Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.

INTRODUCTION: Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes. AIM: This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. METHOD: In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0. RESULTS: The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing. CONCLUSION: Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

Triggers of intensive care patients with palliative care needs from nurses' perspective: a mixed methods study.

PURPOSE: Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses. METHODS: For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the "content-structuring content analysis" according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey. RESULTS: In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%. CONCLUSION: Intensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

Actions speak louder than words; pediatricians, gynecologists, nurses, and other mothers' perspectives on the human papillomavirus vaccine: an Istanbul multicenter study.

Introduction: Gynecologists and pediatricians have an essential duty to prevent cervical cancer. In this study, we compared the compliance of gynecologists (n = 22) and pediatricians (n = 49) with nurse/midwife (n = 66) and non-medical moms (n = 120) with regards to cervical cancer precautions. Methods: A questionnaire was used to gather data on their demographics, personal vaccination and screening practices, children's immunization status, and awareness of cervical cancer prevention. Results: The findings demonstrated that gynecologists and pediatricians were better than others at understanding the risk factors and prevention of cervical cancer. It was noted that compared to other groups, physician mothers and their offspring had higher vaccination rates (n = 13, 18.3%; n = 10, 29.4%, respectively). Medical professionals typically provided thorough and accurate answers to informational questions. More frequent Pap smear tests were performed by gynecologists. It was noted that mothers who worked as pediatricians and nurses/midwives neglected their own screening needs. Discussion: This questionnaire survey sought to ascertain Istanbul's health professionals' present opinions regarding HPV vaccination. Healthcare professionals should be the first to receive information on HPV vaccination and cervical cancer incidence reduction. The public could then readily use them as an example.

Motherhood experiences of nurses receiving postgraduate education: A phenomenological research study.

OBJECTIVE: Trying to juggle multiple roles and responsibilities as a student, nurse, and mother can be challenging due to pressures from overlapping time management. This study was conducted to explore the experiences of graduate students who work as nurses and are mothers. METHODS: The qualitative phenomenological data for this study were gathered from nurses at a training and research hospital between August and November 2022, utilizing face-to-face interviews. The study cohort comprised twelve nurses aged 28 to 48, all actively engaged in postgraduate education. Data were collected using a descriptive information form and semi-structured interviews. Thematic analysis was executed through inductive coding, facilitated by the Max Qualitative Data Analysis (MAXQDA) Analytics Pro2022 software. RESULTS: Four central themes were developed: "Experiences During the Breastfeeding Process," "Positive Effects," "Encountered Challenges," and "Expectations." CONCLUSIONS: The findings underscored that nurses who are mothers and pursuing postgraduate education encounter difficulties throughout their academic pursuits, notably attributed to working conditions and professional cultural values.

Nurses' knowledge, Practice, and Associated Factors Towards Adult Palliative Care: A Cross-sectional Study.

The demand for palliative care is increasing rapidly, but inadequate knowledge and practice remain a significant issue. This study aimed to assess nurses' knowledge, practice, and associated factors toward adult palliative care. A cross-sectional study was conducted including 277 randomly selected nurses from May through September 2021. The data related to knowledge were gathered using the Palliative Care Quiz for Nursing, and an observational checklist to assess the practice was used. EpiData and SPSS software were used for data entry and analysis, respectively. Descriptive statistics and bivariable and multivariable analyses were also applied. Depending on the value of the adjusted odds ratio with a 95% confidence level, statistical significance was declared at a P value of .05. Findings showed that 43.2% and 47% of nurses had good knowledge and practice in palliative care, respectively. The odds of trained nurses having good knowledge were 9.65 times higher than those who did not. There were 2.7 times more odds of practicing palliative care among nurses with good knowledge than those with poor knowledge. Overall, over half of the nurses have poor knowledge and practice in palliative care. To enhance their knowledge and practice, formal palliative care education and training will be beneficial.

Investigation of related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy.

OBJECTIVE: The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy. METHODS: A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument. RESULTS: The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries. CONCLUSIONS: While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.

Aircraft noise exposure and body mass index among female participants in two Nurses' Health Study prospective cohorts living around 90 airports in the United States.

OBJECTIVE: Aircraft noise exposure is linked to cardiovascular disease risk. One understudied candidate pathway is obesity. This study investigates the association between aircraft noise and obesity among female participants in two prospective Nurses' Health Study (NHS and NHSII) cohorts. METHODS: Aircraft day-night average sound levels (DNL) were estimated at participant residential addresses from modeled 1 dB (dB) noise contours above 44 dB for 90 United States (U.S.) airports in 5-year intervals 1995-2010. Biennial surveys (1994-2017) provided information on body mass index (BMI; dichotomized, categorical) and other individual characteristics. Change in BMI from age 18 (BMI18; tertiles) was also calculated. Aircraft noise exposures were dichotomized (45, 55 dB), categorized (<45, 45-54, ≥55 dB) or continuous for exposure ≥45 dB. Multivariable multinomial logistic regression using generalized estimating equations were adjusted for individual characteristics and neighborhood socioeconomic status, greenness, population density, and environmental noise. Effect modification was assessed by U.S. Census region, climate boundary, airline hub type, hearing loss, and smoking status. RESULTS: At baseline, the 74,848 female participants averaged 50.1 years old, with 83.0%, 14.8%, and 2.2% exposed to <45, 45-54, and ≥55 dB of aircraft noise, respectively. In fully adjusted models, exposure ≥55 dB was associated with 11% higher odds (95% confidence interval [95%CI]: -1%, 24%) of BMIs ≥30.0, and 15% higher odds (95%CI: 3%, 29%) of membership in the highest tertile of BMI18 (ΔBMI 6.7 to 71.6). Less-pronounced associations were observed for the 2nd tertile of BMI18 (ΔBMI 2.9 to 6.6) and BMI 25.0-29.9 as well as exposures ≥45 versus <45 dB. There was evidence of DNL-BMI trends (ptrends ≤ 0.02). Stronger associations were observed among participants living in the West, arid climate areas, and among former smokers. DISCUSSION: In two nationwide cohorts of female nurses, higher aircraft noise exposure was associated with higher BMI, adding evidence to an aircraft noise-obesity-disease pathway.

Development and validation of impact of early integration of palliative care and oncology(IEI PCO) questionnaire: a survey for medical oncologists and nurses.

OBJECTIVES: Many associations have recently recommended early integration of oncology and palliative care for more standard cancer care and better quality of life. We aimed to create a questionnaire to assess the opinion of medical oncologists and nurses about the clinical impact of the integrated palliative care and oncology (PCO) program. METHODS: A novel semi-structured questionnaire called Impact of Early Integration of Palliative Care Oncology (IEI PCO) questionnaire was developed and tested for validity and reliability then distributed to the oncologists and nurses working in Kuwait Cancer Control Center. RESULTS: After the pilot stage, testing the final questionnaire for validity and reliability was done with satisfactory results. Finally, the complete questionnaires were 170 out of 256 (response rate 66.41%). More awareness about the available palliative care services and the new available PCO services (p-value < 0.001 for all). Most of the oncologists and nurses agreed with the currently available structure of PCO, appreciated the patients' discharge plan and continuity of care of palliative medicine, admitted less work burden, a better attitude, and higher satisfaction (p-value for all < 0.001) toward palliative care. Significant improvements in symptoms were appreciated by oncologists and nurses after the integration of palliative care (p-value for all < 0.001. Oncologists and nurses valued repeated honest communication, discussion of the goals of care, dealing more effectively with ending active treatment, and higher acceptance of patients and families of PC policy of transfer, and significant progress in the care of end-of-life symptoms (p-value for all < 0.001). CONCLUSIONS: The IEI PCO questionnaire demonstrated the psychometric criteria for content, face, and construct validity and reliability. It provides a valuable tool to assess the impact of PCO integration. The opinion of medical oncologists and nurses was significantly positive toward the early integration of PCO in Kuwait in most aspects of care. This integration led to improved symptom control, end-of-life care, communication, and planned discharge and follow-up plans. Moreover, decreases the work burden, improves attitude, higher satisfaction of the oncology staff, and continuity of care.

Knowledge, attitude, and practice toward the prevention of occupational exposure in public health emergencies among nurses in Wuhan.

Background and objective: Nurses have an essential role in dealing with public health emergencies (PHE). This study explored the knowledge, attitude, and practice (KAP) towards preventing occupational exposure in PHE among nurses in Wuhan. Methods: This cross-sectional study was conducted in May 2023 to assess the KAP of nurses in Wuhan, China. Questionnaires were created and distributed to evaluate the KAP of nurses and explore the factors associated with KAP. Univariate and multivariate logistic regression analyses were used to assess the association between baseline demographic characteristics and KAP, and structural equation modeling (SEM) was used to explore complex relationships and causal pathways among relevant factors. Results: A total of 440 valid questionnaires were collected. The mean knowledge, attitude, and practice scores were 11.84 ± 2.37, 39.87 ± 3.10, and 44.05 ± 3.76, respectively. The univariate and multivariate logistic regression analyses revealed that age >50 years old (p = 0.039), working experience of 1-3 years (p = 0.060) and 4-6 years (p = 0.024), participation in PHE training, and scene rescue (p < 0.001) were significantly associated with knowledge score. In addition, the attitude of the nurses was significantly related to knowledge scores (p = 0.002). Moreover, practice was significantly associated with knowledge scores (p = 0.005) and attitude scores (p < 0.001). The correlation analysis showed that the practice was significantly associated with knowledge (r = 0.336, p < 0.001) and attitude (r = 0.449, p < 0.001). Conclusion: Nurses exhibited moderate knowledge, relatively positive attitude, and practice, which needed to be improved regarding occupational exposure in PHE. The practice of the nurses could be promoted by paying more attention to the working experience, participation in training and scene rescue in PHE, and their knowledge and attitude.

Recreational physical activity and breast cancer risk by menopausal status and tumor hormone receptor status: results from the Nurses' Health Studies.

PURPOSE: Physical activity is associated with lower breast cancer risk, especially in postmenopausal women. Associations in premenopausal women are less well established. METHODS: We evaluated recreational physical activity and breast cancer risk in the Nurses' Health Study (NHS) and NHSII (187,278 women; n = 12,785 breast cancers; follow-up: NHS = 1986-2016, NHSII = 1989-2017) by menopausal status and estrogen (ER) and progesterone (PR) receptor status. Physical activity was evaluated as updated cumulative average of metabolic equivalent of task (MET)-h/week. Cox proportional hazards models were used to estimate multivariable hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Recreational physical activity was inversely associated with breast cancer risk in pre- and postmenopausal women. Higher activity levels were associated with lower risk of ER+/PR + breast cancer in both pre- and postmenopausal women (e.g., total recreational activity, ≥ 27 vs < 3 MET-h/week, premenopausal HR = 0.83, 95%CI = (0.70-0.99), postmenopausal HR = 0.86 (0.78-0.95); pheterogeneity = 0.97). Results were attenuated with adjustment for current body mass index (BMI) among postmenopausal, but not premenopausal, women (e.g., ≥ 27 vs < 3 MET-h/week, premenopausal HR = 0.83 (0.69-0.98); postmenopausal HR = 0.95 (0.85-1.05); pheterogeneity = 0.99). In analyses of moderate-vigorous activity and breast cancer risk, no heterogeneity by menopausal status was observed (phet ≥ 0.53; e.g., ≥ 27 vs < 3 MET-h/week, ER+/PR+, premenopausal HR = 0.88 (0.69-1.11); postmenopausal HR = 0.71 (0.58-0.88). No associations were observed for ER-/PR- disease. CONCLUSIONS: Recreational physical activity was associated with lower breast cancer risk in both pre- and postmenopausal women, supporting recreational physical activity as an accessible, modifiable exposure associated with reduced breast cancer risk regardless of menopausal status.

Metformin and other anti-diabetic medication use and breast cancer incidence in the Nurses' Health Studies.

We aimed to examine the association between the use of metformin and other anti-diabetic medications and breast cancer incidence within two large prospective cohort studies. We followed 185,181 women who participated in the Nurses' Health Study (NHS; 1994-2016) and the NHSII (1995-2017), with baseline corresponding to the date metformin was approved for type 2 diabetes (T2D) treatment in the US Information on T2D diagnosis, anti-diabetes medications, and other covariates was self-reported at baseline and repeatedly assessed by follow-up questionnaires every 2 years. Breast cancer cases were self-reported and confirmed by medical record review. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between medication use and breast cancer were estimated using Cox proportional hazards regression models, adjusting for breast cancer risk factors. During 3,324,881 person-years of follow-up, we ascertained 9,192 incident invasive breast cancer cases, of which 451 were among women with T2D. Compared with women without T2D (n = 169,263), neither metformin use (HR = 0.97; 95% CI = 0.81-1.15) nor other anti-diabetic medications use (HR = 1.11; 95% CI = 0.90-1.36) associated with significantly lower breast cancer incidence. Among women with T2D (n = 15,918), compared with metformin never users, metformin ever use was not significantly inversely associated with breast cancer (HR = 0.92; 95% CI = 0.74-1.15). Although we observed that past use of metformin was inversely associated with breast cancer in the T2D population (HR = 0.67; 95% CI = 0.48-0.94), current use (HR = 1.01; 95% CI = 0.80-1.27) and longer duration of metformin use were not associated with breast cancer (each 2-year interval: HR = 1.01; 95% CI = 0.95-1.07). Overall, metformin use was not associated with the risk of developing breast cancer among the overall cohort population or among women with T2D.

Factors that influence critical care nurses' management of sedation for ventilated patients in critical care: A qualitative study.

BACKGROUND: Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce. AIM: To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making. DESIGN: Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis. SETTING AND PARTICIPANTS: This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate. FINDINGS: Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation. CONCLUSION: Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns. IMPLICATIONS FOR CLINICAL PRACTICE: Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making.

Precarização do trabalho de enfermeiras: uma análise na Atenção Primária à Saúde brasileira / Precarization of nurses' work: an analysis in the Brazilian Primary Health Care / Precarización del trabajo de las enfermeras: un análisis en la Atención Primaria de Salud Brasileña

Resumo Este artigo teve como objetivo analisar os tipos de vínculos de trabalho das enfermeiras da Atenção Primária à Saúde no Brasil. Tratou-se de um estudo transversal de abordagem quantitativa e descritiva. Utilizaram-se os microdados secundários referentes ao desdobramento da pesquisa de avaliação externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Quanto ao tipo de vínculo, com exceção da Região Norte (33,70%), todas as outras regiões apresentaram como principal respondente servidoras públicas estatutárias: Sul (66,20%), Centro-Oeste (56,50%), Nordeste (40,33%), Sudeste (36,69%). Enfermeiras com contrato temporário pela administração pública e contrato temporário por prestação de serviço tiveram participação importante no Nordeste (29,51% e 19,33%) e Centro-Oeste (16,03% e 17,86%). Contrato e empregado via Consolidação das Leis do Trabalho tiveram mais expressão no Sudeste (23,54% e 8,27%) e no Sul (5,93% e 19,31%). No Sudeste, foi expressiva a participação de trabalhadoras contratadas por organizações sociais de saúde. Notou-se a presença crescente de vínculos precários de trabalho em detrimento dos vínculos estáveis. As novas formas de organização flexível das relações de trabalho trazem impacto significativo ao processo de trabalho, sobrecarregam as enfermeiras, em condições de trabalho inadequadas, e comprometem a qualidade da assistência, reduzindo a resolutividade da Atenção Primária.

Abstract This article aimed to analyze the types of work bond of nurses from Primary Health Care in Brazil. This was a cross-sectional study of a quantitative and descriptive approach. Secondary microdata related to the breakdown of the external evaluation research of the Access Improvement Program and the Quality of Basic Care were used. As for the type of bond, except for the Northern Region (33.70%), all other regions presented as the main respondent for statutory public servants: South (66.20%), Central-West (56.50%), Northeast (40.33%), Southeast (36.69%). Nurses with temporary contracts for public administration and temporary service contracts had important participation in the Northeast (29.51% and 19.33%) and Central-West (16.03% and 17.86%). Contract and employee through Consolidation of Labor Laws had more expression in the Southeast (23.54% and 8.27%) and in the South (5.93% and 19.31%). In the Southeast, the participation of workers employed by social health organizations was expressive. The growing presence of precarious labor links was noted, to the detriment of stable bonds. The new forms of flexible organization of work relationships bring significant impact to the work process, overload nurses in inadequate working conditions, and compromise the quality of care, reducing the resolubility of Primary Care.

Resumen El presente artículo tuvo como objetivo analizar los tipos de vínculos laborales de las enfermeras de Atención Primaria de Salud en Brasil. Se trata de un estudio transversal de enfoque cuantitativo y descriptivo. Se utilizaron microdatos secundarios relacionados con la división de la investigación de evaluación externa del Programa de Mejora del Acceso y la Calidad de la Atención Básica. En cuanto al tipo de vínculo, a excepción de la Región Norte (33,70%), todas las demás regiones se presentaron como principal demandado para los funcionarios públicos estatutarios: Sur (66,20%), Centro Oeste (56,50%), Noreste (40,33%), Sureste (36,69%). Las enfermeras con contratos temporales de administración pública y contratos temporales de servicios tuvieron una participación importante en el Nordeste (29,51% y 19,33%) y Centro Oeste (16,03% y 17,86%). Contrato y empleado a través de la Consolidación de Las Leyes Laborales tuvieron más expresión en el Sudeste (23,54% y 8,27%) y en el Sur (5,93% y 19,31%). En el Sudeste, la participación de los trabajadores empleados por las organizaciones de salud social fue expresiva. Se observó la creciente presencia de vínculos laborales precarios, en detrimento de vínculos estables. Las nuevas formas de organización flexible de las relaciones laborales tienen un impacto significativo en el proceso de trabajo, sobrecargan a las enfermeras en condiciones laborales inadecuadas y comprometen la calidad de la asistencia, reduciendo la solubilidad de la Atención Primaria.

Portación nasal de Staphylococcus aureus en el personal de salud de áreas críticas de un Hospital Pediátrico durante julio-setiembre 2018 / Nasal carriage of Staphylococcus aureus in health personnel in critical areas of a Pediatric Hospital during July-September 2018 / Transporte nasal de Staphylococcus aureus em profissionais de saúde em áreas críticas de um Hospital Pediátrico durante julho-setembro de 2018

Las infecciones intrahospitalarias (IIH) son causa de elevada morbimortalidad y representan un problema sanitario importante. El personal de salud es reservorio y potencial transmisor de los agentes etiológicos de las mismas. S. aureus es uno de los microorganismos implicados, por lo tanto es importante conocer la frecuencia de portación en el personal de salud y establecer el perfil de susceptibilidad antimicrobiana para contribuir con la elaboración de medidas de prevención incluyendo actividades educativas. Objetivo: Conocer la frecuencia de portación de S. aureus, distribución y antibiotipos de las cepas presentes en el personal sanitario del Hospital Pediátrico de Referencia (HPR). Materiales y métodos: Se realizó un estudio descriptivo durante el periodo julio-setiembre del año 2018. Se incluyeron muestras de hisopados nasales de trabajadores de la salud de distintas áreas de internación que consintieron participar en el estudio. Se excluyeron aquellos que recibieron antibióticos dentro de los 3 meses previos al estudio. Las muestras fueron sembradas en agar sangre ovina al 5% (ASO) y se incubaron a 35-37ºC en aerobiosis por 24-48 horas. La identificación de las colonias sospechosas de Staphylococcus aureus por métodos convencionales y MALDI-TOF. El patrón de resistencia antimicrobiana de S. aureus se detectó por disco-difusión. En los cultivos resistentes a meticilina (SAMR) se determinó la presencia del gen mecA y se realizó la tipificación del SCCmec por pruebas de reacción en cadena de polimerasa. Resultados: Se obtuvieron 225 hisopados a partir de 225 trabajadores, presentaron desarrollo 212. En 49 se recuperaron cultivos de S. aureus. Correspondieron a SAMR 11 de las 49 cepas, todas portaban el gen mecA. Hubo predominio en el personal de enfermería (7/11), en los servicios de hemato-oncología (3/11) y cuidados intensivos neonatales (4/11). Asociaron resistencia a macrólidos y clindamicina 8 de 11 aislamientos SAMR, a gentamicina 2 y a mupirocina uno. El SCCmec más frecuentemente identificado fue el tipo IV (7/11). Conclusiones: Los resultados muestran la presencia de cepas SAMR entre el personal de salud del CHPR y aportan información complementaria para efectuar prevención y control de las IIH, actuando sobre todo en el personal de salud encargado de la atención de pacientes susceptibles.

Hospital-acquired infections (IIH) are a cause of high morbidity and mortality and represent a major health problem. Health personnel are reservoirs and potential transmitters of their etiological agents. S. aureus is one of the microorganisms involved, therefore it is important to know the frequency of carriage in health personnel and establish the antimicrobial susceptibility profile to contribute to the development of prevention measures, including educational activities. Objective: To know the frequency of carriage of S. aureus, distribution and antibiotypes of the strains present in the health personnel of the Reference Pediatric Hospital (HPR). Materials and methods: A descriptive study was carried out during the period July-September 2018. Nasal swab samples from health workers from different hospitalization areas who agreed to participate in the study were included. Those who received antibiotics within 3 months prior to the study were excluded. The samples were seeded in 5% sheep blood agar (ASO) and incubated at 35-37ºC in aerobiosis for 24-48 hours. Identification of suspicious Staphylococcus aureus colonies by conventional methods and MALDI-TOF. The antimicrobial resistance pattern of S. aureus was detected by disc diffusion. In methicillin-resistant cultures (MRSA), the presence of the mecA gene was determined and SCCmec was typified by polymerase chain reaction tests. Results: 225 swabs were obtained from 225 workers, 212 showed development. S. aureus cultures were recovered from 49. 11 of the 49 strains corresponded to MRSA, all of them carried the mecA gene. There was a predominance in the nursing staff (7/11), in the hematology-oncology services (3/11) and neonatal intensive care (4/11). They associated resistance to macrolides and clindamycin in 8 of 11 MRSA isolates, 2 to gentamicin, and 1 to mupirocin. The most frequently identified SCCmec was type IV (7/11). Conclusions: The results show the presence of MRSA strains among the health personnel of the CHPR and provide complementary information to carry out prevention and control of IIH, acting especially on the health personnel in charge of the care of susceptible patients.

As infecções hospitalares (HII) são causa de alta morbidade e mortalidade e representam um importante problema de saúde. Os profissionais de saúde são reservatórios e potenciais transmissores de seus agentes etiológicos. O S. aureus é um dos micro-organismos envolvidos, por isso é importante conhecer a frequência de portadores em profissionais de saúde e estabelecer o perfil de suscetibilidade antimicrobiana para contribuir no desenvolvimento de medidas de prevenção incluindo atividades educativas. Objetivo: Conhecer a frequência de portadores de S. aureus, distribuição e antibiótipos das cepas presentes no pessoal de saúde do Hospital Pediátrico de Referência (HPR). Materiais e métodos: Foi realizado um estudo descritivo durante o período de julho a setembro de 2018. Foram incluídas amostras de swab nasal de profissionais de saúde de diferentes áreas de internação que concordaram em participar do estudo. Aqueles que receberam antibióticos nos 3 meses anteriores ao estudo foram excluídos. As amostras foram semeadas em 5% de ágar sangue de carneiro (ASO) e incubadas a 35-37ºC em aerobiose por 24-48 horas. Identificação de colônias suspeitas de Staphylococcus aureus por métodos convencionais e MALDI-TOF. O padrão de resistência antimicrobiana de S. aureus foi detectado por difusão em disco. Em culturas resistentes à meticilina (MRSA), a presença do gene mecA foi determinada e SCCmec foi tipificado por testes de reação em cadeia da polimerase. Resultados: 225 swabs foram obtidos de 225 trabalhadores, 212 apresentaram desenvolvimento. Culturas de S. aureus foram recuperadas de 49. 11 das 49 cepas correspondiam a MRSA, todas carregavam o gene mecA. Houve predominância na equipe de enfermagem (7/11), nos serviços de hematologia-oncologia (3/11) e de terapia intensiva neonatal (4/11). Eles associaram resistência a macrolídeos e clindamicina em 8 de 11 isolados de MRSA, 2 à gentamicina e 1 à mupirocina. O SCCmec mais frequentemente identificado foi o tipo IV (7/11). Conclusões: Os resultados mostram a presença de cepas de MRSA entre os profissionais de saúde do CHPR e fornecem informações complementares para realizar a prevenção e controle da HII, atuando principalmente sobre os profissionais de saúde responsáveis ​​pelo atendimento de pacientes suscetíveis.

Compliance with hand disinfection in the surgical area of an orthopedic university clinic: results of an observational study.

BACKGROUND: Hand hygiene using alcoholic hand rub solution is essential for the prevention of surgical site infections. There are several opportunities for hygienic hand disinfection (termed "hand hygiene" in the following) during immediate pre-, intra- and postoperative orthopedic patient care. However, the level of hand hygiene compliance among surgical and anesthesia staff in this context is unclear. Therefore, we conducted an observational study in operating theatres of an orthopedic university clinic in northern Germany during July and August 2020. METHODS: One trained person directly and comprehensively observed hand hygiene compliance of surgical and anesthesia staff according to the WHO "My 5 moments for hand hygiene" model (WHO-5). In addition to cross-tabulations with Chi2 tests, multiple logistic regression models were used to study associations between occupational group, medical specialty, and compliance (both overall and for each WHO-5 indication). Models were adjusted for hand hygiene opportunities being associated with female or male healthcare workers, being located within or outside the operation room, and occurring in adult or pediatric surgery. RESULTS: In total, 1145 hand hygiene opportunities during 16 surgeries were observed. The overall compliance was 40.8% (95% CI 37.9-43.6%), with a larger difference between surgical versus anesthesia staff (28.4% vs. 46.1%, p < 0.001) than between physicians versus nurses (38.5% vs. 42.9%, p = 0.13). Adjusting for sex, place of observation, and adult versus pediatric operation theatre, logistic regression analyses revealed a significant interaction between medical specialty and occupational group (p < 0.001). In particular, the odds for compliance were higher for anesthesiologists (47.9%) than for surgeons (19.6%) (OR = 4.8, 95% CI 3.0-7.6). In addition, compliance was higher in pediatric surgery (OR = 1.9, 95% CI 1.4-2.6). In general, WHO-5-stratified results were in line with these overall patterns. CONCLUSIONS: Hygienic hand disinfection compliance was approximately 41%. Notably, surgeons performed worse than anesthesiologists did. These results indicate that hand hygiene compliance in orthopedic surgery needs to be improved. Tailored interventions promise to be an appropriate way to address each occupational group's specific needs.

[Development and assessment of a MOOC about delirium in geriatric oncology]. / Création et évaluation d'un MOOC sur le syndrome confusionnel en oncogériatrie.

INTRODUCTION: Among the themes to be addressed by a Massive Open Online Course (MOOC) on geriatric oncology, one of the priorities was delirium, due to its frequency, complications and difficulties encountered by healthcare professionals in diagnosing and managing delirium. Our study aims to evaluate professional practices in the area of education, regarding the evaluation of the content of a MOOC module about delirium syndrome in geriatric oncology. METHODS: We created a multidisciplinary group to define the scientific content, the pedagogical objectives, the scriptwriting and the development of a training module. The quality of instructional design was then evaluated according to eleven MOOC design principles to promote learning. Participants were studied. RESULTS: Seven of the eleven criteria for evaluating pedagogical quality were documented. Among the 1020 participants, 455 (44.6%) completed the final test concerning delirium: 417 (40.8%) passed the final test; 406 documented their profession and the region of France where they worked: 146 (32%) nurses (confirming the participation of the targeted audience), 103 (22.6%) doctors/pharmacists (illustrating the multi-professional interest of the thematic), with a wide distribution of the participants over the national territory. DISCUSSION: The multidisciplinary team's investment in developing these teaching materials strengthened the group's cohesion and valuated its professional skills. All teaching resources developed for access via the internet must be accompanied by an evaluation of the quality of the scientific content, objectives and teaching methods, before being able to appreciate its use in the field and assess its real impact on the participants' learning and practice.

Adiposity, Adulthood Weight Change, and Risk of Incident Hepatocellular Carcinoma.

Prospective data are limited regarding dynamic adulthood weight changes and hepatocellular carcinoma (HCC) risk. We included 77,238 women (1980-2012) and 48,026 men (1986-2012), who recalled young-adult weight [age 18 years (women); 21 years (men)], and provided biennially updated information regarding weight, body mass index (BMI), and comorbidities. Overall adulthood weight change was defined as the difference in weight (kilograms) between young-adulthood and present. Using Cox proportional hazards models, we calculated multivariable adjusted HRs (aHR) and 95% confidence intervals (CI). Over 3,676,549 person-years, we documented 158 incident HCC cases. Elevated HCC risk was observed with higher BMI in both young-adulthood and later-adulthood [continuous aHRs per each 1 unit = 1.05; 95% CI = 1.02-1.09 (P trend = 0.019), and 1.08; 95% CI = 1.06-1.10 (P trend = 0.004), respectively]. Moreover, overall adulthood weight gain was also significantly associated with increased HCC risk (aHR per each 1-kg increase = 1.03; 95% CI = 1.01-1.08; P trend = 0.010), including after further adjusting for young-adult BMI (P trend = 0.010) and later-adult BMI (P trend = 0.008). Compared with adults with stable weight (±5 kg), the multivariable-aHRs with weight gain of 5-<10 kg, 10-<20 kg, and ≥20 kg were, 1.40 (95% CI = 0.67-2.16), 2.09 (95% CI = 1.11-3.95), and 2.61 (95% CI = 1.42-5.22), respectively. In two prospective, nationwide cohorts, adulthood weight gain was significantly associated with increased HCC risk. PREVENTION RELEVANCE: Our data suggest that maintaining a stable weight during adulthood, specifically by preventing weight gain, could represent an important public health strategy for the prevention of hepatocellular carcinoma.

Adolescent and early adulthood inflammation-associated dietary patterns in relation to premenopausal mammographic density.

BACKGROUND: Adolescence and early adulthood has been identified as a critical time window for establishing breast cancer risk. Mammographic density is an independent risk factor for breast cancer that may be influenced by diet, but there has been limited research conducted on the impact of diet on mammographic density. Thus, we sought to examine the association between adolescent and early adulthood inflammatory dietary patterns, which have previously been associated with breast cancer risk, and premenopausal mammographic density among women in the Nurses' Health Study II (NHSII). METHODS: This study included control participants with premenopausal mammograms from an existing breast cancer case-control study nested within the NHSII who completed a Food Frequency Questionnaire in 1998 about their diet during high school (HS-FFQ) (n = 685) and/or a Food Frequency Questionnaire in 1991 (Adult-FFQ) when they were 27-44 years old (n = 1068). Digitized analog film mammograms were used to calculate the percent density, absolute dense, and non-dense areas. Generalized linear models were fit to evaluate the associations of a pro-inflammatory dietary pattern and the Alternative Healthy Eating Index (AHEI, an anti-inflammatory dietary pattern) with each breast density measure. RESULTS: Significant associations were observed between an adolescent pro-inflammatory dietary pattern and mammographic density in some age-adjusted models; however, these associations did not remain after adjustment for BMI and other breast cancer risk factors. No associations were observed with the pro-inflammatory pattern or with the AHEI pattern in adolescence or early adulthood in fully adjusted models. CONCLUSIONS: To our knowledge, this is the first study to evaluate the dietary patterns during adolescence and early adulthood in relation to mammographic density phenotypes. Our findings do not support an association between adolescent and early adulthood diet and breast density in mid-adulthood that is independent of BMI or other breast cancer risk factors.

Registered nurses' perspectives on barriers of cervical cancer screening in Swaziland: a qualitative study.

INTRODUCTION: cervical cancer is highly preventable and curable if diagnosed and treated early, however, it is still the leading cause of death among women. Despite efforts to increase cervical cancer screening, its uptake is still low. The purpose of the study was to investigate the perspectives of registered nurses on barriers of cervical cancer screening in Swaziland. METHODS: an exploratory qualitative design was used for the study. Face to face in depth interviews were conducted with 15 registered nurses using an interview guide. The study was conducted in four clinics from both the private and public sectors, which were purposively sampled. Interviews were captured using an audio recording device, they were transcribed verbatim and then analysed using thematic analysis. RESULTS: four themes emerged which were deterrents to cervical cancer screening. These were perceived client barriers, health care system related barriers, nurse related barriers and the nature of the procedure. CONCLUSION: these barriers to service provision need to be addressed by extensive health education to women as well as the cervical cancer screening programme to provide all resources required to increase the uptake of screening.

[Work, family and nurses perception about their own health: relationship with breast cancer and shift work.] / Trabajo, familia y percepción de la propia salud en las enfermeras: relación con el cáncer de mama y el trabajo a turnos.

OBJECTIVE: Breast cancer is a commonly diagnosed disease in nurses that, from recent years, has been linked to shift work and night work. Also, different components of work stress have such an impact on the nurses' health and work, family and social conciliation. The objective of this research was to analyze the family and working characteristics of Spanish nurses who perform shift work (including night shifts) in search of possible associations with manifestations of psychosomatic stress and the risk of breast cancer. METHODS: A cross-sectional descriptive study was conducted through a virtual questionnaire in a sample of 966 Registered Nurses in Spain between December 2019 and November 2020. A descriptive analysis of sociodemographic and occupational variables was performed, and statistically significant differences and associations were contrasted by estimating risks and confidence intervals. RESULTS: The number of night shifts throughout life and the number of years worked were statistically significant for the association with breast cancer. In addition, other psychosomatic manifestations such as insomnia, palpitations or extreme tiredness were highlighted. Among the most appreciated aspects to generate job satisfaction, co-worker's relationship was underlined. CONCLUSIONS: Rotating shift work can cause multiple clinical alterations that could lead to problems related to family conciliation, self-care or employment wellness. It is important to control the physical, psychological and emotional overload of nurses.

OBJETIVO: El cáncer de mama es una enfermedad comúnmente diagnosticada en las enfermeras que en los últimos años se ha relacionado con el trabajo a turnos y el trabajo nocturno. A su vez, diferentes componentes del estrés laboral también afectan a la salud y la conciliación laboral, familiar y social de las enfermeras. El objetivo de esta investigación fue analizar las características familiares y laborales de las enfermeras españolas que realizan trabajo por turnos (incluyendo el nocturno) en busca de posibles asociaciones con las manifestaciones del estrés psicosomático y el riesgo de padecer cáncer de mama. METODOS: Se diseñó un estudio descriptivo transversal a través de un cuestionario virtual en una muestra de 966 enfermeras colegiadas en España entre diciembre de 2019 y noviembre de 2020. Se realizó un análisis descriptivo de las variables sociodemográficas y laborales, y se contrastaron las diferencias y asociaciones estadísticamente significativas estimando riesgos e intervalos de confianza. RESULTADOS: El número de noches y el número de años trabajados fueron estadísticamente significativos para la asociación con el cáncer de mama. Además, otras manifestaciones psicosomáticas como el insomnio, las palpitaciones o el cansancio extremo fueron destacadas. Entre los aspectos más apreciados para generar satisfacción laboral se encontraba la relación con los compañeros de trabajo. CONCLUSIONES: El trabajo a turnos rotatorios puede provocar múltiples alteraciones clínicas y puede generar problemas relacionados con la conciliación familiar, el autocuidado personal o con el propio bienestar laboral. Es importante regular la sobrecarga física, psicológica y emocional de las enfermeras.