This article investigates how image, perceived service quality and satisfaction determine loyalty in a retail bank setting at the global construct level, as well as the level of construct dimensions. At the global level the results of a large‐scale empirical study reveal that image is indirectly related to bank loyalty via perceived quality. In turn, service quality is both directly and indirectly related to bank loyalty via satisfaction. The latter has a direct effect on bank loyalty. At the level of the dimensions underlying aforementioned constructs, it becomes clear that reliability (a quality dimension) and position in the market (an image dimension) are relatively important drivers of retail bank loyalty.

Two double-blind randomised controlled studies (phase I and I/II) were performed to assess for the first time the safety and immunogenicity of a recombinant subunit gp350 Epstein–Barr virus (EBV) vaccine in 148 healthy adult volunteers. All candidate vaccine formulations had a good safety profile and were well tolerated, with the incidence of solicited and unsolicited symptoms within a clinically acceptable range. One serious adverse event was reported in the phase I trial which was considered to be of suspected relationship to vaccination. The gp350 vaccine formulations were immunogenic and induced gp350-specific antibody responses (including neutralising antibodies).

Background The aim of this interim analysis of a large, international phase III study was to assess the efficacy of an AS04 adjuvanted L1 virus-like-particle prophylactic candidate vaccine against infection with human papillomavirus (HPV) types 16 and 18 in young women.Methods 18 644 women aged 15-25 years were randomly assigned to receive either HPV16/18 vaccine (n=9319) or hepatitis A vaccine (n=9325) at 0, 1, and 6 months. Of these women, 88 were excluded because of high-grade cytology and 31 for missing cytology results. Thus, 9258 women received the HPV16/18 vaccine and 9267 received the control vaccine in the total vaccinated cohort for efficacy, which included women who had prevalent oncogenic HPV infections, often with several HPV types, as well as low-grade cytological abnormalities at study entry and who received at least one vaccine dose. We assessed cervical cytology and subsequent biopsy for 14 oncogenic HPV types by PCR. The primary endpoint-vaccine efficacy against cervical intraepithelial neoplasia (CIN) 2+ associated with HPV16 or HPV18-was assessed in women who were seronegative and DNA negative for the corresponding vaccine type at baseline (month 0) and allowed inclusion of lesions with several oncogenic HPV types. This interim event-defined analysis was triggered when at least 23 cases of CIN2+ with HPV16 or HPV18 DNA in the lesion were detected in the total vaccinated cohort for efficacy. Analyses were done on a modified intention-to-treat basis. This trial is registered with the US National Institutes of Health clinical trial registry, number NCT00122681.Findings Mean length of follow-up for women in the primary analysis for efficacy at the time of the interim analysis was 14.8 (SD 4.9) months. Two cases of CIN2+ associated with HPV16 or HPV18 DNA were seen in the HPV16/18 vaccine group; 21 were recorded in the control group. Of the 23 cases, 14 (two in the HPV16/18 vaccine group, 12 in the control group) contained several oncogenic HPV types. Vaccine efficacy against CIN2+ containing HPV16/18 DNA was 90.4% (97.9% Cl 53.4-99.3; p < 0.0001). No clinically meaningful differences were noted in safety outcomes between the study groups.Interpretation The adjuvanted HPV16/18 vaccine showed prophylactic efficacy against CIN2+ associated with HPV16 or HPV18 and thus could be used for cervical cancer prevention.

Active surveillance of ambulatory and hospitalized children 2-23 months old in Cordoba, Argentina for invasive pneumococcal disease and radiographically confirmed "obvious" pneumonia revealed annual incidences of 206.8 and 2422 cases, respectively, per 100,000 children. The invasive pneumococcal disease incidence was substantially higher than those previously reported from Latin America and Europe.

Aclaracion de intereses: Estudio desarrollado con el apoyo de Glaxo Smith Kline Biological’s. RESUMEN Introduccion. El objetivo del trabajo fue investigar la incidencia de enfermedad invasiva por Streptococcus pneumoniae en pacientes hospitalizados y ambulatorios atendidos en centros de la ciudad de Cordoba, Argentina. Poblacion, material y metodos. Este estudio de incidencia se realizo entre diciembre de 1999 y noviembre de 2002. Se obtuvieron hemocultivos en todos los pacientes de 2 a 23 meses de edad con sospecha de la enfermedad (temperatura axilar ≥ 39 oC, sospecha clinica de neumonia o sospecha clinica de otra enfermedad invasiva por Streptococcus pneumoniae). A los pacientes con sintomatologia respiratoria y temperatura <39 °C, se les realizo radiografia de torax y a los que presentaban neumonias con condensacion, se les realizo hemocultivo. Tanto la informacion demografica y patologica como la evolucion de la enfermedad se consignaron en una hoja de toma de datos. Resultados. La incidencia global de enfermedad invasiva por S. pneumoniae fue de 206,8 por 105/ano, mayor en los pacientes de 6 a 17 meses. Entre las formas de presentacion de la enfermedad se encontraron: 47,5% (IC 95% 40,0-55,0) de bacteriemia sin foco; 45,8% (IC 95% 38,4-53,4) de neumonia; 3,9% (IC 95% 1,7-8,2) de meningitis y 2,8% (IC 95%1,06,7) de abscesos. El serotipo mas frecuente fue el 14 en el 45,6% de los aislamientos, seguido del 6B y 1 con ambos en el 10,8% de los casos. Durante la vigilancia se encontro un 68% de cepas sensibles, 26% con resistencia intermedia y 6% resistentes a penicilina. Conclusiones. La tasa de incidencia de la enfermedad invasiva por S. pneumoniae en ninos de Cordoba se situa en valores elevados en comparacion con Latinoamerica y Europa, probablemente revelada por la pesquisa de la enfermedad, que en este estudio se realizo en pacientes ambulatorios que representaron mas de la mitad del total de aislamientos. Palabras clave: incidencia, enfermedad invasiva, pesquisa. SUMMARY Introduction. The aim of this study was to investigate the incidence of the invasive Streptococcus pneumoniae disease (ISPD) in Cordoba city, Argentina. This study was performed in hospitalized as well as outpatients. Population, material and methods. The study was conducted between December 1999 and November 2002. Blood cultures were taken from every patient from 2 to 23 months of age who met the inclusion criteria: axilar fever ≥39 °C, pneumonia suspected clinically or any ISPD suspected. Patients who had fever lower than 39 °C with respiratory symptoms had a chest Xray; for those who presented with consolidated pneumonia, a blood culture was performed. Demographic and pathologic information, as well as the clinical outcome, were captured on special forms. Results. The overall incidence of ISPD was 206.8 105/year, and it was higher in those patients between 6 and 17 months of age. Bacteriemia without focus and pneumonia were the most frequent presentations of ISPD, 47.5% (IC 95% 40.0-55.0) and 45.8% (IC 95% 38.4-53.4) respectively. These were followed by meningitis and abscess, 3.9% (IC 95% 1.7-8.2) and 2,8% (IC 95% 1.0-6.7), respectively. The most common serotype isolated was 14 (45.7%), followed by 6B (10.8%) and 1 (10.8%). Trought out surveillance strains susceptible to penicillin in 68% of isolation, 26% intermediate and 6% non-susceptible were found. Conclusions. The incidence of ISPD in Cordoba, Argentina, is relatively high compared to Latin America and Europe previous reports. This high incidence is partly due to the inclusion of ambulatory patients, who represent more than half of the Streptococcus pneumoniae isolated.

BACKGROUND:Acute otitis media is one of the most commonly-diagnosed childhood infections. This study assessed the efficacy of a novel vaccine that contained polysaccharides from 11 different Streptococcus pneumoniae serotypes each conjugated to Haemophilus influenzae-derived protein D in prevention of acute otitis media.METHODS:4968 infants were randomly assigned to receive either pneumococcal protein D conjugate or hepatitis A vaccine at the ages of 3, 4, 5, and 12-15 months and were followed-up until the end of the second year of life. Middle-ear fluid was obtained for bacteriological culture and serotyping in children who presented with abnormal tympanic membrane or presence of middle-ear effusion, plus two predefined clinical symptoms. The primary endpoint was protective efficacy against the first episode of acute otitis media caused by vaccine pneumococcal serotypes. Analysis was per protocol.FINDINGS:From 2 weeks after the third dose to 24-27 months of age, 333 clinical episodes of acute otitis media were recorded in the protein D conjugate group (n=2455) and 499 in the control group (n=2452), giving a significant (33.6% [95% CI 20.8-44.3]) reduction in the overall incidence of acute otitis media. Vaccine efficacy was shown for episodes of acute otitis media caused by pneumococcal vaccine serotypes (52.6% [35.0-65.5] for the first episode and 57.6% [41.4-69.3] for any episode). Efficacy was also shown against episodes of acute otitis media caused by non-typable H influenzae (35.3% [1.8-57.4]). The vaccine reduced frequency of infection from vaccine-related cross-reactive pneumococcal serotypes by 65.5%, but did not significantly change the number of episodes caused by other non-vaccine serotypes.INTERPRETATION:These results confirm that using the H influenzae-derived protein D as a carrier protein for pneumococcal polysaccharides not only allowed protection against pneumococcal otitis, but also against acute otitis media due to non-typable H influenzae. Whether this approach would also allow improved protection against lower respiratory tract infections warrants further investigation.

Background: Development is ongoing to increase the serotype coverage of pneumococcal conjugate vaccines. We report here the immunogenicity and safety of a new 11-valent pneumococcal conjugate vaccine (Pn-PD) in infants. Methods: In a randomized, single blind study, 154 Finnish infants received 1 of 3 regimens: 4 doses of Pn-PD at 2, 4, 6 and 12–15 months; 3 doses of the Pn-PD at 2, 4 and 6 months and 1 dose of 23-valent polysaccharide vaccine (PncPS) at 12–15 months; or 3 doses of the hepatitis B vaccine at 2, 4 and 6 months and Pn-PD at 12–15 months. Serum IgG antibodies to vaccine serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F were measured with an enzyme immunoassay at the ages of 2, 7 and 12–15 months and at 4 or 28 days after the last vaccination. Local and systemic reactions were recorded by parents during 8 days after each dose. Serious adverse reactions were recorded during the entire study period. Results: There was a significant increase in the IgG concentrations to vaccine serotypes after 3 doses of Pn-PD. Antibody concentrations after the primary series varied between 1.26 and 4.92 &mgr;g/ml depending on the serotype and study group. PncPS vaccine induced a better booster response than the Pn-PD, measured at 28 days after the fourth dose. IgG concentrations after the Pn-PD booster ranged between 1.60 and 9.63 &mgr;g/ml and after the PncPS booster between 4.24 and 40.54 &mgr;g/ml, depending on the serotype. The antibody concentrations after the first dose of Pn-PD administered at 12–15 months increased significantly but were lower than after the fourth dose at the same age. No significant antibody increase was measured 4 days after the vaccinations at 12–15 months. The safety profile of the vaccine was acceptable. Conclusions: The Pn-PD we tested was immunogenic and safe in infants.

Recent research linking service quality and service satisfaction has raised issues which require conceptual and empirical elaboration. Among these are the conceptual overlap as well as distinctions between these two customer judgments, the role of expectations and perceptions and the question whether service satisfaction is a superordinate concept to quality or vice versa. In this article an integrative model is presented in which both concepts and their antecedents are delineated on the basis of conceptual advances made in the services marketing literature recently. Moreover, this model is empirically tested in a health care setting to determine the nature of the relationship between service quality and service satisfaction. The results suggest that service quality should be treated as an antecedent of service satisfaction. It was also found that service satisfaction, in addition to service quality, is a direct function of disconfirmation and perception. Furthermore, service quality and disconfirmation seem to be directly related to perception.