Suchergebnisse

INTRODUCTION: Efforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public's health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing. METHODS: Survey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout. RESULTS: Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units. CONCLUSIONS: Hospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public's health. Such risks could be addressed by safe nurse staffing policies currently under consideration.

BACKGROUND: Hepatitis C Virus (HCV) is a leading cause for chronic liver diseases worldwide. The European Union and World Health Organization aspire to eliminate HCV by 2030. However, among at-risk populations, including, homeless people, prisoners and People Who Inject Drugs, access to diagnosis and treatment is challenging. Hepcare Europe is an integrated model of care developed to address this by assessing potential reasons for these restrictions and determining measures needed to improve HCV diagnosis, treatment and access to care within different communities. OBJECTIVES: HepCare Europe is an EU-supported project involving collaboration between five institutions in: Ireland, United Kingdom, Spain and Romania. We aim to explore the journey of care experienced by those living with HCV with a focus on previous care disruptions (loss to follow up) and the new HepCare Europe Programme. METHODS: Research teams conducted semi-structured interviews with patients who accessed services through HepCare Europe thus, patients were recruited by purposeful sampling. Patients interviewed had received, or were in the final weeks of receiving, treatment. The interviews were audio recorded, transcribed and translated into English, and sent to the Dublin team for inductive thematic analysis. Researchers from the HepCare Europe research team coded the data separately, then together. RESULTS: Common themes are introduced to present similarities, following individual site themes to highlight the importance of tailored interventions for each country. Key themes are: 1) Hepatitis C patients lost to follow up 2) HepCare improved access to treatment and 3) the need for improved HCV education. Individual themes also emerged for each site. These are: Ireland: New opportunities associated with achieving Sustained Virologic Responses (SVR). Romania: HCV is comparatively less crucial in light of Human Immunodeficiency Viruses (HIV) coinfections. UK: Patients desire support to overcome social barriers and Spain: Improved awareness of HCV, ...

The ocean is inextricably linked with the way we live. The EU-funded Horizon 2020 Project SOPHIE (Seas, Oceans and Public Health in Europe; https://sophie2020.eu/) is establishing the foundations for the future of Oceans and Human Health research in Europe through review, diverse community input, and discussion of strategy, to produce a strategic research agenda for Europe. SOPHIE is funded by the European Union's Horizon 2020 research and innovation programme, grant agreement No. 774567. The meta-discipline of Oceans and Human Health (OHH) spans expertise in the marine, public health and medical fields, and social science, and explores the complex interactions between Ocean Health and Human Health. Key aspects for this field of research is ocean observation, and building the evidence base of data to start drawing concrete links between the impacts of the ocean on human health, and our impacts on ocean health. Only through better understanding of these complex linkages can both the ocean and humans benefit. Identification and strategic monitoring of human-relevant ocean observation variables and indicators are vital first steps. The benefits of doing so could be felt in a wide array of fields, including: food and nutrition, sustainable ocean use, blue tourism and coastal living, climate change and adaptation, marine pollution, disaster risk management, mental health and wellbeing, and blue biotechnology. This will only become more important as we strive to move towards a more sustainable future. The SOPHIE Project is exploring the needs, gaps, benefits and priorities, especially in relation to ocean observing, and will make concrete proposals in a Strategic Research Agenda for Europe; a key project output. These recommendations can contribute to the implementation and future evolution of the European Ocean Observing System (EOOS). Highlighting the direct links to health, daily lives and leisure time might be the draw that society needs to reconnect with the ocean, and strive to protect it better in the future ...

Purpose. To test effectiveness of Active School Day policy implementation on physical activity outcomes and estimate school-level implementation costs. Design. The design of the study was quasi-experimental (pretest–posttest matched controls). Setting. The study took place in six elementary schools with three matched pairs in Boston, Massachusetts, February to June 2011. Subjects. Subjects were 455 consenting fourth- and fifth-grade students among 467 eligible. Intervention. Active School Day policy implementation provided equipment, curricular materials, and training to physical educators and school wellness champions to promote 150 weekly minutes of quality physical education, recess, and physical activity integrated into classrooms. Measures. Accelerometer assessments of accumulated minutes and bouts of moderate, vigorous, and sedentary physical activity on 5 school days before and after implementation were used. Implementation costs were collected by record review and reported resource utilization. Analysis. Analysis was conducted using multivariate mixed models estimated with repeated measures of daily physical activity, adjusted for student demographics and other confounding and design/clustering variables. Results. Accelerometer data were provided by 201 intervention and 192 comparison students for an average of 4 days per period (84% response). During school time, students in intervention schools demonstrated greater increases in minutes per day of moderate-to-vigorous physical activity (3.9, 95% confidence interval [CI] 1.8–6.0; p < .001) and vigorous physical activity (1.8, 95% CI.7–3.0; p < .001), and greater decreases in minutes per day of sedentary time (–10.6, 95% CI—15.3– −5.8; p < .001) than controls. Ongoing annual implementation costs totaled $4,523/school ($14/student). Conclusion. Active School Day implementation increased student moderate-to-vigorous physical activity levels by 24% and decreased sedentary time during school at modest cost.

It is well documented that young women's social physique anxiety is associated with a number of health-compromising behaviors. The bulk of this research has used the Social Physique Anxiety Scale (SPAS); however, the use of questionnaires in the body domain has been critiqued because of the assumption that women's experiences are singular and static. Therefore, the purpose of this study was to try to better understand young women's experiences of social physique anxiety. Feminist theory was used as a guiding perspective for this case study. Four young women participated (all 15 years old) and multiple methods (i.e. focus group, interviews, abstract photography task) were employed. The four themes developed were: (1) web of emotion; (2) uncertainty; (3) beyond physique; and (4) resignation. The stories of the young women suggest that their experiences are not easily reduced to this singular construct, and that, as a construct, social physique anxiety is limited in helping us to understand women's diverse experiences.

AbstractIntroduction: Decentralized HIV care for adults does not appear to compromise clinical outcomes. HIV care for children poses additional clinical and social complexities. We conducted a prospective cohort study to investigate clinical outcomes in children aged 6–15 years who registered for HIV care at seven primary healthcare clinics (PHCs) in Harare, Zimbabwe.Methods: Participants were recruited between January 2013 and December 2014 and followed for 18 months. Rates of and reasons for mortality, hospitalization and unscheduled PHC attendances were ascertained. Cox proportional modelling was used to determine the hazard of death, unscheduled attendances and hospitalization.Results: We recruited 385 participants, median age 11 years (IQR: 9–13) and 52% were female. The median CD4 count was 375 cells/mm3 (IQR: 215–599) and 77% commenced ART over the study period, with 64% of those who had viral load measured achieving an HIV viral load <400 copies/ml. At 18 months, 4% of those who started ART vs. 24% of those who remained ART‐naïve were lost‐to‐follow‐up (p < 0.001). Hospitalization and mortality rates were low (8.14/100 person‐years (pyrs) and 2.86/100 pyrs, respectively). There was a high rate of unscheduled PHC attendances (34.94/100 pyrs), but only 7% resulted in hospitalization. Respiratory disease was the major cause of hospitalization, unscheduled attendances and death. CD4 count <350cells/mm3 was a risk factor for hospitalization (aHR 3.6 (95%CI 1.6–8.2)).Conclusions: Despite only 64% of participants achieving virological suppression, clinical outcomes were good and high rates of retention in care were observed. This demonstrates that in an era moving towards differentiated care in addition to implementation of universal treatment, decentralized HIV care for children is achievable. Interventions to improve adherence in this age‐group are urgently needed.