In-vitro susceptibility and molecular characterisation of macrolide resistance mechanisms among Streptococcus pneumonia isolates in The Netherlands: the DUEL 2 study

In total, 881 presumptive clinical isolates of Streptococcus pneumoniae collected from throughout The Netherlands were analysed to determine their mechanisms of macrolide resistance. Isolates were identified initially by participating laboratories using their own standard identification technique, followed by determination of MICs with Etests. Only 797 isolates were confirmed as pneumococci following bile-solubility tests, lytA PCR and 16S rRNA sequencing. Of these confirmed pneumococci, 59 (7.4%) isolates were macrolide-resistant. Analysis by PCR indicated that 34 (57.6%) isolates harboured only the erm(B) gene and 16 (27.1%) only the mef gene. Three (5.1%) isolates carried both erm(B) and mef, while six (10.2%) isolates were negative for both mechanisms. Of the six negative isolates, three had a mutation in the 23S rRNA gene, and three were negative for all mechanisms tested. No isolates with the erm(A) subclass erm(TR) gene were detected. Among the 19 mef-positive isolates, 14 (73.7%) carried the mef(A) gene, and only five (26.3%) carried the mef(E) gene. No linezolid cross-resistance or multiresistance (resistance to more than two classes of antibiotics) was observed.     

Organizational determinants of high-quality routine diabetes care

Abstract

Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients’ recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12–2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06–6.35), and number of hours’ nurse education on cholesterol control (OR = 2.51, 95% CI 1.02–6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.     

Embedding of the spiritual dimension in palliative consultation services in the Netherlands: inventory,evaluation, and recommendations

Abstract

Caregivers in the Netherlands can ask for advisory support from Palliative Consultation Teams (PCTs). It is largely unclear, though, how consultants of these teams deal with spiritual questions. This article explores in what way the spiritual dimension of palliative care is embedded in the PCTs. The coordinators of the teams were asked to fill out a questionnaire concerning the team mission statement with regard to spiritual care, their expertise in the spiritual domain, and their plans for developing this expertise. The answers to yes-or-no questions were statistically analysed by frequency counts, the answers to the open questions were analysed by peer debriefing. This study shows that the spiritual dimension is only embedded to a limited extent in the PCTs. Most respondents are of the opinion that their team lacks expertise in spiritual care, the majority of the consultants do not receive regular training in dealing with the spiritual dimension, and many plans for education and training are in a preliminary stage. These limitations, however, go together with a clear desire for education and training in dealing with the spiritual dimension. Although most teams do not clearly distinguish between psychological, social and spiritual competences, the healthcare chaplain is most often mentioned as the expert in the field of spiritual care. On the basis of the results of this study and in keeping with the quality standards for palliative care consultants, recommendations are made for the further professionalization of PCTs regarding the spiritual dimension of palliative care.     

Job characteristics, organizational conditions, and distress/well-being among Italian and Dutch nurses: a cross-national comparison

Background

Among health care workers, nursing has been identified as particularly stressful. Several studies have shown cross-national differences in nurses’ levels of occupational stress and burnout.

Objectives

The purpose of the study was to compare job characteristics, organizational conditions, and strain reactions in Italian (N = 609) and Dutch (N = 873) nurses. It was also examined how and to what extent various job characteristics and organizational conditions explain occupational and general strain.

Design

The study was a cross-sectional questionnaire survey.

Method

Based on the Job Demand-Control-Support Model and the Tripod accident causation model, respectively job characteristics and organizational conditions were assessed as independent variables. Strain was operationalized in terms of job satisfaction, burnout, and psychosomatic complaints.

Results

Italian nurses perceived their job characteristics, organizational conditions, and well-being as more unfavourable than their Dutch colleagues. Hierarchical regression analyses showed that high job demands, low skill discretion, and low social support from supervisor were the most consistent predictors of occupational and general strain across samples. Organizational conditions added significantly to the prediction of job satisfaction and burnout. Furthermore, lack of personnel was a stronger predictor of burnout in the Italian nurses than in the Dutch nurses.

Conclusions

The study provides cross-national confirmation of the impact of job characteristics and organizational conditions on nurses’ well-being. Differences in job characteristics partially explain the observed cross-national differences in distress/well-being. Furthermore, some evidence for crossnational differential effects of job characteristics and organizational conditions on well-being was found.     

Hospital nurses' work environment, quality of care provided and career plans

HINNO S., PARTANEN P. & VEHVILÄINEN‐JULKUNEN K. (2011) Hospital nurses' work environment, quality of care provided and career plans. International Nursing Review 58 , 255–262 Background: In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. Aim: The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. Methods: A cross‐sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Results: Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse‐assessed quality of care also increased and intentions to leave current job decreased linearly. Conclusions: Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.     

Changes in the professional domain of Dutch dental hygienists

To cite this article:
Int J Dent Hygiene  8 , 2010; 301–307
DOI: 10.1111/j.1601‐5037.2009.00418.x
Jerkovic K, van Offenbeek MAG, Slot DE, Van der Schans CP. Changes in the professional domain of Dutch dental hygienists. Abstract: Objective: This study’s purpose was to compare the scope of practice of Dutch dental hygienists educated through a two‐ or three‐year curriculum (‘old curriculum dental hygienists’ [OCDHs]) with that of hygienists educated through a new extended four‐year curriculum leading to a bachelor’s degree (‘new curriculum dental hygienists’ [NCDHs]). Methods: In 2005 and 2007, we obtained surveys from 320 OCDHs and the first 67 NCDHs, respectively, in which respondents were asked to complete a questionnaire and score how often they performed certain dental tasks. By means of factor analysis, these tasks were grouped into nine activity groups and 5 remaining single activities. T‐tests and Mann‐Whitney U‐tests were used to compare the scope of practice between OCDHs and NCDHs. Results: NCDHs worked more often in dental offices (instead of being self‐employed) and generally worked more hours per week than OCDHs. They performed more often tasks dealing with caries diagnosis and treatment and less often tasks dealing with prevention and periodontology. These differences were statistically significant. However, in dental offices the differences between OCDHs en NCDHs were far less pronounced. In those practices OCDHs performed dental sealants, small corrections of dentures and/or restoration and caries diagnosis during dental check‐up no less frequently than NCDHs. Conclusions: Although prevention remains the core domain (or role) of all Dutch dental hygienists surveyed, the scope of practice substantially differed. This, however, depended not only on education, but also on type of practice. The new curriculum answers to and legitimates an already developed practice of task delegation.     

Postponing worrisome thoughts in children: The effects of a postponement intervention on perseverative thoughts,emotions and somatic complaints

In this study we examined the prospective relationships between perseverative thoughts, internalizing negative emotions, and somatic complaints in children aged 9–13, and evaluated whether a perseverative thoughts intervention had a beneficial effect on these experiences. Children (N = 227) from 7 primary schools in Leiden, the Netherlands, recorded their perseverative thoughts during one week, 138 of whom were instructed to postpone these thoughts to a special 30 min period in the early evening. Children who had received the postponement instructions showed a reduction in the frequency of perseverative thoughts, and girls also in the duration of them. Girl's perseverative thoughts were positively associated with the number of somatic complaints and with negative emotions. The postponement intervention also seemed to reduce somatic complaints in the seventh grade children. These findings confirm the previously found prospective relationship between perseverative thoughts and children's well-being and provide initial validation for the use of the postponement intervention to reduce perseverative thoughts in this age group, particularly for girls.     

Patient satisfaction revisited: A multilevel approach

Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands, the results of these surveys are reported at the univariate level without taking case mix factors into account. The first objective of the present study was to determine whether differences in patient satisfaction are attributed to the hospital, department or patient characteristics. Our second aim was to investigate which case mix variables could be taken into account when satisfaction surveys are carried out for benchmarking purposes. Patients who either were discharged from eight academic and fourteen general Dutch hospitals or visited the outpatient departments of the same hospitals in 2005 participated in cross-sectional satisfaction surveys. Satisfaction was measured on six dimensions of care and one general dimension. We used multilevel analysis to estimate the proportion of variance in satisfaction scores determined by the hospital and department levels by calculating intra-class correlation coefficients (ICCs). Hospital size, hospital type, population density and response rate are four case mix variables we investigated at the hospital level. We also measured the effects of patient characteristics (gender, age, education, health status, and mother language) on satisfaction. We found ICCs on hospital and department levels ranging from 0% to 4% for all dimensions. This means that only a minor part of the variance in patient satisfaction scores is attributed to the hospital and department levels. Although all patient characteristics had some statistically significant influence on patient satisfaction, age, health status and education appeared to be the most important determinants of patient satisfaction and could be considered for case mix correction. Gender, mother language, hospital type, hospital size, population density and response rate seemed to be less important determinants. The explained variance of the patient and hospital characteristics ranged from 3% to 5% for the different dimensions. Our conclusions are, first, that a substantial part of the variance is on the patient level, while only a minor part of the variance is at the hospital and department levels. Second, patient satisfaction outcomes in the Netherlands can be corrected by the case mix variables age, health status and education.     

Determinants of regional differences in the incidence of impetigo

Background and objective

Impetigo is a common contagious skin infection, mostly seen in children and caused by Staphylococcus aureus and/or group A B-hemolytic Streptococcus. Two surveys performed in general practice showed a strong geographical gradient in the incidence rates among children in the Netherlands. The incidence in the south was approximately twice as high as in the rest of the Netherlands. We hypothesized that this difference could be explained by differences in the presence of animal farms and differences in temperature. This study examined whether there is a relationship with the numbers of bovines, pigs, sheep, and poultry per km², and temperature, which could explain the observed regional gradient in the incidence of impetigo.

Design and setting

In this ecological study, data on the incidence of impetigo in children 0-17 years of age from the second Dutch national survey were linked to data on the density of farm animals from Statistics Netherlands and temperature data from the Dutch Metereological Service. Using logistic regression allowing for overdispersion, we tested the significance of the effect of bovines, pigs, sheep, and poultry per km², and temperature on the incidence of impetigo, correcting for known risk factors.

Results

Only the number of sheep at the (COROP) regional level was significant; however, this effect could not explain the regional differences.

Conclusion

The regional differences in the incidence of impetigo in children cannot be explained by the variation in the presence of farm animals or differences in temperature.     

Persistent organochlorine and organobromine compounds in mother's milk from Sweden 1996-2006: Compound-specific temporal trends

High body burdens of persistent halogenated organic pollutants (POPs) among pregnant and nursing women are of concern because of exposure of the growing foetus and breast-feeding infant. We examined the temporal trends of polychlorinated biphenyls (PCBs), dibenzo-p-dioxin (PCDDs) and dibenzofurans (PCDFs), polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCD) in milk samples from Swedish women. POPs were analysed in individual mother's milk samples from randomly recruited primiparas (N=335) who lived in Uppsala County and delivered between 1996 and 2006. Results were adjusted for life-style factors that are associated with POP body burdens. PCB levels declined 3.9-8.6% per year. The levels of PCDDs decreased faster (6-9% per year) than the levels of PCDFs (3-6% per year). Temporal trends of PBDEs did not follow any consistent pattern. Concentrations of BDE-47 and BDE-99 decreased, while the concentrations of BDE-153 increased. No change in BDE-100 concentrations was observed. In most samples, concentrations of HBCD were below the quantification limit (<0.20 ng/g lipid). Generally, adjustment of the temporal trends of PCBs and PCDD/Fs for personal characteristics of the mothers (age, body mass index (BMI), weight changes during and after pregnancy) resulted in faster declining rates, with age having the greatest influence. The age of the participating mothers increased during the study period, and since the POP levels increased with increasing age, this counteracted the decreasing temporal trends in the unadjusted model. It is consequently important to include personal characteristics in the analysis of temporal trends of POPs. Compound-specific temporal trends are probably caused by differences in sources of exposure, as well as by differences in persistence between compounds.