Factors associated with hand hygiene adherence among healthcare workers in Guatemala during the COVID-19 pandemic.

BACKGROUND: Healthcare-associated infections are prevalent in low- and middle-income countries and may be reduced through proper hand hygiene (HH) adherence during patient care. AIM: We produced and distributed alcohol-based hand rub (ABHR) to 19 public primary- and secondary-level healthcare facilities in Quetzaltenango, Guatemala, and carried out HH observations to assess healthcare workers' (HCWs) HH adherence, and to identify factors associated with this practice. HH adherence was defined as washing hands with soap and water or using ABHR. METHODS: Observations were conducted before (2021, baseline) and after (2022, follow-up) ABHR distribution to evaluate the evolution of HH practices over time. Bivariate comparisons and mixed-effects logistic regression models were used to explore associations between HH adherence and the following independent variables: healthcare facility level, type of contact performed, timing of HH performance, occupational category of HCW and materials present (e.g., water, soap, ABHR). FINDINGS: We observed 243 and 300 patient interactions among 67 and 82 HCWs at each time point, respectively. HH adherence was low for both observation periods (40% at baseline and 35% at follow-up). HCWs were more likely to adhere to HH during invasive contacts, after patient contact, and if the HCW was a physician. CONCLUSION: HH adherence varied by scenario, which underscores the importance of addressing multiple determinants of behaviour change to improve adherence. This requires interventions implemented with a multi-modal approach that includes both increasing access to HH materials and infrastructure, as well as HH education and training, monitoring and feedback, reminders, and promoting a HH safety culture.

Results of the Expanded HIV Risk Factor Assessment Project (EHRAP).

An objective of EHRAP was to evaluate the HIV risk factor information reported to CDC through routine surveillance. HIV/AIDS surveillance programmes used medical and ancillary records to determine if information on HIV risk factors can be found for surveillance. Surveillance staff from Mississippi, South Carolina, and Virginia collected data on risk factors for HIV infection on a sample of cases diagnosed during 1998 and 1999. Overall percent agreement and Cohen kappa statistics were calculated for initially reported compared to EHRAP-identified risk factors. Of 160 cases reported without an identified risk factor, 86% were reclassified with a known risk factor. A risk factor was identified for 96% of all cases of HIV infection. Overall, agreement was good (kappa = 0.89) between initially reported and verified HIV risk factor. All three states met the national goal of at least 85% of reported cases with a risk factor for HIV infection. The completeness of collection and reporting of HIV risk factors for national HIV/AIDS surveillance can be improved. The current method of risk factor redistribution at the national level should be evaluated.

Factors associated with sunburn in white children aged 6 months to 11 years.

OBJECTIVE: To determine the sunburn experience and factors associated with sunburn among white children aged 6 months to 11 years. METHODS: Telephone interviews were conducted with parents and primary caretakers of children, selected by random, stratified sampling, in the contiguous United States in the summer of 1998. Information was gathered on demographic characteristics of parents and children, and children's sunburn experience during the past year, protection from sun exposure, and hours per week spent outdoors. The proportion of children experiencing sunburn in the past year was calculated. Multivariate logistic regression analyses were conducted to determine factors associated with sunburn. Information for 1052 white children was available for the analyses. RESULTS: An estimated 42.6% of U.S. white children experienced one or more sunburns within the past year (95% CI 38.2-47.0). Sunburn was less common among children who ever wore hats (adjusted OR 0.59, 95% CI 0.40-0.87) and more common among children who did not always wear sunscreen (OR for using sunscreen sometimes compared with always, 2.25; 95% CI 1.31-3. 86). Sunburn was also more common among children with sun-sensitive skin and older children. CONCLUSIONS: A large proportion of U.S. white children experience sunburns. Parents and children may benefit from education about protection from sun exposure.

Vitamin/mineral supplementation among cancer survivors: 1987 and 1992 National Health Interview Surveys.

The number of cancer survivors in the United States is increasing, but little is known about this population, including its use of vitamin/mineral supplements. We combined data on vitamin/mineral use from the 1987 and 1992 National Health Interview Survey Cancer Epidemiology Supplement (CES) for cancer survivors: persons reporting a diagnosis of cancer other than nonmelanoma skin cancer > 5 yr before their interviews [n = 461 (1987) and 228 (1992)] and persons reporting no history of cancer [n = 20,851 (1987) and 11,186 (1992)]. For both groups, we calculated gender-specific proportions (adjusted for age, race/ethnicity, education, smoking status, and poverty index) for use of multivitamins, vitamins A, C, and E, and calcium during the year before each survey. Supplement use was similar in survivors and persons reporting no history of cancer. Among survivors, calcium use was significantly higher among women (34.9%) than men (13.8%), and vitamin A use was higher among men than women (P < 0.05). Over three-fourths of both groups used multivitamins, and about one-half used vitamin C. No differences were found in vitamin/mineral use between male survivors and men with no cancer history or between female survivors and women with no cancer history. These first nationally representative estimates suggest that persons who have survived cancer and those who report that they never had the disease do not differ appreciably in their use of vitamin/mineral supplements. Results were based on small numbers of survivors, however, and require replication.

Protection from sun exposure in US white children ages 6 months to 11 years.

OBJECTIVES: To estimate the prevalence of protection from sun exposure among US white children ages 6 months to 11 years. METHODS: During the summer of 1998, using telephone directory lists supplemented by random-digit dialing, the authors surveyed parents living in the contiguous United States. They calculated weighted prevalence estimates for protection methods and conducted logistic regression analyses to determine parent and child characteristics predictive of protection behaviors. RESULTS: Parents of 1,055 white children were interviewed. Children spent a median of 20 hours per week outdoors during the summer, of which 10 hours were at school. Sunscreen (61.8%, 95% confidence interval [CI] 57%, 66%) and shade (26.5%, 95% CI 22%, 31%) were the most frequently reported protection methods. Parents reported higher rates of protection for younger children and children who sunburn easily. CONCLUSIONS: Parents report that a large proportion of white children is protected from sun exposure by one or more methods. Health care providers and educators might encourage the use of all methods of protection, not just sunscreen use, and educate older children to protect themselves from the sun.

Prostate cancer screening trends of New York State men at least 50 years of age, 1994 to 1997.

BACKGROUND: Despite the lack of consensus on prostate cancer screening recommendations, men are being screened at high rates in some states. Our objective was to examine the trends in prostate cancer screening awareness and practices from 1994 through 1997 and the relationship among screening practices and demographic characteristics, perceived risk, and family history of prostate cancer. METHODS: Data from the New York State Behavioral Risk Factor Surveillance System surveys and questionnaire modules on prostate cancer screening were used for this study, which excluded men younger than 50 years of age and men with a history of prostate cancer. The questionnaires were administered by random-digit-dialed monthly telephone surveys of the civilian, noninstitutionalized adult population in New York State. RESULTS: A total of 295, 336, 273, and 448 men, the vast majority of whom were white, met the study criteria for 1994, 1995, 1996, and 1997, respectively. Each year the percentage of men who reported having heard of the prostate specific antigen (PSA) test increased (test for trend, P < 0.001). Among those who had heard of the PSA test, the percentage who reported having had a PSA test increased steadily from 1994 to 1997. About 30% of the men in each year's study did not have an impression of their risk of getting prostate cancer. CONCLUSIONS: Given the increasing rate at which men are reporting being screened for prostate cancer and given their reported perceived risk levels, perhaps more needs to be done to educate men about screening implications and personal risk for prostate cancer.