of the top threats to global health. The Changchun Changsheng Biotechnology Company was found to have violated good manufacturing practices in July 2018, leading to widespread distribution of sub-potent vaccines in China. We estimated the prevalence and determinants of vaccine hesitancy following the Changchun Changsheng vaccine incident (CCVI). METHODS:We conducted a cross-sectional survey in China in January 2019, and 2,124 caregivers of children < 6 years old completed self-administered questionnaires. Multinomial logistic regression was used to assess the determinants of vaccine hesitancy; the potential determinants included demographics, socioeconomic status, vaccine confidence, and knowledge of the CCVI. Adjusted Odds Ratios (AORs) and 95% confidence intervals (CI) are reported. RESULTS:Around 89% of caregivers had heard of the CCVI. Although 83% and 88% of caregivers agreed that vaccines are safe and effective, respectively, 60% expressed some hesitancy about vaccination. Of those hesitant, 26% vaccinated their children at times with doubts, 31% delayed vaccination and 3% refused specific vaccines. Multinomial regression analysis showed that confidence in vaccine safety was associated with a reduced odds of doubts on vaccination (AOR = 0.64; 95%CI = 0.44-0.94), whereas caregivers who had heard of the CCVI had a significantly higher odds of doubts on vaccination (AOR = 1.61; 95%CI = 1.05-2.45). Confidence in the vaccine delivery system and government were associated with a lower odds of vaccine hesitancy. Caregivers with higher education and Buddhism or other religions were significantly more hesitant to vaccinate their children. CONCLUSION:Vaccine hesitancy was prevalent following the CCVI. Over half the caregivers either accepted childhood vaccination with doubts or delayed vaccines; only a small number were active refusers. Our findings highlight the importance of addressing vaccine hesitancy, especially following vaccine incidents. Tailored communications are needed to reduce vaccine hesitancy, especially among the highly educated and Buddhist caregivers.

Case studies are widely used in most professions, including medicine, law, engineering, business, planning, and architecture. This practice is becoming increasingly common in landscape architecture as well. The primmy body of knowledge in landscape architecture is contained in the written and visual documentation—that is, stories—of projects, be it well-known ones such as New York's Central Park, or more modest projects such as a small neighborhood park. Together, these cases provide the primary form of education, innovation, and testing for the profession. They also serve as the collective record of the advancement and development of new knowledge in landscape architecture. This article summarizes a research project commissioned by the Landscape Architecture Foundation (LAF) in 1997 to develop a case study method for landscape architecture. The project concludes that the case study method is a highly appropriate and valuable approach in landscape architecture. This article presents a case study methodology for landscape architecture including its limits and benefits, a suggested methodology and format, and an example case study of Bryant Park in New York City. With increased rigor and funding, the case study method promises to be an increasingly common and effective form of analysis, criticism, and dissemination for landscape architecture research and practice.

Francis, Mark Rohit; Nohynek, Hanna; Larson, Heidi; Balraj, Vinohar; Mohan, Venkata Raghava; Kang, Gagandeep; Nuorti, J Pekka; (2017) Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998-2008. Vaccine, 36 (44). pp. 6559-6566. ISSN 0264410X DOI: https://doi.org/10.1016/j.vaccine.2017.08.026 Downloaded from: http://researchonline.lshtm.ac.uk/id/eprint/4293903/ DOI: https://doi.org/10.1016/j.vaccine.2017.08.026

Background: Despite almost three decades of the Universal Immunization Program in India, a little more than half the children aged 12-23 months receive the full schedule of routine vaccinations. We examined socio-demographic factors associated with partial-vaccination and non-vaccination and the reasons for non-vaccination among Indian children during 1998 and 2008. Methods: Data from three consecutive, nationally-representative, District Level Household and Facility Surveys (1998-99, 2002-04 and 2007-08) were pooled. Multinomial logistic regression was used to identify individual and household level socio-demographic variables associated with the child's vaccination status. The mother's reported reasons for non-vaccination were analyzed qualitatively, adapting from a previously published framework. Results: The pooled dataset contained information on 178,473 children 12-23 months of age; 53%, 32% and 15% were fully vaccinated, partially vaccinated and unvaccinated respectively. Compared with the 1998-1999 survey, children in the 2007-2008 survey were less likely to be unvaccinated (Adjusted Prevalence Odds Ratio (aPOR): 0.92, 95%CI = 0.86-0.98) but more likely to be partially vaccinated (aPOR: 1.58, 95%Cl = 1.52-1.65). Vaccination status was inversely associated with female gender, Muslim religion, lower caste, urban residence and maternal characteristics such as lower educational attainment, non-institutional delivery, fewer antenatal care visits and non-receipt of maternal tetanus vaccination. The mother's reported reasons for non-vaccination indicated gaps in awareness, acceptance and affordability (financial and non-financial costs) related to routine vaccinations. Conclusions: Persisting socio-demographic disparities related to partial-vaccination and nonvaccination were associated with important childhood, maternal and household characteristics. Further research investigating the causal pathways through which maternal and social characteristics influence decision-making for childhood vaccinations is needed to improve uptake of routine vaccination in India. Also, efforts to increase uptake should address parental fears related to vaccination to improve trust in government health services as part of ongoing social mobilization and communication strategies. (C) 2017 Elsevier Ltd. All rights reserved.

Background: Whilst the majority of patients with chest pain presenting to the Emergency Department do not have myocardial infarction (MI), most are admitted for serial cardiac troponin testing. High-sensitivity cardiac troponin assays may improve the risk stratification of patients at presentation