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Linda Kaljee
Global Health Initiative, Henry Ford Health System, One Ford Place, 1E, Detroit, MI 48202, USA

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Journal article
Published: 24 August 2021 in Vaccines
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Background: Vaccine hesitancy is the next great barrier for public health. Arab Americans are a rapidly growing demographic in the United States with limited information on the prevalence of vaccine hesitancy. We therefore sought to study the attitudes towards the coronavirus disease 2019 (COVID-19) vaccine amongst Arab American health professionals living in the United States. Methods: This was a cross sectional study utilizing an anonymous online survey. The survey was distributed via e-mail to National Arab American Medical Association members and Arab-American Center for Economic and Social Services healthcare employees. Respondents were considered vaccine hesitant if they selected responses other than a willingness to receive the COVID-19 vaccine. Results: A total of 4000 surveys were sent via e-mail from 28 December 2020 to 31 January 2021, and 513 responses were received. The highest group of respondents were between the ages of 18–29 years and physicians constituted 48% of the respondents. On multivariable analysis, we found that respondents who had declined an influenza vaccine in the preceding 5 years (p< 0.001) and allied health professionals (medical assistants, hospital administrators, case managers, researchers, scribes, pharmacists, dieticians and social workers) were more likely to be vaccine hesitant (p = 0.025). In addition, respondents earning over $150,000 US dollars annually were less likely to be vaccine hesitant and this finding was significant on multivariable analysis (p = 0.011). Conclusions: Vaccine hesitancy among health care providers could have substantial impact on vaccine attitudes of the general population, and such data may help inform vaccine advocacy efforts.

ACS Style

Anita Shallal; Evi Abada; Rami Musallam; Omar Fehmi; Linda Kaljee; Ziad Fehmi; Suma Alzouhayli; Deema Ujayli; Doreen Dankerlui; Seongho Kim; Michele L. Cote; Vijaya Arun Kumar; Marcus Zervos; Rouba Ali-Fehmi. Evaluation of COVID-19 Vaccine Attitudes among Arab American Healthcare Professionals Living in the United States. Vaccines 2021, 9, 942 .

AMA Style

Anita Shallal, Evi Abada, Rami Musallam, Omar Fehmi, Linda Kaljee, Ziad Fehmi, Suma Alzouhayli, Deema Ujayli, Doreen Dankerlui, Seongho Kim, Michele L. Cote, Vijaya Arun Kumar, Marcus Zervos, Rouba Ali-Fehmi. Evaluation of COVID-19 Vaccine Attitudes among Arab American Healthcare Professionals Living in the United States. Vaccines. 2021; 9 (9):942.

Chicago/Turabian Style

Anita Shallal; Evi Abada; Rami Musallam; Omar Fehmi; Linda Kaljee; Ziad Fehmi; Suma Alzouhayli; Deema Ujayli; Doreen Dankerlui; Seongho Kim; Michele L. Cote; Vijaya Arun Kumar; Marcus Zervos; Rouba Ali-Fehmi. 2021. "Evaluation of COVID-19 Vaccine Attitudes among Arab American Healthcare Professionals Living in the United States." Vaccines 9, no. 9: 942.

Journal article
Published: 16 December 2020 in Antibiotics
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Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.

ACS Style

Varidhi Nauriyal; Shankar Man Rai; Rajesh Dhoj Joshi; Buddhi Bahadur Thapa; Linda Kaljee; Tyler Prentiss; Gina Maki; Basudha Shrestha; Deepak C. Bajracharya; Kshitij Karki; Nilesh Joshi; Arjun Acharya; Laxman Banstola; Suresh Raj Poudel; Anip Joshi; Abhinav Dahal; Niranjan Palikhe; Sachin Khadka; Piyush Giri; Apar Lamichhane; Marcus Zervos. Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal. Antibiotics 2020, 9, 914 .

AMA Style

Varidhi Nauriyal, Shankar Man Rai, Rajesh Dhoj Joshi, Buddhi Bahadur Thapa, Linda Kaljee, Tyler Prentiss, Gina Maki, Basudha Shrestha, Deepak C. Bajracharya, Kshitij Karki, Nilesh Joshi, Arjun Acharya, Laxman Banstola, Suresh Raj Poudel, Anip Joshi, Abhinav Dahal, Niranjan Palikhe, Sachin Khadka, Piyush Giri, Apar Lamichhane, Marcus Zervos. Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal. Antibiotics. 2020; 9 (12):914.

Chicago/Turabian Style

Varidhi Nauriyal; Shankar Man Rai; Rajesh Dhoj Joshi; Buddhi Bahadur Thapa; Linda Kaljee; Tyler Prentiss; Gina Maki; Basudha Shrestha; Deepak C. Bajracharya; Kshitij Karki; Nilesh Joshi; Arjun Acharya; Laxman Banstola; Suresh Raj Poudel; Anip Joshi; Abhinav Dahal; Niranjan Palikhe; Sachin Khadka; Piyush Giri; Apar Lamichhane; Marcus Zervos. 2020. "Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal." Antibiotics 9, no. 12: 914.

Journal article
Published: 29 August 2020 in Antibiotics
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Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit’s content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.

ACS Style

Gina Maki; Ingrid Smith; Sarah Paulin; Linda Kaljee; Watipaso Kasambara; Jessie Mlotha; Pem Chuki; Priscilla Rupali; Dipendra R. Singh; Deepak C. Bajracharya; Lisa Barrow; Eliaser Johnson; Tyler Prentiss; Marcus Zervos. Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries. Antibiotics 2020, 9, 556 .

AMA Style

Gina Maki, Ingrid Smith, Sarah Paulin, Linda Kaljee, Watipaso Kasambara, Jessie Mlotha, Pem Chuki, Priscilla Rupali, Dipendra R. Singh, Deepak C. Bajracharya, Lisa Barrow, Eliaser Johnson, Tyler Prentiss, Marcus Zervos. Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries. Antibiotics. 2020; 9 (9):556.

Chicago/Turabian Style

Gina Maki; Ingrid Smith; Sarah Paulin; Linda Kaljee; Watipaso Kasambara; Jessie Mlotha; Pem Chuki; Priscilla Rupali; Dipendra R. Singh; Deepak C. Bajracharya; Lisa Barrow; Eliaser Johnson; Tyler Prentiss; Marcus Zervos. 2020. "Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries." Antibiotics 9, no. 9: 556.

Journal article
Published: 23 June 2020 in Health & Justice
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Background Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population. The objective of this analysis is to determine the association of trauma, specifically, domestic violence and forced sex, to six sexual risk behaviors and a history of chlamydia among detained youth. Methods The analysis uses data from a convenience sample of detainees assenting to HIV testing conducted December 2016 – August 2017 using the state-certified Voluntary Counseling Testing and Referral (VCTR) process. Results Of the 379 youth that received VCTR at the facility, 308 (81.3%) were used in this analysis. Report of domestic violence was significantly associated with sex under the influence of alcohol and was also significantly associated with sex under the influence of marijuana. Forced sex was associated with a sexual partner of unknown HIV status. Conclusions Traumatic experiences were related to sexual risk behaviors in this analysis, and substance use was strongly implicated in the association. Trauma is known to be a catalyst to sexual risk behaviors, substance use, and delinquency in adolescence. Results support the findings of other investigators and re-iterate the need for trauma-informed interventions that can improve the life trajectories of detained youth.

ACS Style

Lea Selitsky; Norman Markowitz; Dwayne M. Baxa; Linda Kaljee; Cheryl A. Miree; Nishat Islam; Chez Burse; Rehnuma Newaz; Doreen Dankerlui; Gordon Jacobsen; Christine Joseph. Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees. Health & Justice 2020, 8, 1 -10.

AMA Style

Lea Selitsky, Norman Markowitz, Dwayne M. Baxa, Linda Kaljee, Cheryl A. Miree, Nishat Islam, Chez Burse, Rehnuma Newaz, Doreen Dankerlui, Gordon Jacobsen, Christine Joseph. Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees. Health & Justice. 2020; 8 (1):1-10.

Chicago/Turabian Style

Lea Selitsky; Norman Markowitz; Dwayne M. Baxa; Linda Kaljee; Cheryl A. Miree; Nishat Islam; Chez Burse; Rehnuma Newaz; Doreen Dankerlui; Gordon Jacobsen; Christine Joseph. 2020. "Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees." Health & Justice 8, no. 1: 1-10.

Journal article
Published: 02 October 2019 in The American Journal of Tropical Medicine and Hygiene
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Capacity building is needed in low- and middle-income countries (LMICs) to combat antimicrobial resistance (AMR). Stewardship programs such as post-prescription review and feedback (PPRF) are important components in addressing AMR. Little data are available regarding effectiveness of PPRF programs in LMIC settings. An adapted PPRF program was implemented in the medicine, surgery, and obstetrics/gynecology wards in a 125-bed hospital in Kathmandu. Seven “physician champions” were trained. Baseline and post-intervention patient chart data were analyzed for changes in days of therapy (DOT) and mean number of course days for intravenous and oral antibiotics, and for specific study antibiotics. Charts were independently reviewed to determine justification for prescribed antibiotics. Physician champions documented recommendations. Days of therapy per 1,000 patient-days for courses of aminoglycoside (P < 0.001) and cephalosporin (P < 0.001) decreased. In the medicine ward, data indicate increased justified use of antibiotics (P = 0.02), de-escalation (P < 0.001), rational use of antibiotics (P < 0.01), and conforming to guidelines in the first 72 hours (P = 0.02), and for definitive therapy (P < 0.001). Physician champions documented 437 patient chart reviews and made 138 recommendations; 78.3% of recommendations were followed by the attending physician. Post-prescription review and feedback can be successfully implemented in LMIC hospitals, which often lack infectious disease specialists. Future program adaptation and training will focus on identifying additional stewardship programming and support mechanisms to optimize antibiotic use in LMICs.

ACS Style

Rajesh Dhoj Joshi; Marcus Zervos; Linda M. Kaljee; Basudha Shrestha; Gina Maki; Tyler Prentiss; Deepak Bajracharya; Kshitji Karki; Nilesh Joshi; Shankar Man Rai. Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal. The American Journal of Tropical Medicine and Hygiene 2019, 101, 923 -928.

AMA Style

Rajesh Dhoj Joshi, Marcus Zervos, Linda M. Kaljee, Basudha Shrestha, Gina Maki, Tyler Prentiss, Deepak Bajracharya, Kshitji Karki, Nilesh Joshi, Shankar Man Rai. Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal. The American Journal of Tropical Medicine and Hygiene. 2019; 101 (4):923-928.

Chicago/Turabian Style

Rajesh Dhoj Joshi; Marcus Zervos; Linda M. Kaljee; Basudha Shrestha; Gina Maki; Tyler Prentiss; Deepak Bajracharya; Kshitji Karki; Nilesh Joshi; Shankar Man Rai. 2019. "Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal." The American Journal of Tropical Medicine and Hygiene 101, no. 4: 923-928.

Journal article
Published: 26 March 2019 in Tobacco Prevention & Cessation
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ACS Style

Linda Kaljee; Deska Dimitrievska; Marija Zdraveska; Alexander Plum; Magdalena Pop Trajkova; Amanda Holm; Michael Simoff. A cross-sectional survey of patients attending clinics with physicians trained in the adapted Certified Tobacco Treatment Specialist (aCTTS) program in the Former Yugoslav Republic of Macedonia (FYROM). Tobacco Prevention & Cessation 2019, 5, 1 .

AMA Style

Linda Kaljee, Deska Dimitrievska, Marija Zdraveska, Alexander Plum, Magdalena Pop Trajkova, Amanda Holm, Michael Simoff. A cross-sectional survey of patients attending clinics with physicians trained in the adapted Certified Tobacco Treatment Specialist (aCTTS) program in the Former Yugoslav Republic of Macedonia (FYROM). Tobacco Prevention & Cessation. 2019; 5 (Supplement):1.

Chicago/Turabian Style

Linda Kaljee; Deska Dimitrievska; Marija Zdraveska; Alexander Plum; Magdalena Pop Trajkova; Amanda Holm; Michael Simoff. 2019. "A cross-sectional survey of patients attending clinics with physicians trained in the adapted Certified Tobacco Treatment Specialist (aCTTS) program in the Former Yugoslav Republic of Macedonia (FYROM)." Tobacco Prevention & Cessation 5, no. Supplement: 1.

Journal article
Published: 26 March 2019 in Tobacco Prevention & Cessation
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ACS Style

Linda Kaljee; Marija Zdraveska; Deska Dimitrievska; Alexander Plum; Magdalena Pop Trajkova; Amanda Holm; Michael Simoff. A 12-month longitudinal outcomes and process evaluation of the adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians in the Former Yugoslav Republic of Macedonia (FYROM). Tobacco Prevention & Cessation 2019, 5, 1 .

AMA Style

Linda Kaljee, Marija Zdraveska, Deska Dimitrievska, Alexander Plum, Magdalena Pop Trajkova, Amanda Holm, Michael Simoff. A 12-month longitudinal outcomes and process evaluation of the adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians in the Former Yugoslav Republic of Macedonia (FYROM). Tobacco Prevention & Cessation. 2019; 5 (Supplement):1.

Chicago/Turabian Style

Linda Kaljee; Marija Zdraveska; Deska Dimitrievska; Alexander Plum; Magdalena Pop Trajkova; Amanda Holm; Michael Simoff. 2019. "A 12-month longitudinal outcomes and process evaluation of the adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians in the Former Yugoslav Republic of Macedonia (FYROM)." Tobacco Prevention & Cessation 5, no. Supplement: 1.

Journal article
Published: 22 January 2019 in Current Treatment Options in Infectious Diseases
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Antimicrobial resistance (AMR) is a significant global health issue. Hospital-based antimicrobial stewardship programs (ASPs) are an important component of a “One Health” approach for addressing AMR. However, the adaptation and implementation of ASPs in low-resource settings often faces multiple barriers, which need to be identified and addressed to ensure program effectiveness. Barriers to ASPs adoption have been identified at the health system and hospital levels, within the organization and interpersonal relationships in wards and departments, and at the individual level of knowledge and perceptions of physicians and other health providers regarding AMR and antimicrobial prescribing practices. Utilizing the Consolidated Framework for Implementation Research (CFIR) is one means of providing a model for adapting ASPs to meet local needs and for recognizing and addressing barriers prior to and during program implementation. Despite challenges, hospital-based ASPs have been successfully introduced in low-resource settings. Key components of successful ASPs include a focus on de-escalation, development of local prescribing guidelines, inclusion of non-medical training such as communication, and engagement and partnering with a broad coalition of institutional and organizational stakeholders throughout the adaptation, evaluation, implementation, and scale-up processes.

ACS Style

Linda M. Kaljee; Tyler Prentiss; Marcus Zervos. Physician barriers to implementation of hospital-based antimicrobial stewardship programs (ASPs): a global perspective. Current Treatment Options in Infectious Diseases 2019, 11, 73 -80.

AMA Style

Linda M. Kaljee, Tyler Prentiss, Marcus Zervos. Physician barriers to implementation of hospital-based antimicrobial stewardship programs (ASPs): a global perspective. Current Treatment Options in Infectious Diseases. 2019; 11 (1):73-80.

Chicago/Turabian Style

Linda M. Kaljee; Tyler Prentiss; Marcus Zervos. 2019. "Physician barriers to implementation of hospital-based antimicrobial stewardship programs (ASPs): a global perspective." Current Treatment Options in Infectious Diseases 11, no. 1: 73-80.

Journal article
Published: 29 July 2017 in Journal of Infectious Diseases
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Typhoid fever is a significant contributor to infectious disease mortality and morbidity in low- and middle-income countries, particularly in South Asia. With increasing antimicrobial resistance, commonly used treatments are less effective and risks increase for complications and hospitalizations. During an episode of typhoid fever, households experience multiple social and economic costs that are often undocumented. In the current study, qualitative interview data from Kathmandu and surrounding areas provide important insights into the challenges that affect those who contract typhoid fever and their caregivers, families, and communities, as well as insight into prevention and treatment options for health providers and outreach workers. When considering typhoid fever cases confirmed by blood culture, our data reveal delays in healthcare access, financial and time costs burden on households, and the need to increase health literacy. These data also illustrate the impact of limited laboratory diagnostic equipment and tools on healthcare providers' abilities to distinguish typhoid fever from other febrile conditions and treatment challenges associated with antimicrobial resistance. In light of these findings, there is an urgent need to identify and implement effective preventive measures including vaccination policies and programs focused on at-risk populations and endemic regions such as Nepal.

ACS Style

Linda M Kaljee; Alfred Pach; Denise Garrett; Deepak Bajracharya; Kshitji Karki; Imran Khan. Social and Economic Burden Associated With Typhoid Fever in Kathmandu and Surrounding Areas: A Qualitative Study. Journal of Infectious Diseases 2017, 218, S243 -S249.

AMA Style

Linda M Kaljee, Alfred Pach, Denise Garrett, Deepak Bajracharya, Kshitji Karki, Imran Khan. Social and Economic Burden Associated With Typhoid Fever in Kathmandu and Surrounding Areas: A Qualitative Study. Journal of Infectious Diseases. 2017; 218 (suppl_4):S243-S249.

Chicago/Turabian Style

Linda M Kaljee; Alfred Pach; Denise Garrett; Deepak Bajracharya; Kshitji Karki; Imran Khan. 2017. "Social and Economic Burden Associated With Typhoid Fever in Kathmandu and Surrounding Areas: A Qualitative Study." Journal of Infectious Diseases 218, no. suppl_4: S243-S249.

Journal article
Published: 30 January 2017 in International Education Studies
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In Zambia, as elsewhere throughout sub-Saharan Africa, orphaned and vulnerable children (OVC) face multiple physical, emotional, social and psychological challenges which often negatively affect opportunities for educational attainment. REPSSI (Regional Psychosocial Support Initiative), in collaboration with, the University of Cape Town and other African academic institutions, developed the Teachers’ Diploma Program as part of the Mainstreaming Psychosocial Care and Support into Education Systems to provide teachers and school administrators with the knowledge and skills to provide needed support to students and enhance their learning environments. During initial implementation of the Teachers’ Diploma Program in Zambia (2013-2016), qualitative data was collected as a part of larger outcomes and process evaluation. In the current paper, these qualitative data are presented to describe baseline challenges and strengths within the Zambian government school system and early indicators of change during the first ten months of program implementation. These in-depth data provide both teachers’ and students’ experiences and perspectives and are being utilized to further strengthen the Teachers’ Diploma Program as the Zambian Ministry of Education, Science, Vocational Training and Early Childhood moves forward with plans to implement the training at a national level in colleges of teacher education.

ACS Style

Linda Kaljee; Kelvin Munjile; Anitha Menon; Stephen Tembo; XiaoMing Li; Liying Zhang; Jacob Malungo; Bonita Stanton; Lisa Langhaug. The ‘Teachers Diploma Program’ in Zambian Government Schools: A Baseline Qualitative Assessment of Teachers’ and Students’ Strengths and Challenges in the Context of a School-Based Psychosocial Support Program. International Education Studies 2017, 10, 92 .

AMA Style

Linda Kaljee, Kelvin Munjile, Anitha Menon, Stephen Tembo, XiaoMing Li, Liying Zhang, Jacob Malungo, Bonita Stanton, Lisa Langhaug. The ‘Teachers Diploma Program’ in Zambian Government Schools: A Baseline Qualitative Assessment of Teachers’ and Students’ Strengths and Challenges in the Context of a School-Based Psychosocial Support Program. International Education Studies. 2017; 10 (2):92.

Chicago/Turabian Style

Linda Kaljee; Kelvin Munjile; Anitha Menon; Stephen Tembo; XiaoMing Li; Liying Zhang; Jacob Malungo; Bonita Stanton; Lisa Langhaug. 2017. "The ‘Teachers Diploma Program’ in Zambian Government Schools: A Baseline Qualitative Assessment of Teachers’ and Students’ Strengths and Challenges in the Context of a School-Based Psychosocial Support Program." International Education Studies 10, no. 2: 92.

Journal article
Published: 02 January 2017 in Human Vaccines & Immunotherapeutics
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In the United States, influenza and pneumonia account significantly to emergency room use and hospitalization of adults >65 y. The Centers for Disease Control and Prevention recommends use of the annual influenza vaccine and 2 pneumococcal vaccines for older adults to decrease risks of morbidity and mortality. However, actual vaccine up-take is estimated at 61.3% for pneumococcal vaccines and 65% for influenza vaccine in the 2013-2014 season. Vaccine up-take is affected by multiple socio-cultural and economic factors including general healthcare access and utilization, social networks and norms, communication with health providers and health information sources, as well as perceptions related to vaccines and targeted diseases. In this study, 8 focus group discussions (total N = 48) were conducted with adults 65+ years living in urban and suburban communities in the Detroit Metropolitan Area. The research objective was to increase understanding of barriers and facilitators to vaccine up-take in this age cohort within the context of general healthcare availability and accessibility, social networks, information sources, and personal perceptions of diseases and vaccines. The data suggest the need to integrate broader health care service experiences, concepts of knowledge of one's own well-being and vulnerabilities, and self-advocacy as factors associated with older adults' vaccine-use decisions. These data also support recognition of multiple levels of vaccine acceptance which can be disease specific. Implications include potential for increasing vaccine up-take through general improvement in health care delivery and services, as well as specific vaccine-focused patient and provider education programs.

ACS Style

Linda M. Kaljee; Paul Kilgore; Tyler Prentiss; Lois Lamerato; Daniela Moreno; Samia Arshad; Marcus Zervos. “You need to be an advocate for yourself”: Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system. Human Vaccines & Immunotherapeutics 2017, 13, 206 -212.

AMA Style

Linda M. Kaljee, Paul Kilgore, Tyler Prentiss, Lois Lamerato, Daniela Moreno, Samia Arshad, Marcus Zervos. “You need to be an advocate for yourself”: Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system. Human Vaccines & Immunotherapeutics. 2017; 13 (1):206-212.

Chicago/Turabian Style

Linda M. Kaljee; Paul Kilgore; Tyler Prentiss; Lois Lamerato; Daniela Moreno; Samia Arshad; Marcus Zervos. 2017. "“You need to be an advocate for yourself”: Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system." Human Vaccines & Immunotherapeutics 13, no. 1: 206-212.