Migration and infant immunization timeliness in New Zealand: Evidence from the Growing Up in New Zealand study.

BACKGROUND: Migration has been recognized as an important determinant of child health outcomes including childhood vaccination status. This paper aims to examine the association between parental migration status and a less studied aspect of child immunization outcomes, namely timeliness, within the context of New Zealand (NZ), a country characterized by a substantial proportion of its resident population born overseas. Additionally, the study explored the impact of residential duration on children's immunization timeliness. METHODS: The data was taken from a large, representative population-based cohort study in NZ (Growing Up in NZ study). A total of 6156 children and their parents, comprising 2241 foreign-born and 3915 NZ-born mothers and a sub-group of their partners were included in the analysis. The survey data was linked with the National Immunization Register dataset. Timely immunization was defined as receiving two vaccines at each scheduled vaccination point (at six-week, three-month, and five-month, totaling six doses of vaccines) within 30 days of their due date. We examined the associations between parental migration status, maternal residential duration, and child immunization timeliness while controlling for socio-economic variations. The results were presented as adjusted odds ratios (AORs) with 95 % confidence intervals (CIs). RESULTS: The findings revealed that after adjustment for socioeconomic differences, children of foreign-born mothers exhibited higher odds of receiving all six studied vaccine doses on time compared to children of native-born mothers (AOR 1.51, 95 %CI:1.27-1.78). Similarly, having a foreign-born father was also significantly associated with timely completion of all six vaccine doses. Children of recent immigrants who had resided in the country for less than five years demonstrated higher odds of timely vaccination of all six vaccine doses compared to children of settled immigrants who had lived in the country for five or more years (AOR 1.65, 95 %CI: 1.25-2.19). CONCLUSION: This study revealed a significant pattern in NZ where immigrants exhibited higher rates of timely immunization for their children compared to native-born parents. However, the findings also underscore the importance of providing support to settled immigrants, as their children experienced declines in timely vaccination rates compared to children of recent immigrants and even those born to NZ-born parents.

Health Care Failure Mode and Effect Analysis in the Operating Room Setting.

OBJECTIVES: Operating rooms (ORs) and surgical settings are potential sources of sentinel adverse events. To better understand the characteristics of errors in OR processes, we performed prospective risk analysis. METHODS: The study was mixed qualitative and quantitative research. We used the Healthcare Failure Mode and Effect Analysis (HFMEA) method to analyze the selected perioperative, operative, and postoperative processes in the OR via a 2-round Delphi technique. We identified the most prominent failure modes according to a Hazard Decision Matrix, analyzed and categorized proposed possible causes, and provided solutions to mitigate hazard scores. RESULTS: Ten important processes and 7 subprocesses within the OR were selected and mapped, and 187 failure modes were identified and scored on the basis of severity and probability. A total of 36 potential failure modes were highlighted as high-risk failures and moved to decision trees for further analyses. CONCLUSION: Developing policy for the familiarization of new personnel designing a checklist for accurate gases counting; drafting comprehensive presurgical posters; preparing all necessary equipment in difficult intubation; developing instruction for monthly checking of the OR equipment; and developing the evaluation criteria of staff performance are examples of solutions that are proposed to improve the quality of OR processes.

Hospitals reorientation towards health promotion: A qualitative study of barriers to and strategies for implementation of health promotion in hospitals of Isfahan, Iran.

CONTEXT: The World Health Organization (WHO) has emphasized the need for reorientation of hospitals toward health promotion (HP). AIMS: This study explores health-care professionals' perception of barriers and strategies to implementing HP in educational hospitals of Isfahan Province in Iran. SETTINGS AND DESIGN: The study settings included four selective educational hospitals and the Treatment Administration affiliation to the Isfahan University of Medical Sciences. SUBJECTS AND METHODS: A qualitative content analysis approach was employed in this study, with semi-structured in-depth interviews. Eighteen participants from hospital and accreditation managers, nurses, community medicine specialist, and directors of health-care quality improvement and accreditation participated in the study by purposeful sampling method. The data were analyzed using content analysis method. RESULTS: The barriers can be categorized into the following areas: (1) barriers associated with patient and community, (2) barriers associated with health-care professionals, (3) barriers associated with the organization, and (4) external environment barriers. The results were summarized into four categories as strategies, including: (1) marketing the plan, (2) identifying key people and training, (3) phasing activities and development of feasible goals, and (4) development of strategic goals of health promoting hospitals and supportive policies. CONCLUSIONS: The interactions of individual, organizational, and external environmental factors were identified as barriers to implementation of HP in hospitals. To hospital reorientation toward HP, prioritizing the barriers, and using the proposed strategies may be helpful.