Pregnant women's perception of cesarean section on demand

Aims: To assess pregnant women's awareness of and attitudes towards cesarean section (CS) on demand, as well as to identify specific target groups by focusing on differences dependant on the participants' background, parity and intended mode of delivery. Methods: The study was conducted at two centers during three months. German-speaking pregnant women were invited to answer an anonymous, structured questionnaire. We compared urban vs. rural, nulliparous vs. parous and women opting for a CS vs. denying this wish, with regard to awareness and attitudes towards CS on demand. Results: Ninety-two percent of the 201 participants were aware of the possibility to deliver by CS on demand. Their sources of information were mostly print media reports, television, or friends. Pain avoidance and missing the birth experience were the main reasons for and against CS on demand, respectively. For women opting for CS on demand, traumatically-experienced previous birth and the child's well-being were other important reasons for a CS. Conclusions: Because negative birth experience appears to be decisive for pregnant women's attitude towards CS on demand and their perception of CS seems to be partly based on misconceptions, antenatal counseling should focus on these aspect

Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]

<p>Abstract</p> <p>Background</p> <p>Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.</p> <p>Methods</p> <p>The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session.</p> <p>The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160).</p> <p>Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.</p> <p>Discussion</p> <p>To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.</p

Genomics for public health and international surveillance of antimicrobial resistance.

Historically, epidemiological investigation and surveillance for bacterial antimicrobial resistance (AMR) has relied on low-resolution isolate-based phenotypic analyses undertaken at local and national reference laboratories. Genomic sequencing has the potential to provide a far more high-resolution picture of AMR evolution and transmission, and is already beginning to revolutionise how public health surveillance networks monitor and tackle bacterial AMR. However, the routine integration of genomics in surveillance pipelines still has considerable barriers to overcome. In 2022, a workshop series and online consultation brought together international experts in AMR and pathogen genomics to assess the status of genomic applications for AMR surveillance in a range of settings. Here we focus on discussions around the use of genomics for public health and international AMR surveillance, noting the potential advantages of, and barriers to, implementation, and proposing recommendations from the working group to help to drive the adoption of genomics in public health AMR surveillance. These recommendations include the need to build capacity for genome sequencing and analysis, harmonising and standardising surveillance systems, developing equitable data sharing and governance frameworks, and strengthening interactions and relationships among stakeholders at multiple levels

Acceptance of structured diagnostic interviews for mental disorders in clinical practice and research settings

The objective of this study was to investigate the acceptance of structured diagnostic interviews in clinical practice, as well as research, settings. Using the Diagnostisches Interview bei Psychischen Störungen (the modified and extended German version of the Anxiety Disorders Interview Schedule for DSM-IV), 10 certified interviewers conducted 183 structured interviews in different inpatient, outpatient, and research settings in Switzerland and Germany. After each interview, patients and interviewers filled out a questionnaire asking for their evaluation of the interview. Patients' and interviewers' reactions to the interview were highly positive. On a scale measuring overall satisfaction with the interview (0=not at all satisfied, 100=totally satisfied) the mean patient rating was 86.55 (SD=13.18), and the mean interviewer rating was 85.82 (SD=12.84). The procedure used by the interviewer was rated by 142 (78.5%) patients as being helpful, and 176 (96.7%) rated the relationship as being positive. Less than 16% of the interviews were described as exhausting by the patients and interviewers. A majority of the interviewers (92.6%) indicated that during the interview they could respond adequately to the patient. The results of this study indicate that structured diagnostic interviews are highly accepted by interviewers and patients in a variety of settings. These findings, together with the existing evidence of the reliability and validity of structured interviews, should encourage their use in the diagnostic process, in outpatient and inpatient clinical settings as well as in research studies

Previous birth experience and birth anxiety : predictors of caesarean section on demand?

OBJECTIVE: The purpose of this study was to investigate pregnant women's intentions for opting for caesarean section (CS), their experiences regarding previous births and their expectations for subsequent delivery. Our objectives were to identify medical and psychological predictors pertaining to the decision for CS on demand. DESIGN: The cross-sectional survey was conducted at two study centres over a three-month period including German speaking women at any time of pregnancy and consisted of an anonymous structured questionnaire. Logistic regression was computed to investigate the predictive value of medical variables, birth experience and birth anxiety on the demand for CS. RESULTS: Nineteen of 201 participants preferred to deliver by CS on demand and 15 felt uncertain about their decision. How the preceding delivery had been experienced was significantly better in the vaginal delivery (VD)-group (women not considering CS on demand) than in the CS-group (good experience in 81.7% and 52.0% respectively, p = 0.007). A negative previous birth experience and a preceding CS were predictors for the wish to deliver by CS. CONCLUSIONS: As negative birth experience predicts the wish for a CS, specific supportive care during first pregnancy could play a pivotal role in making this decision

Pregnant women's perception of cesarean section on demand

AIMS: To assess pregnant women's awareness of and attitudes towards cesarean section (CS) on demand, as well as to identify specific target groups by focusing on differences dependant on the participants' background, parity and intended mode of delivery. METHODS: The study was conducted at two centers during three months. German-speaking pregnant women were invited to answer an anonymous, structured questionnaire. We compared urban vs. rural, nulliparous vs. parous and women opting for a CS vs. denying this wish, with regard to awareness and attitudes towards CS on demand. RESULTS: Ninety-two percent of the 201 participants were aware of the possibility to deliver by CS on demand. Their sources of information were mostly print media reports, television, or friends. Pain avoidance and missing the birth experience were the main reasons for and against CS on demand, respectively. For women opting for CS on demand, traumatically-experienced previous birth and the child's well-being were other important reasons for a CS. CONCLUSIONS: Because negative birth experience appears to be decisive for pregnant women's attitude towards CS on demand and their perception of CS seems to be partly based on misconceptions, antenatal counseling should focus on these aspects

Results of Use of WHO Global Salm-Surv External Quality Assurance System for Antimicrobial Susceptibility Testing of Salmonella Isolates from 2000 to 2007 ▿

An international External Quality Assurance System (EQAS) for antimicrobial susceptibility testing of Salmonella was initiated in 2000 by the World Health Organization (WHO) Global Salm-Surv in order to enhance the capacities of national reference laboratories to obtain reliable data for surveillance purposes worldwide. Seven EQAS iterations have been conducted from 2000 to 2007. In each iteration, participating laboratories submitted susceptibility results from 10 to 15 antimicrobial agents for eight Salmonella isolates and an Escherichia coli reference strain (ATCC 25922). A total of 287 laboratories in 102 countries participated in at least one EQAS iteration. A large number of laboratories reported results for the E. coli ATCC 25922 reference strain which were outside the quality control ranges. Critical deviations for susceptibility testing of the Salmonella isolates varied from 4% in 2000 to 3% in 2007. Consistent difficulties were observed in susceptibility testing of amoxicillin-clavulanic acid, cefotaxime, ceftazidime, streptomycin, sulfonamides, and tetracycline. Regional variations in performance were observed, with laboratories in central Asia, Africa, and the Middle East not performing as well as those in other regions. Results from the WHO Global Salm-Surv EQAS show that most laboratories worldwide are capable of correctly performing antimicrobial susceptibility testing of Salmonella isolates, but they also indicate that further improvement for some laboratories is needed. In particular, further training and dissemination of information on quality control, appropriate interpretive criteria (breakpoints), and harmonization of the methodology worldwide through WHO Global Salm-Surv and other programs will contribute to the generation of comparable and reliable antimicrobial susceptibility data (D. M. A. Lo Fo Wong, R. S. Hendriksen, D. J. Mevius, K. T. Veldman, and F. M. Aarestrup, Vet. Microbiol. 115:128-139, 2006)

WHO Global Salm-Surv External Quality Assurance System for Serotyping of Salmonella Isolates from 2000 to 2007▿

An international external quality assurance system (EQAS) for the serotyping of Salmonella species was initiated in 2000 by WHO Global Salm-Surv to enhance the capacity of national reference laboratories to obtain reliable data for surveillance purposes worldwide. Seven EQAS iterations were conducted between 2000 and 2007. In each iteration, participating laboratories submitted serotyping results for eight Salmonella isolates. A total of 249 laboratories in 96 countries participated in at least one EQAS iteration. A total of 756 reports were received from the participating laboratories during the seven EQAS iterations. Cumulatively, 76% of participating laboratories submitted data for all eight strains, and 82% of strains were correctly serotyped. In each iteration, 84% to 96% of the laboratories correctly serotyped the Salmonella enterica serovar Enteritidis isolate that was included as an internal quality control strain. Regional differences in performance were observed, with laboratories in Central Asia and the Middle East performing less well overall than those in other regions. Errors that resulted in incorrect serovar identification were typically caused by difficulties in the detection of the phase two flagellar antigen or in differentiation within antigen complexes; some of these errors are likely related to the quality of the antisera available. The results from the WHO Global Salm-Surv EQAS, the largest of its kind in the world, show that most laboratories worldwide are capable of correctly serotyping Salmonella species. However, this study also indicates a continuing need for improvement. Future training efforts should be aimed at enhancing the ability to detect the phase two flagellar antigen and at disseminating information on where to purchase high-quality antisera

Genomics for public health and international surveillance of antimicrobial resistance

Historically, epidemiological investigation and surveillance for antimicrobial resistant (AMR) bacteria has relied on relatively low-resolution isolate-based phenotypic analyses undertaken at local and national reference laboratories. Genomic sequencing has the potential to provide a far more high-resolution picture of AMR evolution and transmission and is already beginning to revolutionize how public health surveillance networks monitor and tackle AMR bacteria. However, the routine integration of genomics in surveillance pipelines still has considerable barriers to overcome. In 2022, a workshop series and online consultation brought together international experts in AMR and pathogen genomics to assess the status of genomic applications for AMR surveillance in a range of settings. Here we focus on discussions around the use of genomics for public health and international AMR surveillance, noting the potential advantages of, and barriers to, implementation and proposing recommendations from the working group to help drive the adoption of genomics in public health AMR surveillance. These include the need to build capacity for genome sequencing and analysis, harmonising, and standardising surveillance systems, developing equitable data sharing and governance frameworks and strengthening interactions and relationships among stakeholders at multiple levels.KSB reports funding from the BBSRC and MRC and partial salary cover from Wellcome Trust and UKHSA over the course of this work. EJ had partial salary cover from Wellcome Trust over the course of this work. SWL has received Receive Robert Austrian Research Award sponsored by Pfizer in 2022. DGA reports funding from the NIHR. INO reports funding from the Bill and Melinda Gates Foundation, JPIAMR, Wellcome Trust, Grand Challenges Africa Award, UK MCR, royalties for Genetics: Genes, Genomes and Evolution (Oxford University Press), Divining Without Seeds and for Antimicrobial Resistance in Developing Countries (Springer), consulting fees from Wellcome Trust, honoraria for Harvard University seminars and Peter Wildy Lecture Award 2023. DGA, BE, RSH, INO report receiving funding from the UK Department of Health and Social Care: grant managed by the Fleming Fund and work performed under the auspices of the SEQAFRICA project. LSB reports funding by Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia (Spain), under Plan GenT (Ref. CDEI-06/20-B). NAF reports funding from the BMGF, UKRI and NIHR. SJP is a member of the Scientific Advisory Board of Next Gen Diagnostics and was supported by Illumina to attend the ECCMID conference. All other authors declare no conflicts of interest