Influenza seasonality and vaccination timing in tropical and subtropical areas of southern and south-eastern Asia

Objective

To characterize influenza seasonality and identify the best time of the year for vaccination against influenza in tropical and subtropical countries of southern and south-eastern Asia that lie north of the equator.

Methods

Weekly influenza surveillance data for 2006 to 2011 were obtained from Bangladesh, Cambodia, India, Indonesia, the Lao People''s Democratic Republic, Malaysia, the Philippines, Singapore, Thailand and Viet Nam. Weekly rates of influenza activity were based on the percentage of all nasopharyngeal samples collected during the year that tested positive for influenza virus or viral nucleic acid on any given week. Monthly positivity rates were then calculated to define annual peaks of influenza activity in each country and across countries.

Findings

Influenza activity peaked between June/July and October in seven countries, three of which showed a second peak in December to February. Countries closer to the equator had year-round circulation without discrete peaks. Viral types and subtypes varied from year to year but not across countries in a given year. The cumulative proportion of specimens that tested positive from June to November was > 60% in Bangladesh, Cambodia, India, the Lao People''s Democratic Republic, the Philippines, Thailand and Viet Nam. Thus, these tropical and subtropical countries exhibited earlier influenza activity peaks than temperate climate countries north of the equator.

Conclusion

Most southern and south-eastern Asian countries lying north of the equator should consider vaccinating against influenza from April to June; countries near the equator without a distinct peak in influenza activity can base vaccination timing on local factors.     

Costs of addressing heroin addiction in Malaysia and 32 comparable countries worldwide

Objective

Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide.

Data Sources/Study Setting

Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003–May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources.

Study Design

Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita.

Principal Findings

Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29–53 percent) and buprenorphine (33–72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People''s Democratic Republic could be treated for $8 and $30 million, respectively.

Conclusions

Buprenorphine treatment can be provided at low cost in countries across the world. This study''s new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions.     

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective

To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods

A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results

12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions

Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.     

Social network effects on post-traumatic stress disorder (PTSD) in female North Korean immigrants

Objectives

The goal of this paper is to examine the social network effects on post-traumatic sdress disorder (PTSD) in female North Korean immigrants who entered South Korea in 2007. Specifically, it attempts to verify if the density and composition of networks make a difference after controlling for the network size.

Methods

A multivariate logistic regression is used to probe the effects of social networks using the North Korean Immigrant Panel data set. Because the data set had only completed its initial survey when this paper was written, the analysis was cross-sectional.

Results

The size of the support networks was systematically related to PTSD. Female North Korean immigrants with more supporting ties were less likely to develop PTSD, even after controlling for other risk factors (odds-ratio for one more tie was 0.8). However, once we control for the size of the network, neither the density nor the composition of the networks remains statistically significant.

Conclusions

The prevalence of the PTSD among female North Korean immigrants is alarmingly high, and regardless of the characteristics of supporting network members, the size of the supporting networks provides substantial protection. This implies that a simple strategy that focuses on increasing the number of supporting ties will be effective among North Korean immigrants who entered South Korea in recent years.     

The long-term impact of early parental death: lessons from a narrative study

Objective

To explore the individual experiences of those who had experienced the death of a parent(s) before the age of 18, and investigate how such experiences were perceived to impact on adult life.

Design

An exploratory qualitative design using written (n = 5) and oral (n = 28) narratives and narrative analysis was adopted to explore the experiences 33 adults (7 men and 26 women) who had experienced parental death during childhood.

Setting

UK

Participants

Individuals living in the North West of England who had lost a parent(s) before the age of 18.

Main outcome measures

Views of adults bereaved of a parent before the age of 18 of impact of parental loss in adult life.

Results

While individual experiences of bereavement in childhood were unique and context bound, the narratives were organized around three common themes: disruptions and continuity, the role of social networks and affiliations and communication and the extent to which these dynamics mediated the bereavement experience and the subsequent impact on adult life. Specifically they illustrate how discontinuity (or continuity that does not meet the child''s needs), a lack of appropriate social support for both the child and surviving parent and a failure to provide clear and honest information at appropriate time points relevant to the child''s level of understanding was perceived to have a negative impact in adulthood with regards to trust, relationships, self-esteem, feeling of self-worth loneliness and isolation and the ability to express feelings. A model is suggested for identifying and supporting those that may be more vulnerable to less favourable outcomes in adult life.

Conclusions

The findings suggest that if the negative consequences are to be minimized it is crucial that guidelines for ‘best practice’ that recognize the complex nature of the bereavement experience are followed.     

Supporting hospital staff to provide compassionate care: Do Schwartz Center Rounds work in English hospitals?

Objective

To assess (1) whether the Schwartz Center Rounds (“Rounds”), a multidisciplinary forum which brings together hospital staff to discuss the nonclinical, social and emotional aspects of caring for patients, could transfer from the US to a UK setting; and (2) whether UK Rounds would achieve a similar positive impact on individuals and teams, and hospital culture.

Design

The results reported are based on 41 qualitative interviews with context provided by additional quantitative research.

Setting

We introduced Rounds at two pilot sites, both NHS hospitals providing acute care.

Participants

Over the one-year, ten-Rounds pilot period, Rounds were attended by 1250 staff across the two sites. We conducted qualitative research into the experiences of staff involved in implementing Rounds at the outset and the end of the pilot.

Main outcome measures

Interviewees'' assessment of the effects of Rounds on participants, their relationships with colleagues, and the wider hospital.

Results

The findings show that in the two pilot trusts, Rounds are perceived by participants as a source of support and that their benefit may translate into benefits for patients and team working; and that Rounds have the potential to effect change in the hospital culture.

Conclusion

Rounds appear to transfer successfully from the US to the UK, and there is some evidence that they are having a similarly positive impact, but more research is needed.     

An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey

Objective

Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health.

Design

A survey-based post-intervention evaluation.

Setting

UK

Participants

232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys.

Main Outcome Measures

Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences.

Results

12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R.

Conclusion

Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R.     

The reasons of the nursing staff to notify adverse events

OBJECTIVE:

this research aimed to understand the motivation for reporting adverse events from the perspective of nursing staff in the work environment.

METHOD:

qualitative study that used the phenomenology of Alfred Schutz for reference, which offers a systematic approach to understand the social aspects of human action. Data were collected by open interviews with 17 nurses and 14 technicians/assistant nurses in a university hospital.

RESULTS:

motivation was revealed through six categories: all types of occurrences must be reported; the incident report is an auxiliary instrument to health care provision management; the culture of punishment in transition; nurses as the agents responsible for voluntary reporting; sharing problems with higher management and achieving quality in the work process.

DISCUSSION:

it was unveiled that, when reporting adverse events, team members perceived themselves to be in a collaborative relationship with the institution and trusted that they would receive administrative support and professional security, which encouraged them to continue reporting. Reporting allows health care professionals to share responsibilities with managers and encourages corrective actions.

FINAL CONSIDERATIONS:

the study revealed the nursing staff''s motivation for adverse event reporting, contributing to reflections on institutional policies aimed at patient safety in health care.     

Degree of exposure and peritraumatic dissociation as determinants of PTSD symptoms in the aftermath of the Ghislenghien gas explosion

Background

This paper investigates risk factors for the development of posttraumatic stress symptoms in the different survivor groups involved in a technological disaster in Ghislenghien (Belgium). A gas explosion instantly killed five firefighters, one police officer and 18 other people. Moreover, 132 people were wounded among which many suffered severe burn injuries.

Methods

In the framework of a large health survey of people potentially involved in the disaster, data were collected from 3,448 households, of which 7,148 persons aged 15 years and older, at 5 months (T1) and at 14 months (T2) after the explosion. Hierarchical regression was used to determine the significant predictors and to assess their proportion in variance accounted for.

Results

The degree of exposure to the disaster was a predictor of the severity of posttraumatic stress symptoms. Peritraumatic dissociation appeared to be the most important predictor of the development of posttraumatic stress symptoms at T1. But at T2, posttraumatic stress symptoms at T1 had become the most important predictor. Dissatisfaction with social support was positively linked to development of posttraumatic stress symptoms at T1 and to the maintenance of these symptoms at T2. Survivors who received psychological help reported significant benefits.

Conclusions

In harmony with the findings from studies on technological disasters, at T1 6,0% of the respondents showed sufficient symptoms to meet all criteria for a full PTSD. At T2, 6,6% still suffered from posttraumatic stress symptoms. The symptoms of the different victim categories clearly indicated the influence of the degree of exposure on the development of posttraumatic stress symptoms. Problems inherent to retrospective scientific research after a disaster are discussed.     

Incubation Period of Ebola Hemorrhagic Virus Subtype Zaire

Objectives

Ebola hemorrhagic fever has killed over 1300 people, mostly in equatorial Africa. There is still uncertainty about the natural reservoir of the virus and about some of the factors involved in disease transmission. Until now, a maximum incubation period of 21 days has been assumed.

Methods

We analyzed data collected during the Ebola outbreak (subtype Zaire) in Kikwit, Democratic Republic of the Congo, in 1995 using maximum likelihood inference and assuming a log-normally distributed incubation period.

Results

The mean incubation period was estimated to be 12.7 days (standard deviation 4.31 days), indicating that about 4.1% of patients may have incubation periods longer than 21 days.

Conclusion

If the risk of new cases is to be reduced to 1% then 25 days should be used when investigating the source of an outbreak, when determining the duration of surveillance for contacts, and when declaring the end of an outbreak.     

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Objective

To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake.

Methods

A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child.

Findings

The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51–7.50), depression (OR: 9.47; 95% CI: 2.58–34.80), PTSD (OR: 5.11; 95% CI: 2.31–11.34) and CG (OR: 10.73; 95% CI: 1.88–61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms.

Conclusion

Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.     

Depressive symptoms in institutionalized older adults

OBJECTIVE

To estimate the prevalence of depressive symptoms among institutionalized elderly individuals and to analyze factors associated with this condition.

METHODS

This was a cross-sectional study involving 462 individuals aged 60 or older, residents in long stay institutions in four Brazilian municipalities. The dependent variable was assessed using the 15-item Geriatric Depression Scale. Poisson’s regression was used to evaluate associations with co-variables. We investigated which variables were most relevant in terms of presence of depressive symptoms within the studied context through factor analysis.

RESULTS

Prevalence of depressive symptoms was 48.7%. The variables associated with depressive symptoms were: regular/bad/very bad self-rated health; comorbidities; hospitalizations; and lack of friends in the institution. Five components accounted for 49.2% of total variance of the sample: functioning, social support, sensory deficiency, institutionalization and health conditions. In the factor analysis, functionality and social support were the components which explained a large part of observed variance.

CONCLUSIONS

A high prevalence of depressive symptoms, with significant variation in distribution, was observed. Such results emphasize the importance of health conditions and functioning for institutionalized older individuals developing depression. They also point to the importance of providing opportunities for interaction among institutionalized individuals.     

Funding health and social services for older people - a qualitative study of care recipients in the last year of life

Objectives

This study explores the views of older adults who are receiving health and social care at the end of their lives, on how services should be funded, and describes their health-related expenditure.

Design

Qualitative interview study

Setting

North West England

Participants

30 people aged 69–93 years, diagnosed with lung cancer, heart failure or stroke and judged by health professionals to be in their last year of life. Sixteen participants lived in disadvantaged areas.

Main outcome measures

Views of older adults on funding of services.

Results

Participants expressed a belief in an earned entitlement to services funded from taxation, based on a broad sense of being a good citizen. Irrespective of social background, older people felt that those who could afford to pay for social care, should do so. Sale of assets and use of children''s inheritance to fund care was widely perceived as an injustice. The costs of living with illness are a burden, and families are filling many of the gaps left by welfare provision. People who had worked in low-wage occupations were most concerned to justify their current acceptance of services, and distance themselves from what they described as welfare ‘spongers’ or ‘layabouts.’

Conclusions

There is a gap between the health and social care system that older adults expect and what may be provided by a reformed welfare state at a time of financial stringencies. The values that underpinned the views expressed – mutuality, care for the most needy, and the importance of working to contribute to society – are an important contribution to the debate on welfare funding.     

Peer Reviewed: Perceptions of Diabetes,Barriers to Disease Management,and Service Needs: A Focus Group Study of Working Adults with Diabetes in Hawaii

Introduction

Research about the support needs for and barriers to successful disease management of working adults with diabetes is limited. Our objective was to gain an in-depth understanding of how working adults in Hawaii perceive diabetes, barriers to disease management, and the services needed to keep people healthy and working.

Methods

From November 2008 through March 2009, we conducted focus group interviews with 74 employed adults with diabetes enrolled in the Hawaii Demonstration to Maintain Independence and Employment project. Responses to questions were analyzed within and across groups to identify recurring themes. A third layer of analysis examined themes across responses to all questions, specifically, how barriers related to identified service needs.

Results

Employed participants with diabetes experienced pervasive effects on their lives as a result of the disease, although they interpreted these effects positively or negatively. Barriers to disease management, such as additional health issues, social prejudice, and lack of social support, indicated a need to educate the general public about the disease. Participants identified needing social support from other people with diabetes, psychological support to address the emotional side of diabetes, and coordinated teams of specialists to address medication side effects and other health-related barriers to disease management. Many participants discussed the challenge of integrating diabetes management with work and family responsibilities and the need for monetary support.

Conclusion

This study provides insight into how employed adults perceived their disease and what they perceived as challenges to successfully managing diabetes. The findings provide future directions for community and workplace diabetes initiatives.     

Psychological,Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea

Objectives

The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea.

Methods

A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers.

Results

Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes.

Conclusions

This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.     

Peer Reviewed: Lessons Learned From a Collaborative to Improve Care for Patients With Diabetes in 17 Community Health Centers,Massachusetts, 2006

Introduction

In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative.

Methods

The collaborative''s activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams'' successes, challenges, and take-home messages for future collaborative efforts. We organized their responses into common themes by using the Chronic Care Model as a framework.

Results

Themes that emerged as facilitators of success included shifting clinic focus to more actively involve patients and to promote their self-management; improving the understanding and implementation of professional guidelines; and expanding staff roles to accommodate these goals. Patient registries were perceived as beneficial but lacking adequate technical support. Other barriers were staffing and time constraints.

Conclusions

Cooperative efforts to improve health care delivery for people with diabetes may benefit from educating the health care team about guidelines, establishing a stronger role for the patient as part of the health care team, and providing adequate technical instruction and support for the use of clinical databases.     

Support to women who denounce experiences of violence based on her social network

Objective:

to analyze the possibilities of help/support through the mapping and acknowledgement of the social network of women who denounce experiences of violence at a Police Precinct for Women.

Method:

qualitative study based on the theoretical-methodological framework of Lia Sanicola''s Social Network, through interviews with 19 women.

Results:

the analysis of the network maps evidenced that the primary social network was more present than the secondary on and, despite consisting of significant relations, it demonstrates limitations. The women access the secondary network occasionally in the violence problem and/or its repercussions in their life and health. The discrete presence of the health network in the composition of the social network was revealed and, when mentioned, the relation between the health professional and the woman was characterized as fragile.

Conclusion:

the importance of the social network relates to the creation of spaces of help/support for the women beyond the moment of the aggression, which accompany them throughout their process of emancipation from an experience annulled by violence, considering that each woman acts and makes decisions in the relational context when she is ready for it.     

Listening to food workers: Factors that impact proper health and hygiene practice in food service

Background

Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers'' improper health and hygiene practice.

Objective

To investigate food workers'' perceptions of factors that impact proper food safety practice.

Method

Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior.

Results

Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies.

Conclusion

Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers'' social and structural context, that impact food safety practice.