Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective

BACKGROUND: When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective. METHODS: This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire. RESULTS: From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen. CONCLUSIONS: This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective. Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospital

Exploring breast cancer and screening awareness among Irish women with intellectual disabilities

Accessible Summary: We asked women with intellectual disabilities what they knew about breast cancer and screening programmes. We asked women what would put them off going to see a doctor whether they found something wrong with their breast. Most of those we asked knew that a lump was a warning sign for breast cancer. Most of those we asked did not know about the risk factors for breast cancer. Many women did not know much about the breast screening programme. Many women said they would be worried about what the doctor might find. Improving breast cancer and screening awareness is important for women with intellectual disabilities. Women with intellectual disabilities need to be taught more about breast cancer and screening. Abstract: Background: Internationally, it is known that there are gaps in cancer and screening awareness among women with intellectual disabilities. Little is known about this awareness among Irish women with intellectual disabilities. The aim of this study was to explore this awareness among these women. Materials and Methods: The study design incorporated a cross‐sectional descriptive survey using an accessible version of the Cancer Research UK Cancer Awareness Measure. The questionnaire was administered to women with mild to moderate intellectual disabilities (n = 45, age range 20–59 years) living in the South East of Ireland. Results: Almost three quarters of the women (77.8%) recognised a breast lump as a breast cancer warning sign. Knowledge about nonlump warning signs was much lower; 40% of the women did not feel confident that they would notice a change in their breast; 80% of the women could not recall a breast cancer risk factor. Overall, there was poor awareness of the national breast screening programme in Ireland. Worry and embarrassment about talking about their breasts would put women off seeking early medical intervention. Conclusion: There was poor awareness about breast cancer warning signs, risk factors and the breast screening programme among the women. Where women with intellectual disabilities are lacking this knowledge, breast cancer warning may be missed. Carers and intellectual disability services need to ensure that theoretically based cancer and screening education interventions are undertaken which will enable these women to identify warning signs and seek attention promptly

Gender Differences in Economic Support and Well-Being of Older Asians

This report provides a comprehensive analysis of gender differences in economic support and well-being in eight countries in Southern and Eastern Asia (Bangladesh, Malaysia, Indonesia, Singapore, Thailand, Vietnam, Philippines, and Taiwan). We examine multiple economic indicators, including sources of income, receipt of financial and material support, income levels, ownership of assets, and subjective well-being. Results show substantial variation in gender differences across indicators and provide an important qualification to widely held views concerning the globally disadvantaged position of older women. Whereas men tend to report higher levels of income than women, there is generally little gender difference in housing characteristics, asset ownership, or reports of subjective economic well-being. Unmarried women are economically advantaged compared to unmarried men in some respects, in part because they are more likely to be embedded in multigenerational households and receive both direct and indirect forms of support from family members.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42986/1/10823_2004_Article_487430.pd

Men's information-seeking behavior regarding cancer risk and screening: A meta-narrative systematic review

Objective: Preventive strategies are known to reduce cancer risk and incidence and improve prognosis. Men seldom seek medical information about cancer prevention and risk reduction. The aim of this meta-narrative systematic review was to critically appraise evidence from qualitative, quantitative, and mixed-methods studies that explored men's information-seeking behaviors in relation to cancer prevention and risk reduction. Methods: MEDLINE, CINAHL Plus with Full Text, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Education Full Text, and ERIC were systematically searched for studies published in English between January 1, 2006 and May 30, 2016. A total of 4117 titles were identified; of which, 31 studies were included (21 qualitative studies, 9 quantitative studies, and 1 mixed-methods study). The methodological quality of the studies was appraised by using different tools. Results: Most studies focused on screening for prostate (n = 18) and colorectal cancer (n = 7). Most men were passive information-gatherers rather than active information-seekers. Key sources of information included the Internet for active information-seekers and health care professionals for passive information-gatherers. Barriers to information-seeking included information overload, embarrassment, and fear. Low literacy and health literacy levels were addressed in 3 studies and were identified as impediments to active information-seeking. Facilitators to information-seeking included family support, media, celebrity endorsements, and targeted information. Conclusions: Men's information-seeking behavior regarding cancer risk reduction, prevention, and screening is influenced by several factors. This necessitates targeted interventions aimed at raising awareness of cancer prevention and screening, while accounting for men's informational needs, preferred learning strategies, and literacy levels

Periodontal Regeneration â Furcation Defects: A Consensus Report From the AAP Regeneration Workshop

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141183/1/jpers131.pd

Promoting men’s knowledge of cancer risk reduction: A systematic review of interventions

Objective: To critically appraise and discuss evidence from interventions designed to increase men's knowledge about cancer risk reduction. Methods: A systematic review was conducted. Six electronic databases were searched for interventions published between January 1st 2006 and May 30th 2016 in English. Studies were included if they used an experimental design, included adult males (≥18 years), and had a primary focus on the acquisition and utilisation of information on cancer risk reduction. The methodological quality of the included studies was appraised. Results: A total of 25 studies met the inclusion criteria, 23 of which involved prostate cancer risk reduction. Twenty-one studies reported knowledge gain among the men. Three studies found that knowledge gain was associated with health literacy. Conclusions: Interventions aiming to improve men’s knowledge about cancer risk reduction require a multimodal approach. Findings highlight the need to design and measure the impact of interventions for men on wider cancer risk reduction topics, while accounting for different socio-demographic and ethnic groups, literacy and health literacy levels. Practice implications: More research is warranted into the development and evaluation of theoretically-driven multimodal community-based approaches to information dissemination for men taking into account their daily information spheres such as workplaces and community environs

Health literacy influences men's active and passive cancer information seeking

BACKGROUND: For cancer prevention information to be effective, it must be accessible to its target populations. Prevalence of inadequate health literacy (HL) is high, but there is a dearth of information on the impact of HL on men's cancer information seeking. OBJECTIVE: We investigated (1) men's cancer information seeking behaviors, (2) the effect of HL on men's cancer information seeking behavior, and (3) men's preferences for cancer information, considering their HL level. From a national perspective, we investigated men's information seeking behavior from the Irish Cancer Society (ICS), the largest provider of cancer information in Ireland. METHODS: Men from adult literacy classes and men's groups were invited to complete a questionnaire. General and ICS-specific cancer information seeking behavior was investigated. Univariate and multivariate logistic regression models were conducted with “ever” seeking cancer information from any source, and actively seeking and passively acquiring ICS information as dependent variables.KEY RESULTS: Overall, 259 men completed the questionnaire and 44% had inadequate HL. About one-half of responders reported “ever” actively looking for cancer information. In the study group, 19% actively sought and 67% passively acquired ICS-specific information. In multivariate analysis, the odds of actively seeking (2.93; 95% CI [1.05, 8.15]) or passively acquiring (4.7; 95% CI [1.99, 11.05]) ICS-specific cancer information was significantly higher among those with adequate versus inadequate HL, respectively. HL was not significantly associated with odds of “ever” cancer information seeking in multivariate analysis (odds ratio 1.81; 95% CI [0.90, 3.63]). Men want information about cancer prevention. Suggested future cancer information sources differed by HL levels. General practitioners and the Internet were the preferred source for men with inadequate (53.3%) and adequate HL (57%), respectively. CONCLUSIONS: Men both passively acquire and actively seek cancer prevention information. Multimodal dissemination of cancer prevention information is necessary to reach a wide cross-section of men, including those with inadequate HL. This could potentially lower men's cancer burden and reduce gender inequalities in cancer mortality. [HLRP: Health Literacy Research and Practice. 2019;3(3):e147–e160.]PLAIN LANGUAGE SUMMARY: Most men get cancer prevention information by coming across it passively in their daily lives, instead of actively looking for this information. Men with low health literacy are less likely to obtain cancer information both passively and actively. Men want this information. Organizations need to make this information available in many places and formats (e.g., Internet, doctor, television, sports clubs)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Promoting Cancer and Screening Awareness in Women with Intellectual Disabilities: A Mixed Methods Study [Volume 1]

Promoting Cancer and Screening Awareness in Women with Intellectual Disabilities: A Mixed Methods Study. BY Mary Reidy Background: People with intellectual disabilities are living longer which has led to increasing cancer rates among this demographic. Women with intellectual disabilities are more likely to have poorer cancer awareness and lower screening participation than women in the general population. They also present at later stages of cancer despite similar cancer rates in both populations. Aim: This two phase mixed methods study tested the feasibility and acceptability of a targeted educational intervention for women with ID and their carers. EMBRACES-ID (Early Monitoring of Breast and Cervical Cancer Signs & Screening in Intellectual Disabilities) aimed to raise the awareness of warning signs, risk factors, screening programmes, and promote early help-seeking on symptom discovery. Methods: In line with the MRC’s Guidance for Complex Interventions this work was based on empirical evidence and was theoretically underpinned by Bandura’s Social Cognitive Theory. Phase I involved a survey of carers (n= 125) and women with mild to moderate ID (n = 45), as well as semi- structured interviews with 25 carers. Phase II involved the feasibility and acceptability testing of EMBRACES- ID among 25 women with mild to moderate ID and 9 carers. A pre-test/post-test design incorporating a 12 week evaluation survey and interview was utilised. Ethical approval for the study was received from the relevant Research Ethics Committees. Findings: In Phase I, gaps in cancer and screening awareness were found. These results formed the basis for the development of the EMBRACES-ID intervention. In Phase II, testing of EMBRACES-ID identified changes in cancer and screening awareness for women with ID and their carers, the majority of changes were retained over the 12 week post intervention time frame. Conclusions: EMBRACES-ID raised cancer and screening awareness for women with ID and their carers. This may lead to earlier diagnosis and treatment of cancers with better survival outcomes