Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.
Governing Immunization in Canada
Catherine Ling Mah
Raisa Berlin Deber
Health Policy, Management and Evaluation
public health; public policy; immunization; Canada
Modern immunization’s role in health systems is threefold: it is simultaneously a pharmaceutical product, a personal health care intervention, and a public health measure, each constituting a distinct, yet overlapping set of governance arrangements. This thesis examines immunization policy change and governance at the federal-provincial interface over the last decade (1997-2008) in Canada, situated against broader trends in public policy and public health. The research is based upon a case study design and a discursive approach to policy analysis, using documentary sources, supplemented with archival information, direct observations, and decision-maker informants. Over time, structures and instruments used to deal with immunization at the federal-provincial interface have undergone adaptation. New decision-making structures include the Public Health Agency of Canada and the Pan-Canadian Public Health Network; new instruments include the National Immunization Strategy, accompanied by targeted federal funding. Consistent with other sectors, however, the decade also witnessed an ongoing emphasis on fiscal prudence, risk-based regulation, and informal networks to accomplish policy goals. This thesis concludes that effective federal governance and lasting policy change for immunization requires resolution of two major tensions in the policy ideas underlying national processes. First, the interpretation of federal authority over matters of national concern remains ambiguous. While the National Immunization Strategy reflected dominant ideas around equitable access to vaccines and a broad conception of the federal sharing community, persistent gaps, particularly linking national-level decisions, financing, and delivery, have reinforced the existing notion of the appropriate degree of federal influence for immunization, rather than expanding it. Second, an increasing focus on personal security dimensions of immunization amid structural changes intended to address public security concerns is in tension with a situation that predisposes the state to avoid an unjust application of compulsory measures rather than to protect from harm those individuals who consent freely to immunization. Immunization in Canada requires a new paradigm that expands the notion of the state’s role in prevention as it applies to immunization, that addresses specific needs for protection in the life of the individual, and that reasserts the importance of strong, substantive, and sustained federal contributions to matters of national concern.