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Magnet4Europe Intervention to Improve Clinician and Patient Well-Being: A Quasi-Experimental Study of 56 Hospitals in 6 European Countries.
Get PDFBACKGROUND: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model is an organizational hospital intervention associated with better clinician and patient outcomes but there is insufficient evidence as to whether the Magnet model based on structural empowerment of clinicians results in better outcomes or rewards hospitals with good work environments, and whether the Magnet model can be implemented at scale outside the United States.
OBJECTIVE: To evaluate whether Magnet4Europe-a multiyear organizational intervention of European hospitals-could be implemented and would result in improvements in nurse well-being, care quality, and patient safety.
DESIGN: Quasi-experimental longitudinal evaluation of 56 European intervention hospitals in 6 countries. Hospital-level implementation of the intervention measured by changes (from baseline to follow-up) in 77 Magnet model intervention targets. Outcome measures (eg, nurse burnout, intent to leave, quality of care, patient safety) were derived from surveys of nurses (4546 nurses at baseline; 3171 at follow-up).
FINDINGS: Hospitals that implemented intervention targets during the study period observed reductions in nurse burnout, nurses' intentions to leave their jobs, and unfavorable care quality. Each 10-percentage-point increase in intervention target implementation was associated with 2.7%-point reduction in nurses who intend to leave (β -2.66; 95% CI: -4.74, -0.58, P <0.05). Hospitals which implemented more than 25% of intervention targets observed 6.3%-point reduction in nurse burnout, 7.6%-point reduction in intent to leave, 6.4%-point reduction in unfavorable care quality, and 3.7%-point reduction in unfavorable patient safety. Improvements in hospital percentages of nurses reporting staffing adequacy were associated with reductions in burnout, intentions to leave, unfavorable care quality, and patient safety.
CONCLUSION: Successful implementation of Magnet4Europe demonstrates promise for international adoption at scale of Magnet as an organizational intervention for improving clinician well-being, care quality, and patient safety
A Cross-Sectional Virological and Sero-Epidemiological Study of Exposures to Avian Influenza A(H5N1) and A(H9N2) Viruses in Live Bird Market Workers in Dhaka, Bangladesh.
Get PDFBACKGROUND: Avian influenza A viruses (AIVs) are endemic among poultry in Bangladesh sold at live bird markets (LBMs). We assessed virologic and serologic evidence of exposure to AIVs among LBM workers. METHODS: A cross-sectional study recruited 702 randomly sampled workers from 42 LBMs in Dhaka, Bangladesh, during 2017. Nasal and throat swabs collected from workers and air samples from LBMs were tested for influenza A virus by RT-PCR with positives subtyped for A(H5), A(H7), and A(H9). Baseline sera from 695 workers and follow-up sera from 89 workers with influenza A positive respiratory specimens were tested by microneutralization assay for antibodies to A(H5N1) clade 2.3.2.1a and A(H9N2) G1 lineage viruses circulating in poultry. A seropositive result was defined as a neutralizing antibody titer ≥ 1:40. RESULTS: Most LBM workers reported slaughtering (93.3%) and defeathering (84.5%) poultry. Ninety-nine (14.1%) had ≥ 1 respiratory specimen that tested influenza A positive but negative for A(H1) and A(H3). Of these 99, subtyping identified 28 (28.3%) A(H9), 2 (2%) A(H5), 3 (3%) both A(H5) and A(H9), and 66 (66.7%) A (nonsubtypeable). Influenza A viruses were detected in air samples at 25 LBMs (59.5%), including A(H9) only in 10 LBMs (40%), A(H5) only in one (4%), both A(H5) and A(H9) in 13 (52%), and one A (nonsubtypeable) (4%). None of the participants were seropositive for AIVs. CONCLUSIONS: LBM workers had extensive exposure to AIVs, but none had serologic evidence of infection with A(H5N1) or A(H9N2) viruses circulating among poultry in Bangladesh. Ongoing surveillance of AIVs in LBMs and poultry workers is needed
A best practice guide for conducting healthy food retail research: A resource for researchers and health promotion practitioners.
Get PDFRetail food environments play a pivotal role in influencing dietary behaviors, and therefore have huge potential as settings for promoting good nutrition and preventing obesity. Conducting research in retail settings can be challenging due to the varied motivations of the parties involved and the complex nature of retail environments. To improve the quality and consistency of research in this field, we have identified 16 thematic topics aimed at guiding researchers and public health practitioners on how to conduct healthy food retail research. A summary for each topic, encompassing existing methodologies, best practice examples, and knowledge gaps, was developed based on available literature and the collective experience and expertise of 32 multidisciplinary researchers from a high-income perspective engaged in healthy food retail research in a diverse range of retail settings. A summary checklist describing key considerations at each stage of conducting healthy food retail research was also developed
Optimisation of a sexual health and healthy relationships intervention for Further Education in England and Wales (SaFE).
Get PDFBACKGROUND: Adverse sexual health, dating and relationship violence, and sexual harassment are significant public health concerns, especially among young people. Sexually transmitted infection rates are at a 10-year high, and dating and relationship violence affects nearly half of young people. Further education provides a population-wide setting for delivering dating and relationship violence and sexual health interventions, but only a few interventions have been shown to be effective in further education.
OBJECTIVES: To optimise intervention materials and identify refinements for the Sexual Health and Healthy Relationships for further education (SaFE) intervention, an intervention to improve sexual health and reduce dating and relationship violence and sexual harassment among young people attending further education. Optimised materials were used in a pilot cluster randomised controlled trial of SaFE. SaFE had three components: (1) onsite access to sexual health and relationship services in further education settings provided by sexual health nurses for 2 hours, 2 days per week; (2) publicity about onsite services and (3) further education staff training on how to promote sexual health and recognise and respond to dating and relationship violence and sexual harassment. This paper reports on the optimisation of the SaFE intervention materials.
DESIGN AND METHODS: A multistage iterative process was used to optimise further education staff training and publicity materials. This involved a series of consultation and focus group feedback sessions.
SETTING AND PARTICIPANTS: In Stage 1, feedback was collected from the SaFE Trial Management Group. Stage 2 involved: (1) two focus groups; one with four further education staff and one with three further education students at one further education institution and (2) stakeholder consultation with seven experts. Stage 3 saw consultation with the Trial Steering Committee who had independent oversight of the study. The operational feasibility of the training was evaluated in Stage 4 through a trial run with further education safeguarding and well-being teams. Stage 5 comprised a final review of intervention material by the Trial Management Group. Stage 6 gained online feedback from a young people's advisory group. The study was conducted in England and Wales.
RESULTS: In Stage 1, Trial Management Group reviewers recommended improving clarity and factual accuracy, reducing the length of slide decks and adding content on sending explicit images. Stage 2 feedback from further education staff and students focused on training content addressing comprehensiveness, structure and visual design and training delivery addressing preferred training formats and opportunities for scenario-based learning. The Trial Steering Committee in Stage 3 advised on managing participant disclosures and reordering content. Stage 4's trial run with further education staff identified redundancy in content, the incorporation of task-based exercises and varied learning approaches. Stage 5's Trial Management Group review led to the integration of multimedia elements and case studies. Stage 6 feedback from young people improved clarity and accessibility in publicity materials.
LIMITATIONS: Low participation and self-selection in focus groups may limit the generalisability of the findings. The move to online engagement during COVID-19 may have hindered the depth of interaction. Recruiting from a single institution could introduce sampling bias.
CONCLUSIONS: Fully optimised staff training and publicity materials were produced that were considered acceptable and consistent with the theory of change as agreed by the research team, Trial Steering Committee, stakeholder advisory group and further education students staff and young people.
FUTURE WORK: After the optimisation phase, the SaFE intervention was delivered in a pilot cluster randomised controlled trial with high fidelity to six further education settings in England and Wales. Future work could explore strategies to evaluate the effectiveness as well as improve scalability and sustainability of interventions like SaFE.
FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/149/12
Predictors of outcome following neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
Get PDFBACKGROUND: Intrapartum-related neonatal encephalopathy (NE) is a leading cause of neonatal deaths and childhood-onset developmental disabilities worldwide. Accurate prediction of neurodevelopmental outcomes is crucial to support effective neonatal follow-up strategies, guide parental counselling, and inform future neuroprotection research. Whilst NE disproportionately affects those in low- and middle-income countries (LMICs), existing prognostic accuracy research is primarily based in high-income countries. This systematic review and meta-analysis aims to provide a comprehensive synthesis of the predictors of adverse early childhood outcome following NE in LMICs. METHODS: Four databases were searched, using terms related to "neonate", "encephalopathy", "predictor", "outcome", and "LMIC". NE was defined as ≥35 weeks' gestation, evidence of intrapartum event, and abnormal neurology on early clinical assessment. Adverse childhood outcome was defined as neurodevelopmental impairment (assessed using a standardised tool) +/- death, at ≥12 months of age. At least two reviewers performed screening of abstracts and full texts, data extraction, and bias assessment (Quality in Prognosis Studies tool). We reported sensitivity and specificity for each predictive tool, stratifying results by therapeutic hypothermia (TH) status. Meta-analyses were performed where possible. The protocol was registered on PROSPERO in January 2024 (CRD42024485734). RESULTS: Of the 7,464 articles screened, 32 were included, totalling 1,538 infants with NE from 14 LMICs. Predictors were categorised into neonatal clinical scores for NE severity (16 studies), neurophysiology (13), neuroimaging (14), biomarkers (10), and post-neonatal neurological clinical assessments (5). Highest prognostic accuracy was demonstrated by MRI (moderate to severe abnormalities; sensitivity 69% and specificity 90%), electroencephalography (early severe background abnormality; sensitivity 87% and specificity 93%), Prechtl's General Movements Assessment (absent fidgety movements; sensitivity 78% and specificity 95%), and Hammersmith Infant Neurological Examination (score <67; sensitivity 88-100% and specificity 88%-100%). CONCLUSIONS: A range of standardised tools showed good prognostic accuracy for adverse early childhood outcome following NE. However, this review highlights the paucity of NE research in LMICs using adequate sample sizes and duration of follow-up. Data synthesis and comparability were limited by substantial heterogeneity between study populations, definitions and timing of predictors and outcomes, and variable study quality. Data to evaluate the role of TH on prognostic accuracy were insufficient. Further research to evaluate combinations of the most promising predictors is warranted
Forced vaginal sex and genital immune correlates of HIV risk: a prospective study of female sex workers in Kenya.
Get PDFBACKGROUND: The likelihood of HIV acquisition is increased following forced vaginal sex. This relates in part to epidemiological and behavioural factors; however, the biological effects of forced vaginal sex, including impacts on immune parameters linked to HIV susceptibility, are poorly understood. Here, we examine biological mediators of HIV susceptibility among female sex workers (FSWs) in Nairobi, Kenya, who recently experienced forced vaginal sex.
METHODS: The Maisha Fiti study was a longitudinal cohort study of FSWs from Nairobi, Kenya. At up to three visits, HIV-uninfected participants completed a detailed sociodemographic survey in which they were asked if they had experienced forced vaginal sex in the past 7 days. Proinflammatory cytokines and soluble E-cadherin (sE-cad), a biomarker of epithelial barrier disruption, were quantified in cervico-vaginal secretions by multiplex immunoassay. Associations between recent forced sex and genital inflammation were assessed longitudinally in a mixed-effects regression model adjusted for potential confounders and within-participant correlation.
RESULTS: Of the 746 participants, 44 (6%) reported forced vaginal sex in the past 7 days at baseline, with strong evidence of associations with adverse childhood experiences (p<0.001), mental health issues (p<0.001) and poverty (p=0.02). Recent forced sex was associated with increased genital inflammation (adjusted OR (aOR)=2.74; 95% CI 1.33 to 5.68; p<0.01) independent of previously defined confounders but was not associated with altered levels of sE-cad (p=0.56). Neither recent consensual sex (aOR=0.94, 95% CI 0.63 to 1.40, p=0.76) nor forced sex within the past 6 months, excluding the past 7 days (aOR=0.93, 95% CI 1.21 to 5.42, p=0.70), was associated with genital inflammation.
CONCLUSIONS: Cervicovaginal inflammation is increased in FSWs for at least a week after forced vaginal sex. This has important implications for HIV prevention programmes that provide care to women experiencing gender-based violence. Further studies are needed to understand the specific timing of proinflammatory cytokine release following forced vaginal sex
HIV and herpes simplex virus 2 incidence among adolescent girls and young women who sell sex in rural South Africa.
Get PDFOBJECTIVE: We investigate the risk of acquiring HIV or herpes simplex virus type 2 (HSV-2) among young women who sell sex (YWSS) in rural South Africa.
DESIGN: A representative population-based prospective cohort study of adolescent girls and young women (AGYW).
METHODS: Between 2017 and 2019, we interviewed a random sample of AGYW (13-30 years) annually and collected dried blood spot (DBS) samples for HIV and HSV-2 serology. YWSS were defined as engaging in transactional sex and/or sex work in the past 12 months. We used Cox regression to estimate the association between selling sex and incident HIV or HSV-2 infections, using inverse probability weighting to adjust for potential confounding (age, education, rural/urban locality, socioeconomic status (SES), food insecurity, and pregnancy status).
RESULTS: Among eligible AGYW ( n = 3846), 89.2% provided responses for at least one follow-up time-point, of whom 17% reported selling sex in the past 12 months. HIV and HSV-2 prevalence at enrolment were 21 and 37.9%, respectively and higher among YWSS at 42 and 69%, respectively. HIV incidence was 3.4/100 person-years [95% confidence interval (CI): 2.6-4.2] higher among YWSS than others (8.2 vs. 2.7/100 person-years; hazard ratio: 2.70; 95% CI: 1.83-3.99). HSV-2 incidence was 18.4/100 person-years (95% CI: 16.5-20.5), and was higher among YWSS than others (29.3 vs. 17.2/100 person-years; hazard ratio 1.83; 95% CI: 1.41-2.39). HSV-2 at baseline was associated with subsequent HIV infection (hazard ratio 6.32; 95% CI: 3.86-10.47, P < 0.001).
CONCLUSION: HIV and HSV-2 incidence was higher among AGYW selling sex compared those who did not sell sex. These findings highlight the need for preexposure prophylaxis (PrEP) and socioeconomic support for this priority population of AGYW in rural settings
Association Between Self-Reported Sleep Quality and Conversion From Mild Cognitive Impairment to Dementia: A Retrospective Cohort Study Using the English Longitudinal Study of Ageing.
Get PDFPURPOSE: Poor sleep quality is common in people diagnosed with mild cognitive impairment (MCI) and dementia and may be associated with conversion to dementia. METHOD: This retrospective cohort study investigated the association of self-reported sleep quality and duration with dementia incidence in a cohort of people aged ≥ 50 with MCI from the English Longitudinal Study of Ageing (ELSA) panel study. We identified the MCI cohort using three waves (2008/2009, 2012/2013, 2016/2017) based on absence of diagnosed dementia, self-reported memory problems, preserved ability for daily activities, and reduced cognitive function in neuropsychological assessments. Exposures were self-reported poor sleep quality and sleep duration in the month before the baseline interview. The outcome was self-reported physician-diagnosed dementia from later waves. We modeled associations with Cox proportional hazards regression adjusted for multiple confounders. FINDING: Among 1885 patients with MCI at baseline, 24.7% reported poor sleep quality, 17.6% reported average sleep duration per night to be < 6 h, 74.6% reported average sleep duration per night to be 6-< 9 h, and 7.5% reported average sleep duration per night to be ≥ 9 h. Note that 176 (9.3%) developed dementia during follow-up (median 5.8 years, interquartile range [IQR] 2.1-6.3). Age-adjusted hazard for all-cause dementia, compared to 6-< 9 h sleep duration, was increased with sleep duration ≥ 9 h (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.62-4.02) but not short sleep duration (HR 0.94, 95% CI 0.55-1.61); there was weak evidence of reduced risk in persons with poor sleep quality, compared to good sleep quality (HR 0.68, 95% CI 0.41-1.12). CONCLUSION: We found evidence for an association between long sleep duration and dementia risk in patients with MCI and limited evidence of an association between poor sleep quality and dementia
Biannual Mass Azithromycin Distributions for Preschool Children and Malaria Parasitemia: A Secondary Analysis of the MORDOR Cluster Randomized Trial.
Get PDFIMPORTANCE: Mass azithromycin distributions may reduce malaria parasitemia in the short term, but longer-term effectiveness is unclear. OBJECTIVE: To examine whether biannual mass azithromycin distributions are associated with lower rates of malaria parasitemia in preschool children living in Niger. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial was performed from November 23, 2014, until June 9, 2020, as an ancillary trial to a larger trial studying the effect of mass azithromycin on child mortality. Study communities (ie, government-defined health catchment areas) in Niger were randomized in a 1:1 ratio to biannual (ie, twice-yearly) mass administration of azithromycin or placebo to all children aged 1 to 59 months and followed up for 5 years. Data analyses were performed from June 25, 2023, to April 27, 2025. INTERVENTION: Twice-yearly administration of a single dose of oral azithromycin, 20 mg/kg, or placebo. MAIN OUTCOMES AND MEASURES: The prevalence of parasitemia 4 years after the community started treatment, assessed in a random sample of 40 children per community. RESULTS: Among the 30 communities in Niger included in the study at baseline, the 15 communities randomized to azithromycin consisted of 1695 children (mean [SD] age, 30.8 [2.8] months; 858 [51.8%] male) and the 15 communities randomized to placebo consisted of 3031 children (mean [SD] age, 30.6 [2.6] months; 157 [52.0%] male). The mean prevalence of malaria parasitemia at baseline was 8.9% (95% CI, 5.1%-15.7%) in the azithromycin arm and 6.7% (95% CI, 4.0%-12.6%) in the placebo arm. At annual follow-up visits up until month 48, parasitemia was not statistically significantly lower in the azithromycin arm compared with the placebo arm, assuming a 10% prevalence in the placebo arm (-3.3 percentage points [PP]; 95% CI, -5.8 to -0.2 PP; permutation P = .05). The Niger Ministry of Health instituted seasonal malaria chemoprevention (SMC) after the month 36 study visit. Analysis restricted to the period before SMC found significantly less parasitemia in the azithromycin arm compared with the placebo arm (4.8 PP lower; 95% CI, -7.4 to -1.3 PP; permutation P = .02). CONCLUSIONS AND RELEVANCE: In this placebo-controlled cluster randomized trial, malaria among children aged 1 to 59 months was lower in communities treated with biannual mass azithromycin, but the effect was significant only for the first 3 years of the trial, before SMC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02048007
Factors determining the overlap between recipients of the first and second dose of measles vaccine in nineteen surveys.
Get PDFMany countries schedule a second dose of measles-containing vaccine (MCV2) for children in their second year of life. The correlation between recipients of the first dose of measles-containing vaccine (MCV1) and MCV2 is poorly understood but is important for estimating population levels of measles immunity and for meeting elimination targets. Using data from 19 surveys from Demographic and Health Surveys (DHS) we computed the percentage of MCV1 recipients with subsequent MCV2 and of MCV2 recipients with previous MCV1. All countries included in our study recommended MCV1 in the first year of life and MCV2 in the second year of life. For 2 surveys we computed the variation of those percentages over the country's geographical regions. We computed adjusted odds ratios for the association of this percentage with age, sex, residency, mother's education, wealth and birth order. For most of the surveys, over 50% of MCV1 recipients received MCV2, but there was more than 30% MCV1 to MCV2 dropout in more than half of the surveys. The percentage of MCV1 recipients with MCV2 was statistically significantly higher if they received MCV1 below age 12 months and the percentage increased with increasing education status of the mother and higher income levels. A small number of MCV2 recipients were not found to have received MCV1, despite marked on record as having received MCV2 implies having previously received MCV1 (by definition of the survey data collection methodology). Our analyses have highlighted important shortfalls by age, country, mother's education and income status in the proportion of MCV1 recipients who subsequently receive MCV2. Targeting those differentials is essential for achieving the goals of measles elimination