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BACKGROUND: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. METHODS: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. RESULTS: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Pre-program attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. CONCLUSION: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
RESUMO
OBJECTIVES: There is a paucity of information on environmental risk factors for prostate cancer. We conducted a case-control study in Montreal to estimate associations with exposure to ground-level nitrogen dioxide (NO2), a marker for traffic-related air pollution. METHODS: Cases were 803 men with incident prostate cancer, ≤75 years of age, and diagnosed across all French hospitals in Montreal. Concurrently, 969 controls were drawn from electoral lists of French-speaking individuals residing in the same electoral districts as the cases and frequency-matched by age. Concentrations of NO2 were measured across Montreal in 2005-2006. We developed a land use regression model to predict concentrations of NO2 across Montreal for 2006. These estimates were back-extrapolated to 1996. Estimates were linked to residential addresses at the time of diagnosis or interview. Unconditional logistic regression was used, adjusting for potential confounding variables. RESULTS: For each increase of 5 parts per billion of NO2, as estimated from the original land use regression model in 2006, the OR5ppb adjusted for personal factors was 1.44 (95% CI 1.21 to 1.73). Adding in contextual factors attenuated the OR5ppb to 1.27 (95% CI 1.03 to 1.58). One method for back-extrapolating concentrations of NO2 to 1996 (about 10 years before the index date) gave the following OR5ppb: 1.41 (95% CI 1.24 to 1.62) when personal factors were included, and 1.30 (95% CI 1.11 to 1.52) when contextual factors were added. CONCLUSIONS: Exposure to ambient concentrations of NO2 at the current address was associated with an increased risk of prostate cancer. This novel finding requires replication.
