Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results.

Role models in a preventive program for hand eczema among healthcare workers: a qualitative exploration of their main tasks and associated barriers and facilitators.

BACKGROUND: Role models often play a role when implementing guidelines in healthcare. However, little is known about how role models perform their respective roles, or about which factors may hamper or enhance their functioning. The aim of the present study was therefore to investigate how role models perform there role as a part of a multifaceted implementation strategy on the prevention of hand eczema, and to identify barriers and facilitators for the performing of their role. METHODS: The role models were selected to become a role model and received a role model training. All role models worked at a hospital. In total, 19 role models, were interviewed. A topic list was used focussing on how the role models performed their role and what they experienced to be facilitators and barriers for their role. After coding the interviews, the codes were divided into themes. RESULTS: This study shows that the main tasks perceived by the role models were to raise awareness, to transfer information, to interact with colleagues about hand eczema, to provide material, and to perform coordinating tasks. Barriers and facilitators were whether the role suited the participant, affinity with the topic, and risk perception. CONCLUSIONS: Most role models performed only the tasks they learned during their training. They mentioned a wide range of barriers and facilitators for the performing of their role. To enhance the functioning of the role models, a suggestion would be to select role models by taking into account prior coaching experience. TRIAL REGISTRATION NUMBER: NTR2812.

Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers.

BACKGROUND: Evidence-based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful. OBJECTIVES: To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial. METHODS: A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators. RESULTS: Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio-political, organization, user, and facilities) were identified. CONCLUSIONS: To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account.

Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial.

BACKGROUND: Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers. OBJECTIVES: To investigate the effects of the implementation strategy on self-reported hand eczema and preventive behaviour. METHODS: A randomized controlled trial was performed. A total of 48 departments (n = 1649) were randomly allocated to the multifaceted implementation strategy or the control group. The strategy consisted of education, participatory working groups, and role models. Outcome measures were self-reported hand eczema and preventive behaviour. Data were collected at baseline, and 3, 6, 9 and 12 months of follow-up. RESULTS: Participants in the intervention group were significantly more likely to report hand eczema [odds ratio (OR) 1.45; 95% confidence interval (CI) 1.03-2.04], and they reported significantly less hand washing (B, - 0.38; 95%CI: - 0.48 to - 0.27), reported significantly more frequent use of a moisturizer (B, 0.30; 95%CI: 0.22-0.39) and were more likely to report wearing cotton undergloves (OR 6.33; 95%CI: 3.23-12.41) than participants in the control group 12 months after baseline. CONCLUSIONS: The strategy implemented can be used in practice, as it showed positive effects on preventive behaviour. More research is needed to investigate the unexpected effects on hand eczema.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers.

OBJECTIVES: To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. METHODS: The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. RESULTS: Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B -0.40; 95% -0.51 to -0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. CONCLUSIONS: The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. TRIAL REGISTRATION NUMBER: NTR2812.

Implementation of recommendations for hand eczema through a multifaceted strategy. A process evaluation among health care workers.

Process data give important insights into how an intervention is implemented. The aim of the present study is to conduct a process evaluation, alongside a randomised controlled trail, on the implementation of recommendations for the prevention of hand eczema. The intervention was carried out in healthcare workers' departments and consisted of working groups and role models. The role models were selected based on their representativeness, their influence on colleagues, and their motivation. The focus of the working group was to implement recommendations for hand eczema at the department by choosing solutions to overcome barriers for implementation. Out of the 104 solutions, 87 were realised. Solutions regarding moisturisers and use of cotton under gloves, were used by 90.9% and 30.8% of the employees, respectively. Of all participants, 58.2% actively engaged with the role models. This process evaluation showed that the intervention was executed according to protocol and that the solutions were implemented well. However, the role model component in the intervention should be improved.

Food resource competition between African wild dogs and larger carnivores in an ecosystem with artificial water provision.

Predators of similar size often compete over prey. In semi-arid ecosystems where water is a limiting resource, prey availability can be affected by water distribution, which further increases resource competition and exacerbate conflict among predators. This can have implications for carnivore dietary competition. Hence, we evaluated the dynamics of food resource competition between African wild dogs and four competing predators (cheetahs, leopards, lions and spotted hyaenas) in different seasons and across areas with different waterhole densities in Hwange National Park, Zimbabwe. We used the frequency of occurrence of prey items found in predators' scats to analyse diet composition, overlap and prey preference. For most predators, kudu was most frequently consumed and preferred. Low and medium water-dependent prey (medium and small-sized) were mostly consumed by wild dogs, leopards and cheetahs. Wild dog diet overlap was high with all predators, particularly with hyaenas and lions. There were no seasonal differences in the predators diet. The diet overlap of wild dogs with lions was highest in the low waterhole density area, and wild dog diet composition did not differ significantly from the diet of lions and hyaenas. In the low waterhole density area, wild dogs and hyaenas broadened their niche breadth, and predators diet had a higher proportion of low water-dependent prey. A low density of waterholes increased food resource competition. However, high density of waterholes, where there is more prey availability, can increase the aggregation and density of predators, and hence, increase the risks involved in interspecific competition on wild dogs. To reduce food resource competition on wild dogs, we propose to conserve larger-bodied prey that are less dependent on water (e.g. kudu, reedbuck, eland and gemsbok). As the use of water pumping is common practice, we propose maintaining water management heterogeneity where prey which is less dependent on water can also thrive.

Hand eczema among healthcare professionals in the Netherlands: prevalence, absenteeism, and presenteeism.

BACKGROUND: Healthcare professionals have a high risk of developing hand eczema. Hand eczema can interfere with their work. OBJECTIVES: To investigate the prevalence of self-reported hand eczema among healthcare professionals in the Netherlands, and to investigate absenteeism and presenteeism resulting from hand eczema. METHODS: A questionnaire-based observational study was performed. Participants were recruited from hospitals and nursing homes in the Netherlands. The study population consisted of 1232 healthcare professionals. We used the NOSQ-2002 to measure hand eczema and the PRODISQ for absenteeism and presenteeism. RESULTS: The 1-year prevalence of hand eczema among healthcare professionals was 12%. Among all participants, 47% reported symptoms related to hand eczema. Sick leave resulting from hand eczema was reported by 0.3% of healthcare professionals in general, and by 1.7% of healthcare professionals with hand eczema. In the group with hand eczema, 3.1% reported a large effect on presenteeism. CONCLUSIONS: The 1-year prevalence of hand eczema among healthcare professionals in the Netherlands is low, but the prevalence of symptoms related to hand eczema is quite high. Hand eczema seems to have little impact on work in terms of absenteeism and presenteeism.

Fine-Scaled Selection of Resting and Hunting Habitat by Leopard Cats (Prionailurus bengalensis) in a Rural Human-Dominated Landscape in Taiwan.

Wildlife is increasingly forced to live in close proximity to humans, resulting in human-wildlife conflict and anthropogenic mortality. Carnivores persisting in human-dominated landscapes respond to anthropogenic threats through fine-scaled spatial and temporal behavioral adjustments. Although crucial for conservation, quantitative information on these adjustments is scarce. Taiwan's endangered leopard cat occurs in rural human-dominated landscapes with a high anthropogenic mortality risk. To survive, the nocturnal leopard cat needs suitable habitats for foraging and safe refuge for resting during daytime hours when human activity peaks. In this study, we tracked seven VHF-collared leopard cats. To determine habitat selection patterns, we compared land use at nighttime locations and daytime resting sites with random points and fine-scaled vegetation characteristics at daytime resting sites with random points. Leopard cats selected natural habitats for nighttime hunting and avoided manmade and, to a lesser extent, agricultural habitats or used them according to availability. For daytime resting, leopard cats selected natural habitats and, to a lesser extent semi-natural habitats, such as unused land and abandoned orchards. Resting sites were preferentially situated in natural habitats, with little visibility (<2 m), shrubs, reed and stones, away from areas with high levels of human activity. This suggests leopard cats use a proactive strategy to avoid human encounters, which was supported by the reduced temporal overlap with humans and domestic dogs on agricultural land. Resting sites were placed ca. 1 km apart, 12.9 ± 0.3 m (mean ± SE) from the patch's edges, in patches with a size of 1.21 ± 0.04 ha (mean ± SE). Our results will assist in identifying and preserving suitable resting habitats to support leopard cat conservation.

A nutrition labeling intervention in worksite cafeterias: an implementation evaluation across two large catering companies in the Netherlands.

By both increasing the availability of healthy foods and labeling these products with the Choices logo, caterers may facilitate employees to make a healthier choice in their worksite cafeterias. The aim of this study was to explore which attributes influence the implementation of the Choices logo in worksite cafeterias in the Netherlands. Questionnaires were completed by catering managers of 316 cafeterias of two large caterers in the Netherlands (response rate 49.8%). Attributes from the Diffusion of Innovations Theory were used to investigate whether they could predict implementation. Compatibility (consistency with the beliefs of the catering manager; OR = 1.52), voluntariness (perception of the implementation as voluntary; OR = 0.50), result demonstrability (ability to communicate the implementation; OR = 1.52) and complexity in the sense of time (time needed for implementation; OR = 0.70) were the best predictors for the frequency of offering fresh Choices products (all significant). For the frequency of using Choices promotion material, voluntariness (OR = 0.54), result demonstrability (OR = 1.51) and relative advantage (perceived advantage of the implementation; OR = 1.44) were the best predictors (all significant). In conclusion, this study provides unique insights into which perceived attributes influence the implementation of a nutrition logo in worksite cafeterias. To increase the implementation, the Choices logo should be consistent with catering managers' ideas about healthy food, the workload of implementing the logo should be limited and it could be recommended to incorporate the logo in the health policy of the caterer.

Hands4U: a multifaceted strategy to implement guideline-based recommendations to prevent hand eczema in health care workers: design of a randomised controlled trial and (cost) effectiveness evaluation.

BACKGROUND: Workers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS) is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work. METHODS/DESIGN: This study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1) within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2) role models will help their colleagues in performing the desired behaviour; 3) education to all workers will enhance knowledge about (the prevention of) hand eczema; 4) reminders will be placed at the department reminding workers to use the recommendations; 5) workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs.Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employer's perspective. DISCUSSION: The prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014. TRIAL REGISTRATION NUMBER: NTR2812.

I thought I saw a pussy cat: Portrayal of wild cats in friendly interactions with humans distorts perceptions and encourages interactions with wild cat species.

Most people lack the opportunity to see non-domesticated animals in the wild. Consequently, people's perception of wild animals is based on what they see on (social) media. The way in which (social) media portrays non-domesticated animals determines our perception of and behaviour to these animals. People like to interact with animals, which is why venues which offer the opportunity to interact with non-domesticated animals are popular wildlife tourist attractions (WTAs). However, these WTAs more often than not profit at the expense of animal welfare, conservation and human safety. Participation in such WTAs should therefore be discouraged. Through (social) media we are regularly exposed to images of non-domesticated animals in close interactions with humans. Exposure to such images seems to blur the line between what is a friendly domesticated animal and what is a potentially dangerous wild animal. Such images may also increase our desire to engage in interactions with non-domesticated animals ourselves and reduce moral concerns about the use of non-domesticated animals for such interactions, thereby promoting WTAs in which tourists can interact with non-domesticated animals. Wild cat species are commonly used in the wildlife tourism industry to interact with tourists. In this study, we determine whether portrayal of wild cat species in interactions with humans promotes WTAs with wild cats. We presented respondents with an image of a wild cat species (lion, cheetah, caracal) in a control setting, walked by a human (WTA), petted by a human (WTA) or in the wild and asked them to answer a fixed set of questions. We found that portraying wild cat species in interactions with humans reduced the fear of wild cats, encouraged people to regard WTAs with wild cats as acceptable and stimulated them to participate in such activities themselves.

Cost-effective assembly of the African wild dog (Lycaon pictus) genome using linked reads.

Background: A high-quality reference genome assembly is a valuable tool for the study of non-model organisms. Genomic techniques can provide important insights about past population sizes and local adaptation and can aid in the development of breeding management plans. This information is important for fields such as conservation genetics, where endangered species require critical and immediate attention. However, funding for genomic-based methods can be sparse for conservation projects, as costs for general species management can consume budgets. Findings: Here, we report the generation of high-quality reference genomes for the African wild dog (Lycaon pictus) at a low cost (<$3000), thereby facilitating future studies of this endangered canid. We generated assemblies for three individuals using the linked-read 10x Genomics Chromium system. The most continuous assembly had a scaffold and contig N50 of 21 Mb and 83 Kb, respectively, and completely reconstructed 95% of a set of conserved mammalian genes. Additionally, we estimate the heterozygosity and demographic history of African wild dogs, revealing that although they have historically low effective population sizes, heterozygosity remains high. Conclusions: We show that 10x Genomics Chromium data can be used to effectively generate high-quality genomes from Illumina short-read data of intermediate coverage (∼25x-50x). Interestingly, the wild dog shows higher heterozygosity than other species of conservation concern, possibly due to its behavioral ecology. The availability of reference genomes for non-model organisms will facilitate better genetic monitoring of threatened species such as the African wild dog and help conservationists to better understand the ecology and adaptability of those species in a changing environment.

The distribution and numbers of cheetah (Acinonyx jubatus) in southern Africa.

Assessing the numbers and distribution of threatened species is a central challenge in conservation, often made difficult because the species of concern are rare and elusive. For some predators, this may be compounded by their being sparsely distributed over large areas. Such is the case with the cheetah Acinonyx jubatus. The IUCN Red List process solicits comments, is democratic, transparent, widely-used, and has recently assessed the species. Here, we present additional methods to that process and provide quantitative approaches that may afford greater detail and a benchmark against which to compare future assessments. The cheetah poses challenges, but also affords unique opportunities. It is photogenic, allowing the compilation of thousands of crowd-sourced data. It is also persecuted for killing livestock, enabling estimation of local population densities from the numbers persecuted. Documented instances of persecution in areas with known human and livestock density mean that these data can provide an estimate of where the species may or may not occur in areas without observational data. Compilations of extensive telemetry data coupled with nearly 20,000 additional observations from 39 sources show that free-ranging cheetahs were present across approximately 789,700 km2 of Namibia, Botswana, South Africa, and Zimbabwe (56%, 22%, 12% and 10% respectively) from 2010 to 2016, with an estimated adult population of 3,577 animals. We identified a further 742,800 km2 of potential cheetah habitat within the study region with low human and livestock densities, where another ∼3,250 cheetahs may occur. Unlike many previous estimates, we make the data available and provide explicit information on exactly where cheetahs occur, or are unlikely to occur. We stress the value of gathering data from public sources though these data were mostly from well-visited protected areas. There is a contiguous, transboundary population of cheetah in southern Africa, known to be the largest in the world. We suggest that this population is more threatened than believed due to the concentration of about 55% of free-ranging individuals in two ecoregions. This area overlaps with commercial farmland with high persecution risk; adult cheetahs were removed at the rate of 0.3 individuals per 100 km2 per year. Our population estimate for confirmed cheetah presence areas is 11% lower than the IUCN's current assessment for the same region, lending additional support to the recent call for the up-listing of this species from vulnerable to endangered status.

Gender and Personality Differences in Response to Social Stressors in Great Tits (Parus major).

In response to stressors, animals can increase the activity of the hypothalamic-pituitary-adrenocortical axis, resulting in elevated glucocorticoid concentrations. An increase in glucocorticoids results in an increase in heterophils and a decrease in lymphocytes, which ratio (H/L-ratio) is an indicator of stress in birds. The physiological response to a stressor can depend on individual characteristics, like dominance rank, sex and personality. Although the isolated effects of these characteristics on the response to a stressor have been well studied, little is known about the response in relation to a combination of these characteristics. In this study we investigate the relationship between social stress, dominance rank, sex and exploratory behaviour as a validated operational measure of personality in great tits (Parus major). Great tits show consistent individual differences in behaviour and physiology in response to stressors, and exploratory behaviour can be classified as fast or slow exploring. We group-housed four birds, two fast and two slow explorers, of the same sex that were previously singly housed, in an aviary and compared the H/L-ratio, lymphocyte and heterophil count before and after group housing. After experiencing the social context all birds increased their H/L-ratio and heterophil count. Females showed a stronger increase in H/L-ratio and heterophil count than males, which seemed to be related to a higher number of agonistic interactions compared to males. Dominance rank and exploration type did not affect the H/L-ratio or heterophil count. Contrary to our expectations, all birds increased their lymphocyte count. However, this increase was slower for fast than for slow explorers. Our study suggests that personality and sex related differences, but not dominance rank, are associated with changes in an individual's physiological response due to a social context.