Much ado about flu: A mixed methods study of parental perceptions,trust and information seeking in a pandemic

Background

Effective public health messaging is essential in both the planning phase and duration of a pandemic.

Objectives

This study aimed to gain an understanding of parental information seeking, trusted sources and needs in relation to pandemic influenza A 2009 (pH1N1) to inform future policy planning and resource development.

Patients/Methods

We conducted a mixed methods study; parents from 16 childcare centres in Sydney, Australia, were surveyed between 16 November and 9 December 2009, and interviews were conducted with participants from six childcare centres between June 2009 and May 2011.

Results

From 972 surveys distributed, 431 were completed; a response rate of 44%. Most parents (90%) reported that doctors were “trusted a lot” as a source of influenza information, followed by nurses (59%), government (56%) and childcare centres (52%). Less trusted sources included media (7% selected “trusted a lot”), antivaccination groups (6%) and celebrities (1%). Parents identified a range of key search terms for influenza infection and vaccine. From 42 in‐depth interviews, key themes were as follows: “Action trigger,” “In an emergency, think Emergency,” “Fright to hype” and “Dr Google and beyond.” Parents relied heavily on media messages, but cynicism emerged when the pandemic was milder than expected. Parents viewed a range of information sources as trustworthy, including doctors, authoritative hospital or government websites, and childcare centres and schools.

Conclusions

A user‐centred orientation is vital for pandemic communications including tailored information provision, via trusted sources based on what parents want to know and how they can find it.     

Birthing a better future: a mixed-methods evaluation of multimedia exposition conveying the importance of the first 1001 days of life

Background

The early years of life are marked by a crucial period for child development, occurring between conception and 2 years old. The charity, Zero2 Expo, created a multimedia exposition, Birthing a Better Future, to convey a public health message on the importance of the first 1001 days of life and the potential this period holds for intervention measures to have lifelong benefits. This evaluation aimed to determine whether this exposition is effective at raising awareness of the importance of the first 1001 days of life and inform the implementation of future expositions.

Clinical characteristics of monkeypox virus infections among men with and without HIV: A large outbreak cohort in Germany

Background

Since May 2022, increasing numbers of monkeypox virus (MPXV) infections have been reported from across Europe and North America. Studies, mainly from Africa, have suggested a higher risk for severe MPXV cases in people living with HIV.

Methods

This was a retrospective study of all confirmed MPXV infections observed in the participating centres since 19 May 2022. We conducted a chart review to evaluate clinical characteristics, comorbidities, and coinfections, including HIV, viral hepatitis, and sexually transmitted infections (STIs).

Results

By 30 June 2022, a total of 546 MPXV infections were reported from 42 German centres. All patients were men who have sex with men (MSM), of whom 256 (46.9%) were living with HIV, mostly with a preserved immune system and with viral suppression. In total, 232 (42.5%) MSM were also taking HIV pre-exposure prophylaxis (PrEP) and 58 (10.6%) MSM had no known HIV infection or PrEP use. The median age was 39 years (range 20–67), and comorbidities were rare. However, 52.4% and 29.4% of all patients had been diagnosed with at least one STI within the last 6 months or within the last 4 weeks, respectively. The most frequent localizations of MPXV infection were genital (49.9%) and anal (47.9%), whereas fever (53.2%) and lymphadenopathy (42.6%) were the most frequent general symptoms. The hospitalization rate was low (4.0%), and no fatal course was observed. The clinical picture showed no apparent differences between MSM with or without HIV.

Conclusions

In this preliminary cohort analysis from a current large outbreak among MSM in Germany, the clinical picture of MPXV infection did not differ between MSM with and without HIV infection. Severe courses were rare and hospitalization rates were low. However, most patients were relatively healthy, and only a few people living with HIV were viremic or severely immunosuppressed.     

An expert consensus to define how higher standards of equitable care for von Willebrand disease can be achieved in the UK and Republic of Ireland

Introduction

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder. However, recognition of the disease by both the public and healthcare professionals lags behind that of other bleeding disorders, leading to delays in diagnosis and treatment for patients. Updated national guidelines are needed to highlight an appropriate pathway for managing VWD patients in a timelier manner.

Aim

To identify ways in which care for VWD can be achieved on a more equitable basis.

Methods

Using a modified Delphi approach, a panel of VWD experts developed 29 statements across five key themes. These were used to form an online survey that was distributed to healthcare professionals involved in VWD care across the UK and Republic of Ireland (ROI). Stopping criteria comprised 50 responses received, a 3-month window for response (February—April 2022) and 90% of statements passing consensus threshold. Threshold for consensus for each statement was agreed at 75%.

Results

A total of 66 responses were analysed with 29/29 statements achieving consensus of which 27 attained ≥90% agreement. From the high degree of consensus, eight recommendations were derived regarding how detection and management of VWD can be improved to provide equity of care between men and women.

Conclusion

Implementation of these eight recommendations across the VWD pathway has the potential to raise the standard of care for patients in the UK and ROI by reducing delays to diagnosis and treatment initiation.     

Adherence to pediatric asthma guidelines in the emergency department: A survey of knowledge, attitudes and behaviour among health care professionals

BACKGROUND:

Despite strong evidence for using clinical care pathways to manage acute pediatric asthma, adherence remains suboptimal.

OBJECTIVES:

To elicit information from health care professionals regarding their knowledge, attitudes and use of a care pathway for acute childhood asthma.

METHODS:

A cross-sectional, self-administered survey of physicians, nurses and respiratory therapists who worked in the emergency department at the Montreal Children’s Hospital (Montreal, Quebec) from August to December 2007 was conducted. The survey assessed knowledge, attitude toward and agreement with the care pathway, as well as its use four years after its implementation.

RESULTS:

Of the 128 health care professionals surveyed, 72 (56%) responded. Of these, 99% reported being familiar with the pathway, more than 90% agreed with its use for mild and moderate asthma, while 79% agreed with its use for severe asthma. For 99% of health care professionals, the advantages of using the pathway outweighed the disadvantages; however, 64% admitted to making variations to the pathway. Although 92% of respondents reported that they were quite comfortable with using the asthma severity Pediatric Respiratory Assessment Measure, only 53% and 36% correctly identified the severity score cut-offs for moderate and severe asthma, respectively. Seventeen per cent of respondents underestimated the delay of onset of action of oral corticosteroids, while 36% of physicians incorrectly believed that a higher than necessary dose was recommended for ipratropium bromide.

CONCLUSIONS:

Results of the survey confirmed that the health care professionals queried had a positive attitude toward the pediatric asthma care pathway. Knowledge gaps and the balance between standardization versus individualization of care may be key elements to explain suboptimal adherence to the pathway.     

Underutilisation of the gastroscope for total colonoscopy in adults: a survey of two European countries

Background and study aims

High caecal intubation success rates have been reported with the gastroscope in adults. We surveyed the current use of the gastroscope for total colonoscopy in adults in the UK and Greece.

Methods

A questionnaire was e-mailed to 952 members of the British Society of Gastroenterology (UK) and 478 members of the Hellenic Society of Gastroenterology (GR), enquiring as to access to a paediatric colonoscope, use of gastroscope for total colonoscopy and estimate of caecal intubation success rate.

Results

Valid replies were 17.4% from UK and 19.7% from GR. The paediatric colonoscope was available to 106/138 (77%) UK and to only 18/86 (21%) GR respondents (p?=?0.0002). Of all the UK and GR respondents, 109/138 (79%) and 68/86 (79%), respectively, did not use the gastroscope for total colonoscopy. For the use of the gastroscope for total colonoscopy, 26/29 (89%) UK and 9/18 (50%) GR users did so, while a paediatric colonoscope was also available (p?=?0.001), and 3/29 (10.3%) UK and 9/18 (50%) GR users did so, whilst they had no access to a paediatric colonoscope (p?=?0.001). Estimated gastroscope caecal intubation success rate was 69% (SD 0.26) UK and 46% (SD 0.36) GR, p?=?0.008. Only 37% UK and 28% GR respondents used the gastroscope to examine the left colon.

Conclusions

The gastroscope is underutilised for total colonoscopy in both the UK and Greece. Use of the gastroscope does not appear to be related to lack of access to a paediatric colonoscope in the UK but may be in GR. Gastroscope caecal intubation success rate justifies its use where the colonoscope fails.     

Barriers to and recommendations for integrating the age-friendly 4-Ms framework into electronic health records

Background

The Institute for Healthcare Improvement's 4-Ms framework of care for older adults recommends a multidisciplinary assessment of a patient's Medications, Mentation, Mobility, and What Matters Most. Electronic health record (EHR) systems were developed prior to this emphasis on the 4-Ms. We sought to understand how healthcare providers across the healthcare system perceive their EHRs and to identify any current best practices and ideas for improvement regarding integration of the 4-Ms.

Methods

Anonymous survey of healthcare providers who care for older adults. The survey aimed to evaluate efficiency, error tolerance, and satisfaction (usefulness and likeability). The survey was distributed through organizational list serves that focus on the care of older adults and through social media.

Results

Sixty-six respondents from all geographic segments of the U.S. (n = 62) and non-U.S. practices (n = 4) responded. Most (82%) were physicians. Respondents used a range of EHRs and 82% had >5 years of experience with their current EHR. Over half of respondents agreed that their EHR had easy to find contact information (56%) and advance directives. Finding a patient's prior cognitive status (26% agreement), goals of care (24%), functional status (14%), and multidisciplinary geriatric assessments (27%) was more difficult. Only 3% were satisfied with how their EHR handles geriatric syndromes. In free text responses, respondents (79%) described three areas that the EHR assists in the care of older adults: screening tied to actions or orders; advance care planning, and medication alerts or review. Common suggestions on how to improve the EHR included incorporating geriatric assessments in notes, establishing a unified place to review the 4-Ms, and creating age-specific best practice alerts.

Conclusions

The majority of healthcare providers were not satisfied with how their EHR handles multidisciplinary geriatric assessment and geriatric care. EHR modifications would aide in reporting, communicating, and tracking the 4-Ms in EHRs.     

Personne de confiance et directives anticipées : défaut d’information et de mise en œuvre

Purpose

The French law allows the persons of age to appoint a trusted person and to draft advance directives in case they are one day in a condition that prevents them from expressing their will regarding their health care. Our study objective was to assess patients’ and relatives’ knowledge and collecting their opinion regarding these means of expression of their will.

Methods

An anonymous survey by self-administered questionnaire was conducted in the admission offices of the University Hospital of Nancy in April 2011. The questions focused on trusted person and anticipated directives.

Results

We collected 367 answers, 61.8% of which were females. Average age of respondents was 48.7 years old (standard deviation: 15.6). Three fourths of respondents were informed of their possibility to appoint a trusted person and were able to establish the difference between a trusted person and a contact person. Respondents mainly chose their spouse (52%). They thought that the trusted person's opinion takes precedence over the family's or relatives’ one (64.7%), given that this opinion is based on indications previously provided by the patient (74.8%). The majority of people surveyed were ignorant of the possibility to draft advance directives but were glad of it (57.5%). They would include herein their refusal of unreasonable obstinacy (75.8%), their wishes to withhold/withdraw of some treatments, to stop active treatments in case of high odds of chronic coma or vegetative state (52.8%) or their will to donate organ after death (50.6%). More than three fourths of the patients wished to include these informations on their health care card chip.

Conclusion

Legal means of expression of the patient's wishes and are not systematically known by the population. The possibility to appoint a trusted person is much more known than that to draft advance directives. After the release in December 2012 of the Sicard report regarding the end of life in France, an important information campaign of the general public remains to be undertaken.     

Communication skills of healthcare professionals in paediatric diabetes services

Aims To identify training needs in communication skills and to assess training preferences of staff working in paediatric diabetes services, which will inform the development of a learning programme in behaviour change counselling for healthcare professionals. Methods Three hundred and eighty‐five staff in 67 UK paediatric diabetes services were sent questionnaires to determine their previous communication skills training, to measure their self‐reported view of the importance of and confidence in addressing common clinical problems and to assess the perceived feasibility of training methods to improve skilfulness. Results Two hundred and sixty‐six questionnaires (69%) were returned from 65 services. Sixteen per cent of doctors, nurses and dietitians reported no previous training in communication skills and 47% had received no training since graduating. Respondents rated psychosocial issues as more important to address than medical issues within consultations (t = 8.93, P < 0.001), but felt less confident addressing such issues (t = 15.85, P < 0.001). One‐day workshops and monthly team meetings were the most popular of the training options considered (65% and 77%, respectively). CD ROM and web‐based learning were considered feasible for 54% and 56% of respondents, respectively, although lack of time (55%) and privacy (34%) were potential barriers. Conclusions Addressing psychosocial issues is an important component of consultations involving young people with diabetes, but healthcare professionals find it easier to address medical issues. This represents a key training need in communication skills for diabetes professionals. The survey will inform the development of a tailored learning programme for health professionals in UK paediatric diabetes clinics.     

Peripheral arterial disease: Lack of awareness in Canada

BACKGROUND:

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with a high risk of stroke, myocardial infarction and cardiovascular death. PAD also fosters major morbidity by causing claudication, functional impairment, disability and amputation. PAD is largely unrecognized and under-treated compared with other cardiovascular diseases. The public health impact of PAD, as a contributor to Canadian national rates of heart attack, stroke, amputation, death and disability, will be challenging to address if the public is unaware of this common cardiovascular disease.

OBJECTIVE:

To assess public knowledge of PAD in Canada.

METHODS:

A cross-sectional, population-based telephone survey of 501 adults 50 years of age and older (mean age 64.4 years) was conducted using random digit dialing. The survey assessed demographics and risk factors of the study population and knowledge of PAD causes and consequences.

RESULTS:

Survey respondents reported a high prevalence of atherosclerotic risk factors including high blood pressure (43%), high blood cholesterol (37%), diabetes (12%) and smoking history (18% current and 49% former smokers). Only 36% of respondents reported familiarity with PAD, which was significantly lower than other cardiovascular diseases or risk factors. Knowledge of perceived consequences of PAD was low and knowledge gaps were more pronounced in older, less educated and lower income respondents.

CONCLUSIONS:

The Canadian public is largely unaware of PAD as a prevalent systemic manifestation of atherosclerosis and its associated morbidity and mortality. National PAD awareness programs should be instituted to increase PAD knowledge to levels comparable with other cardiovascular diseases and risk factors.     

The general public’s knowledge of diabetes mellitus: A cross-sectional study in Cameroon

Objective

To assess the general public’s level of knowledge on diabetes mellitus (DM) and identify related sources of information in Cameroon.

UK‐based physical therapists' attitudes and beliefs regarding exercise and knee osteoarthritis: Findings from a mixed‐methods study

Objective

Within the UK, differences exist between physical therapists' use of exercise for patients with knee osteoarthritis (OA) and recent exercise recommendations. This may be explained by their underlying attitudes and beliefs. We aimed to describe UK physical therapists' attitudes and beliefs regarding exercise and knee OA, and understand and explain them.

Methods

A survey was mailed to 2,000 UK‐based chartered physical therapists that included 23 attitude statements derived from recently published recommendations. Semistructured telephone interviews were conducted with a purposeful sample of questionnaire respondents (n = 24), and were recorded and analyzed thematically.

Results

The questionnaire response rate was 58% (n = 1,152); 538 respondents reported treating a patient with knee OA in the last 6 months. The survey highlighted uncertainty about potential benefits of exercise for knee OA: only 56% largely/totally agreed that knee problems are improved by local exercise. Although exercise adherence was deemed important, it was seen as the patient's, not the therapist's, responsibility. Interviews revealed an underlying biomedical model of care of knee pain, with knee OA viewed as a progressive degenerative condition. A paternalistic treatment approach was evident. Health care systems presented a number of barriers to best practice, including limited opportunity to provide followup.

Conclusion

Although the attitudes and beliefs of physical therapists may help to explain differences between current practice and recent exercise recommendations, the wider health care system also plays a part. Further research is needed to support meaningful shifts in physical therapy care in line with the best practice recommendations.     

Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient,caregiver and clinician perspectives

Objective

A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals.

Method

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies.

Results

A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking.

Discussion

Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.     

Young people's experiences of managing Type 1 diabetes at university: a national study of UK university students

Aim

Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self‐care in students with Type 1 diabetes in all UK universities.

Methods

Some 1865 current UK university students aged 18–24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models.

Results

In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA_1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes‐related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19–7.16], illness (OR 3.48, 95% CI 2.06–5.87) and weight management issues (OR 3.19, 95% CI 1.99–5.11) as barriers to self‐care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes.

Conclusion

The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider.     

Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net

BACKGROUND

Electronic and internet-based tools for patient–provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations.

OBJECTIVE

To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network.

DESIGN

Observational, cross-sectional study

PARTICIPANTS

Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH)

MAIN MEASURES

Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data—all self-reported via survey.

KEY RESULTS

Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians.

CONCLUSIONS

A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients’ language, literacy level, and experience with communication technology.     

The current state of knowledge,perception and practice in diabetes management during fasting in Ramadan by healthcare professionals

Aims

Obligatory Ramadan fasting is challenging in the management of Muslims with diabetes due to increased risk of complications from altered meals and activities. This study aimed to evaluate the knowledge, perception and practice of healthcare professionals in diabetes management during fasting and the outcome of education on management.