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Introduction: Suboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI). Methods: This was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 April 2020 and post-intervention November 2021 April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter. Results: There was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 110) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills. Discussion: There was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills.
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Background: High incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and low testing uptake were reported in low-income neighbourhoods in Rotterdam. We aimed to improve willingness and access to testing by introducing community-based test facilities, and to evaluate the effectiveness of a rapid antigen detection test (RDT). Methods: Two to eleven test facilities operated consecutively in three low-income neighbourhoods in Rotterdam, offering the options of walk-in or appointments. Background characteristics were collected at intake and one nasopharyngeal swab was taken and processed using both RDT and reverse transcription polymerase chain reaction (RT-PCR). Visitors were asked to join a survey for evaluation purposes. Results: In total, 19 773 visitors were tested - 9662 (48.9%) without an appointment. Walk-in visitors were older, lived more often in the proximity of the test facilities, and reported coronavirus disease (COVID-19)-related symptoms less often than by-appointment visitors. For 67.7% of the visitors, this was the first time they got tested. A total of 1211 (6.1%) tested SARS-CoV-2-positive with RT-PCR, of whom 309 (25.5%) were asymptomatic. Test uptake increased among residents of the pilot neighbourhoods, especially in the older age groups, compared to people living in comparable neighbourhoods without community-based testing facilities. RDT detected asymptomatic individuals with 71.8% sensitivity, which was acceptable in this high prevalence setting. Visitors reported positive attitudes towards the test facilities and welcomed the easy access. Conclusions: Offering community-based SARS-CoV-2 testing seems a promising approach for increasing testing uptake among specific populations in low-income neighbourhoods.
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COVID-19 , SARS-CoV-2 , Idoso , COVID-19/diagnóstico , Teste para COVID-19 , Humanos , Projetos PilotoRESUMO
Immigrants constitute large proportions of the population in many high-income countries. Knowledge about their perceptions of antibiotics, in comparison to native populations, is limited. We explored these perceptions by organizing nine homogeneous focus group discussions (FGDs) with first-generation immigrant and native Dutch participants (N = 64) from Rotterdam and Utrecht, who were recruited with the assistance of immigrant (community support) organizations. The FGDs were audio-recorded and transcribed verbatim. Inductive thematic analyses were performed with the qualitative analysis software Atlas.ti, using open and axial coding. We did not find noteworthy differences between immigrants and native Dutch participants; all participants had an overall reluctant attitude towards antibiotics. Within-group differences were larger than between-group differences. In each FGD there were, for instance, participants who adopted an assertive stance in order to receive antibiotics, who had low antibiotic-related knowledge, or who used antibiotics incorrectly. Native Dutch participants expressed similar difficulties as immigrant participants in the communication with their GP, which mainly related to time constraints. Immigrants who encountered language barriers experienced even greater communicational difficulties and reported that they often feel embarrassed and refrain from asking questions. To stimulate more prudent use of antibiotics, more attention is needed for supportive multilingual patient materials. In addition, GPs need to adjust their information, guidance, and communication for the individual's needs, regardless of the patient's migration background.
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BACKGROUND: If healthcare professionals perceive that patients strongly expect to be prescribed antibiotics, inappropriate prescriptions may result. As it is unknown whether this happens more often with certain patient groups, we explored whether general practitioners (GPs) and pharmacists perceived such expectations when they provided antibiotics to immigrant patients. METHODS: Ten GPs and five pharmacists from Rotterdam, the Netherlands, were interviewed on the basis of a semi-structured topic guide. Atlas.ti software was then used to conduct a thematic analysis. RESULTS: GPs felt that immigrant patients, especially those who had arrived recently, were more likely to expect to receive antibiotics than native Dutch patients. However, these expectations had decreased over the last years and did not always lead immigrants to exert pressure on them. Except for language barriers, the factors reported by GPs to influence their antibiotic prescribing behaviour were unrelated to patients' immigrant background. If there was a language barrier, GPs experienced greater diagnostic uncertainty and needed additional time to obtain and communicate correct information. To overcome language barriers, they often used point-of-care testing to convince patients that antibiotics were unnecessary. Although pharmacists rarely experienced problems dispensing antibiotics to immigrants, they and GPs both struggled to find effective ways of overcoming language barriers, and stressed the need for multi-language support materials. CONCLUSION: While pharmacists rarely experience any problems providing antibiotics to immigrants, GPs regularly face language barriers with immigrant patients, which complicate the diagnostic process and communicating information in the limited available time. This sometimes leads antibiotics to be prescribed inappropriately.
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Emigrantes e Imigrantes , Clínicos Gerais , Antibacterianos/uso terapêutico , Humanos , Farmacêuticos , Pesquisa QualitativaRESUMO
We investigated whether an intervention to improve hand hygiene compliance in nursing homes changed glove use. Hand hygiene compliance increased, but substitution of hand hygiene with gloves did not decrease. We observed a reduction of inappropriately unchanged gloves after exposure to body fluids.Clinical trials identifier: Netherlands Trial Register, trial NL6049 (NTR6188): https://www.trialregister.nl/trial/6049.
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Infecção Hospitalar , Higiene das Mãos , Infecção Hospitalar/prevenção & controle , Luvas Protetoras , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos , Países Baixos , Casas de SaúdeRESUMO
BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) in a nursing home in the Netherlands, following an on-site church service held on 8 March 2020, triggered an investigation to unravel sources and chain(s) of transmission. METHODS: Epidemiological data were collected from registries and through a questionnaire among church attendees. Symptomatic residents and healthcare workers (HCWs) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction and subjected to whole genome sequencing (WGS). Sequences from a selection of people from the same area were included as community reference. RESULTS: After the church service, 30 of 39 attendees (77%) developed symptoms; 14 (11 residents and 3 nonresidents) were tested and were positive for COVID-19. In the following 5 weeks, 62 of 300 residents (21%) and 30 of 640 HCWs (5%) tested positive for COVID-19; 21 of 62 residents (34%) died. The outbreak was controlled through a cascade of measures. WGS of samples from residents and HCWs identified a diversity of sequence types, grouped into 8 clusters. Seven resident church attendees all were infected with distinct viruses, 4 of which belonged to 2 larger clusters in the nursing home. CONCLUSIONS: Although initial investigation suggested the church service as the source of the outbreak, detailed analysis showed a more complex picture, most consistent with widespread regional circulation of the virus in the weeks before the outbreak, and multiple introductions into the nursing home before the visitor ban. The findings underscore the importance of careful outbreak investigations to understand SARS-CoV-2 transmission to develop evidence-based mitigation measures.
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COVID-19 , SARS-CoV-2 , Surtos de Doenças , Humanos , Países Baixos , Casas de SaúdeRESUMO
OBJECTIVE: To assess the effect of a multimodal intervention on hand hygiene compliance (HHC) in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: HHC was evaluated using direct, unobtrusive observation in a cluster randomized controlled trial at publicly funded nursing homes in the Netherlands. In total, 103 nursing home organizations were invited to participate; 18 organizations comprising 33 nursing homes (n = 66 nursing home units) participated in the study. Nursing homes were randomized into a control group (no intervention, n = 30) or an intervention group (multimodal intervention, n = 36). The primary outcome measure was HHC of nurses. HHC was appraised at baseline and at 4, 7, and 12 months after baseline. Observers and nurses were blinded. INTERVENTION: Audits regarding hand hygiene (HH) materials and personal hygiene rules, 3 live lessons, an e-learning program, posters, and a photo contest. We used a new method to teach the nurses the WHO-defined 5 moments of HH: Room In, Room Out, Before Clean, and After Dirty. RESULTS: HHC increased in both arms. The increase after 12 months was larger for units in the intervention arm (from 12% to 36%) than for control units (from 13% to 21%) (odds ratio [OR], 2.10; confidence interval [CI], 1.35-3.28). The intervention arm exhibited a statistically significant increase in HHC at 4 of the 5 WHO-defined HH moments. At follow-up, HHC in the intervention arm remained statistically significantly higher (OR, 1.93; 95% CI, 1.59-2.34) for indications after an activity (from 37% to 39%) than for indications before an activity (from 14% to 27%). CONCLUSIONS: The HANDSOME intervention is successful in improving HHC in nursing homes.
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Higiene das Mãos , Humanos , Países Baixos , Casas de SaúdeRESUMO
BACKGROUND: Hand hygiene compliance is considered the most (cost-)effective measure for preventing health care-associated infections. While hand hygiene interventions have frequently been implemented and assessed in hospitals, there is limited knowledge about hand hygiene compliance in other health care settings and which interventions and implementation methods are effective. OBJECTIVE: This study aims to evaluate the effect of a multimodal intervention to increase hand hygiene compliance of nurses in nursing homes through a cluster randomized controlled trial (HANDSOME study). METHODS: Nursing homes were randomly allocated to 1 of 3 trial arms: receiving the intervention at a predetermined date, receiving the identical intervention after an infectious disease outbreak, or serving as a control arm. Hand hygiene was evaluated in nursing homes by direct observation at 4 timepoints. We documented compliance with the World Health Organization's 5 moments of hand hygiene, specifically before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The primary outcome is hand hygiene compliance of the nurses to the standards of the World Health Organization. The secondary outcome is infectious disease incidence among residents. Infectious disease incidence was documented by a staff member at each nursing home unit. Outcomes will be compared with the presence of norovirus, rhinovirus, and Escherichia coli on surfaces in the nursing homes, as measured using quantitative polymerase chain reaction. RESULTS: The study was funded in September 2015. Data collection started in October 2016 and was completed in October 2017. Data analysis will be completed in 2020. CONCLUSIONS: HANDSOME studies the effectiveness of a hand hygiene intervention specifically for the nursing home environment. Nurses were taught the World Health Organization's 5 moments of hand hygiene guidelines using the slogan "Room In, Room Out, Before Clean, After Dirty," which was developed for nursing staff to better understand and remember the hygiene guidelines. HANDSOME should contribute to improved hand hygiene practice and a reduction in infectious disease rates and related mortality. TRIAL REGISTRATION: Netherlands Trial Register (NTR6188) NL6049; https://www.trialregister.nl/trial/6049. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17419.
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This study aims to quantify and compare preferences of citizens from different European countries for vaccination programme characteristics during pandemics, caused by pathogens which are transmitted through respiratory droplets. Internet panel members, nationally representative based on age, sex, educational level and region, of four European Union Member States (Netherlands, Poland, Spain, and Sweden, n = 2,068) completed an online discrete choice experiment. These countries, from different geographical areas of Europe, were chosen because of the availability of high-quality Internet panels and because of the cooperation between members of the project entitled Effective Communication in Outbreak Management: development of an evidence-based tool for Europe (ECOM). Data were analysed using panel latent class regression models. In the case of a severe pandemic scenario, vaccine effectiveness was the most important characteristic determining vaccination preference in all countries, followed by the body that advises on vaccination. In Sweden, the advice of family and/or friends and the advice of physicians strongly affected vaccine preferences, in contrast to Poland and Spain, where the advice of (international) health authorities was more decisive. Irrespective of pandemic scenario or vaccination programme characteristics, the predicted vaccination uptakes were lowest in Sweden, and highest in Poland. To increase vaccination uptake during future pandemics, the responsible authorities should align with other important stakeholders in the country and communicate in a coordinated manner.
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Comportamento de Escolha , Doenças Transmissíveis/psicologia , Programas de Imunização/estatística & dados numéricos , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/psicologia , Adolescente , Adulto , Idoso , Doenças Transmissíveis/imunologia , Europa (Continente)/epidemiologia , Inquéritos Epidemiológicos , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Polônia/epidemiologia , Valor Preditivo dos Testes , Espanha/epidemiologia , Suécia/epidemiologia , Vacinação/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level. METHODS: We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models. RESULTS: Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland. CONCLUSIONS: Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.
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Surtos de Doenças/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Opinião Pública , Vacinação/psicologia , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Países Baixos , Polônia , Normas Sociais , Suécia , Confiança , Adulto JovemRESUMO
BACKGROUND: Children attending day care centres are at increased risk of infectious diseases, in particular gastrointestinal and respiratory infections. Hand hygiene of both caregivers and children is an effective prevention measure. This study examined hand hygiene behaviour of children attending day care centres, and describes hygiene facilities at day care centres. METHODS: Data were collected at 115 Dutch day care centres, among 2318 children cared for by 231 caregivers (August to October 2010). Children's hand hygiene behaviour was observed and data on hand hygiene facilities of the day care centres collected by direct unobtrusive observation. National guidelines indicate hand hygiene is required before eating, after toilet use and after playing outside. RESULTS: Among 1930 observed hand hygiene opportunities for children, overall adherence to hand hygiene guidelines was 31% (95% CI: 29-33%). Adherence after both toilet use and playing outside was 48%. Hands were less frequently washed before eating, where guideline adherence was 15%. In 38% of the playrooms there was no soap within reach of children and 17% had no towel facilities. In over 40% of the playrooms, appropriate hand hygiene facilities for children were lacking. CONCLUSION: Adequate hand washing facilities were available for children in only half of the participating day care centres in our study and children washed their hands in only 15-48% of the occasions defined by official guidelines. More attention is needed to hand hygiene of children attending day care centres in the prevention of infectious diseases.
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Creches/estatística & dados numéricos , Desinfecção das Mãos , Higiene das Mãos/estatística & dados numéricos , Adulto , Pré-Escolar , Ingestão de Alimentos , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Jogos e Brinquedos , Banheiros , Adulto JovemRESUMO
The public plays an important role in controlling the spread of a virus by adopting preventive measures. This systematic literature review aimed to gain insight into public perceptions and behavioral responses to the 2009 influenza A (H1N1) pandemic, with a focus on trends over time and regional differences. We screened 5498 articles and identified 70 eligible studies from PubMed, Embase, and PsychINFO. Public misconceptions were apparent regarding modes of transmission and preventive measures. Perceptions and behaviors evolved during the pandemic. In most countries, perceived vulnerability increased, but perceived severity, anxiety, self-efficacy, and vaccination intention decreased. Improved hygienic practices and social distancing were practiced most commonly. However, vaccination acceptance remained low. Marked regional differences were noted. To prevent misconceptions, it is important that health authorities provide up-to-date information about the virus and possible preventive measures during future outbreaks. Health authorities should continuously monitor public perceptions and misconceptions. Because public perceptions and behaviors varied between countries during the pandemic, risk communication should be tailored to the specific circumstances of each country. Finally, the use of health behavior theories in studies of public perceptions and behaviors during outbreaks would greatly facilitate the development of effective public health interventions that counter the effect of an outbreak.
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Acesso à Informação/psicologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Pandemias , HumanosRESUMO
OBJECTIVES: Partner notification is crucial for sexually transmitted infection (STI) control. We developed Suggestatest.nl (SAT), an internet-based notification system for verified diagnoses of STI/HIV. METHODS: SAT uses email, short message service, postal letter or a gay dating site to notify sexual contacts. SAT was piloted at the Public Health STI clinics in two major cities in the Netherlands. We evaluated SAT from March to July 2012 by analysing SAT notifications linked with epidemiological data. Determinants for SAT use were assessed using multivariable logistic regression analysis. RESULTS: Of 988 index clients receiving a SAT code, overall 139 (14%) notified through SAT, sending 505 notifications (median 2), 84% by text messaging and 15% by email; 88% non-anonymously. Of those intending to use SAT, 23% notified with SAT. Intention to use SAT was the only independent determinant of SAT use in heterosexuals and men who have sex with men. Among the 67 SAT users in Rotterdam, 56% (225/402) of their partners at risk were contactable, and 95% (213/225) of those were notified using SAT. 58% of SAT-notified partners accessed the SAT-website and 20% of them subsequently consulted the STI clinics. STI positivity in partners was lower in those notified by SAT (28% (32/116)) than in those with contact cards (45% (68/152); p<0.001). CONCLUSIONS: Although the challenges posed by non-contactable partners are not solved by SAT, it is a valuable novel tool for notification of verified STI diagnoses by index patients and providers. In addition to current standard partner notification practice it suits a small number of clients, especially those reporting more than one partner.
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Instituições de Assistência Ambulatorial , Busca de Comunicante , Internet , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Busca de Comunicante/estatística & dados numéricos , Estudos Transversais , Correio Eletrônico , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
BACKGROUND: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention. METHODS/DESIGN: The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs. DISCUSSION: This is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered. TRIAL REGISTRATION: Netherlands trial registry: NTR3000.
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Creches/métodos , Higiene das Mãos/métodos , Adulto , Criança , Creches/normas , Resfriado Comum/prevenção & controle , Diarreia/prevenção & controle , Higiene das Mãos/normas , Humanos , Modelos Logísticos , Distribuição de Poisson , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de PesquisaRESUMO
BACKGROUND: Although hand hygiene (HH) has proven to be an effective measure to prevent infections, HH compliance is generally low. We assessed sociocognitive determinants of caregivers' HH behavior in child day care centers (DCCs) to develop an effective HH intervention. METHODS: Caregivers' compliance to HH guidelines was observed. Observed caregivers completed a questionnaire on self-reported HH compliance, sociocognitive determinants, and sociodemographic data. To determine sociocognitive determinants of observed compliance, multilevel logistic regression analyses were performed. Self-reported compliance was analyzed using linear regression. RESULTS: In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The response rate on the questionnaire was 100%. Overall observed HH compliance was 42% (841/2,003). Overall mean self-reported HH compliance was 8.7 (scale, 0-10). Guideline knowledge (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.03-1.56) and perceived disease severity (OR, 0.93; 95% CI: 0.87-0.99) were associated with observed compliance. Guideline knowledge (ß = 0.31; P < .001), guideline awareness (ß = 0.16; P < .001), perceived importance (ß = 0.20; P = .004), perceived behavioral control (ß = 0.24; P < .001), habit (ß = 0.27; P < .001), and children at home (ß = 0.30; P = .002) were associated with self-reported compliance. CONCLUSION: When developing HH interventions for caregivers in DCCs, improving guideline knowledge should be considered as this was associated with both observed and self-reported HH compliance. Furthermore, increasing guideline awareness, perceived importance, and perceived behavioral control can contribute to better HH, as well as making HH a habitual behavior.
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Atitude do Pessoal de Saúde , Cuidadores , Creches , Fidelidade a Diretrizes , Higiene das Mãos/métodos , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Children attending day care centers (DCCs) are at high risk for contracting infections, for which hand hygiene (HH) is an effective prevention measure. The study objectives were to assess caregivers' compliance to HH guidelines in DCCs and to identify environmental determinants of HH behavior. METHODS: We observed caregivers' compliance to HH guidelines and collected data on environmental determinants (ie, number of sinks, number and type of towel and soap facilities, availability of alcohol-based hand sanitizers). Using multilevel logistic regression analyses, odds ratios (OR) with 95% confidence intervals (CI) were obtained for environmental determinants of HH behavior. RESULTS: In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The overall compliance was 42% (95% CI: 40%-44%). Compliance for different activities for which HH was indicated ranged from 20% to 79%. In the multivariable model, the number of towel facilities per caregiver (OR, 2.33; 95% CI: 1.40-3.88) and type of towel facilities were significantly associated with HH. Hands were most frequently washed when only paper towels were available compared to only fabric towels (OR, 1.47; 95% CI: 1.00-2.16) or a combination of both paper and fabric towels (OR, 2.13; 95% CI: 1.32-3.44). CONCLUSION: HH compliance of caregivers in Dutch child DCCs can be improved. Interventions for this should take into account environmental determinants such as the number and type of towel facilities.
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Cuidadores/psicologia , Creches , Infecção Hospitalar/prevenção & controle , Monitoramento Ambiental/métodos , Fidelidade a Diretrizes , Higiene das Mãos , Decoração de Interiores e Mobiliário , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Países Baixos , Guias de Prática Clínica como Assunto , Adulto JovemRESUMO
BACKGROUND & AIMS: Migrants born in countries where hepatitis B is endemic are a risk group for chronic hepatitis B virus (HBV) infection. Treatment options have improved, but due to the asymptomatic nature of chronic HBV infection, the majority of patients remain unidentified. METHODS: In 2009, a campaign targeting the Chinese community was held in the city of Rotterdam, The Netherlands. The campaign combined disease awareness activities with free HBV testing at outreach locations. Chronically HBV infected patients were referred to specialist care based on a referral guideline. Before and after the campaign, knowledge of chronic hepatitis B was measured through questionnaires in a convenience sample of the target population (n=285 and n=277). RESULTS: In a period of 3 months, 13 outreach activities took place and 1090 Chinese migrants were tested for HBV. Forty-nine percent had serological signs of a past or recent HBV infection and 8.5% (n=92) were chronically infected. Thirty-eight percent (n=35) of chronically infected patients were referred for evaluation by a specialist and of these, 15 started antiviral treatment within 1 year of follow-up. Before the campaign, 55% answered correctly to 6 or more out of 10 knowledge items. Knowledge was positively associated with educational level. After the campaign, an increase in knowledge was observed in participants with low levels of education. CONCLUSIONS: Chinese migrants could be reached with an outreach campaign, and on-site testing was well accepted. A high prevalence of chronic HBV infection was found and referral to specialist care and initiation of treatment was successful.
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Hepatite B Crônica/tratamento farmacológico , Migrantes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Povo Asiático , Criança , Feminino , Seguimentos , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Encaminhamento e ConsultaRESUMO
This study examines patient's reasons for accepting Q fever vaccination, including risk perception, feelings of doubt, social influence, information-seeking behavior, preventive measures taken, and perceptions regarding received information and governmental action. Data was obtained from exit interviews conducted after Q fever vaccination, between January and April 2011. A total of 413 patients with specific cardiovascular conditions in the Netherlands participated in exit interviews; 70% were older than 60 years. Most reported reasons for accepting Q fever vaccination were: "I am at an increased risk for developing (chronic) Q fever" (69%) and "my general practitioner recommends Q fever vaccination for me" (34%). The majority (86%) reported a high perceived severity of Q fever, and only 6% felt vulnerable to Q fever after vaccination. One-third had doubts about getting vaccinated, primarily related to fears of side effects and practical barriers. Fifty-two percent solicited advice from their social networks; of these, 67% reported influence on their vaccination decision. General practitioners and family were the most reported sources of advice. Thirty percent actively sought information about Q fever vaccination. Twenty-two percent of all respondents had taken other preventive measures, such as avoiding contact with goats and sheep (74%), and cancelling or postponing visits to Q fever-affected areas (36%). Almost one-half of all respondents reported negative feelings regarding governmental action to control Q fever. Significant differences were observed regarding feelings of doubt, information-seeking behavior, perceived vulnerability, preventive measures taken, and perceptions regarding received information and governmental action regarding gender, age, educational level, and/or employment status. Vaccination decision-making may differ among socio-demographic subgroups. When preparing future vaccination campaigns, it is important to obtain greater insight into these differences and take these aspects into account in risk communication strategies by tailoring information to specific target groups.
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Vacinas Bacterianas/administração & dosagem , Doenças Cardiovasculares/imunologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Febre Q/prevenção & controle , Vacinação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Vacinas Bacterianas/imunologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Países BaixosRESUMO
BACKGROUND: Kisumu has shown a rising HIV prevalence over the past sentinel surveillance surveys, and most new infections are occurring among youth. We conducted a qualitative study to explore risk situations that can explain the high HIV prevalence among youth in Kisumu town, Kenya METHODS: We conducted in-depth interviews with 150 adolescents aged 15 to 20, held 4 focus group discussions, and made 48 observations at places where youth spend their free time. RESULTS: Porn video shows and local brew dens were identified as popular events where unprotected multipartner, concurrent, coerced and transactional sex occurs between adolescents. Video halls - rooms with a TV and VCR - often show pornography at night for a very small fee, and minors are allowed. Forced sex, gang rape and multiple concurrent relationships characterised the sexual encounters of youth, frequently facilitated by the abuse of alcohol, which is available for minors at low cost in local brew dens. For many sexually active girls, their vulnerability to STI/HIV infection is enhanced due to financial inequality, gender-related power difference and cultural norms. The desire for love and sexual pleasure also contributed to their multiple concurrent partnerships. A substantial number of girls and young women engaged in transactional sex, often with much older working partners. These partners had a stronger socio-economic position than young women, enabling them to use money/gifts as leverage for sex. Condom use was irregular during all types of sexual encounters. CONCLUSIONS: In Kisumu, local brew dens and porn video halls facilitate risky sexual encounters between youth. These places should be regulated and monitored by the government. Our study strongly points to female vulnerabilities and the role of men in perpetuating the local epidemic. Young men should be targeted in prevention activities, to change their attitudes related to power and control in relationships. Girls should be empowered how to negotiate safe sex, and their poverty should be addressed through income-generating activities.