Beliefs of public health nurses about solution-focused parenting support:A questionnaire study

Background Parenting support guidelines for public health nurses have shifted from a problem-focused to a solution-focused approach. Given the fundamental differences between these two approaches, implementation of solution-focused parenting support is assumed to be difficult. Since the way public health nurses provide parenting support is largely guided by their beliefs, knowledge about their beliefs concerning solution-focused parenting support is important for its actual implementation. This study aims to explore the behavioral, normative, and control beliefs of public health nurses about solution-focused parenting support for future design of implementation interventions and related research activities. Methods A theory of planned behavior questionnaire was systematically developed and tested using focus groups. Thematic analysis and nominal group technique were used to analyze the data and to reach consensus. Next, this questionnaire was conducted among 449 public health nurses in the Netherlands. Factor analysis and descriptive statistical analysis were performed. Results Factor analysis resulted in three distinguishing subscales: behavioral beliefs (α = 0.79), normative beliefs (α = 0.80), and control beliefs (α = 0.64). Beliefs of public health nurses about solution-focused parenting support were moderately positive to positive (means varying from 4.24 to 5.54, on a 1–7 scale), and differences were statistically significant for various background variables. Control beliefs were less positive than behavioral and normative beliefs. Public health nurses trained in solution-focused parenting support reported more positive control beliefs (M = 4.34, SD = 0.83) as compared to untrained public health nurses (M = 4.00, SD = 0.82). Conclusion This study is the first to provide insight into public health nurses’ beliefs about solution-focused parenting support. The overall moderately positive to positive beliefs of PHNs about solution-focused parenting support suggests that PHNs tend to accept solution-focused parenting support as a viable approach. Compared to behavioral and normative beliefs, PHNs score the lowest on control beliefs

Survey of intention among public health nurses in providing solution‐focused parenting support

OBJECTIVE: Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice. DESIGN: The design of this study was cross‐sectional. SAMPLE: The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands. MEASUREMENTS: Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling. RESULTS: A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support. CONCLUSIONS: In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm

Addressing medical absenteeism in pre-vocational secondary students:Effectiveness of a public health intervention, using a quasi-experimental design

Background Students’ health and school absenteeism affect educational level, with adverse effects on their future health. This interdependence is reflected in medical absenteeism. In the Netherlands, a public health intervention has been developed to address medical absenteeism in pre-vocational secondary education. This study aims to investigate the effectiveness of this intervention on students’ medical absenteeism, compared to “medical absenteeism policy as usual”. Methods A quasi-experimental design with an intervention group (493 students) and a control group (445 students) was applied. Multilevel analysis was used to study differences in the development of the level of a student’s medical absence over time (after 3 and 12 months). Results In the intervention group, the level of absenteeism decreased from 8.5 days reported sick in 12 school weeks to 5.7 days after 3 months, and to 4.9 days after 12 months. The number of absence periods fell from 3.9 in 12 school weeks to 2.5 after 3 months, and to 2.2 after 12 months. In the control group, the absence days initially decreased from 9.9 days reported sick in 12 school weeks to 8.4 days after 3 months, after which an increase to 8.9 days was measured. The number of absence periods initially decreased from 4.5 in 12 school weeks to 3.5, after which an increase to 3.7 was measured. The number of absence days per period remained about the same in both groups. Conclusions The study provides first indications for the intervention to be effective for Dutch pre-vocational secondary students with increased medical absence rates. The intervention, which consists of personalised management of medical absenteeism by systematic identification of students with extensive medical absenteeism and consistent referral to youth health care physicians, appears to reduce the absence rates more effectively than “medical absenteeism policy as usual”. The effectiveness of the intervention is shown primarily by a decrease in the number of periods reported sick

The human norepinephrine transporter in combination with C-11-m-hydroxyephedrine as a reporter gene/reporter probe for PET of gene therapy

Although the herpes simplex virus thymidine kinase gene has been frequently applied as a reporter gene for monitoring gene transfection in animals, it has some intrinsic limitations for use in humans. In our search for a reporter gene that lacks these limitations, we have evaluated the feasibility of the human norepinephrine transporter (hNET) as a reporter gene in combination with the reporter probe C-11-m-hydroxyephedrine (mHED) for PET. Methods: An adenoviral vector (AdTrack-hNET) containing the hNET gene as reporter gene and the enhanced green fluorescent protein (EGFP) as a substitute for a therapeutic gene was constructed. After COS-7, A2780, and U373 cells were transiently transduced with AdTrack-hNET, hNET protein expression, EGFP fluorescence, and cellular uptake of C-11-mHED were determined. In rats, U373 tumor xenografts were grown and transiently transduced with either AdTrack-hNET or an AdTrack-Luc control adenovirus. Intratumoral accumulation of C-11-mHED was determined by PET and ex vivo biodistribution. The tumors were subsequently examined for EGFP fluorescence. Results: 11C-mHED uptake was positively correlated with AdTrack-hNET viral titer and hNET protein expression. However, large differences in transfection efficiency between cell lines were observed. The highest 11C-mHED uptake was found in hNET transfected U373 cells, in which tracer uptake was > 70-fold higher than that in control cells. 11C-mHED accumulation could be inhibited by desipramine, a potent inhibitor of hNET. In all cell lines, C-11-mHED uptake was positively correlated with EGFP fluorescence, implying that imaging of hNET with 11C-mHED would enable monitoring of a coexpressed therapeutic gene. In the animal model, gene transfection efficiencies were very low, as determined by EGFP fluorescence. Still a significantly higher C-11-mHED uptake in hNIET transduced tumors than that in control tumors was demonstrated by ex vivo biodistribution studies. PET with a clinical camera could visualize 1 of 3 hNET transduced tumors, indicating that the transfection efficiency was near the detection limit. Conclusion: These results indicate that monitoring of gene therapy using the hNET/C-11-mHED reporter gene/probe is feasible, but further investigation with regard to the sensitivity of the technique is required

Effectiveness of a family-centered method for the early identification of social-emotional and behavioral problems in children: a quasi experimental study

Background: Social-emotional and behavioral problems are common in childhood. Early identification of these is important as it can lead to interventions which may improve the child's prognosis. In Dutch Preventive Child Healthcare (PCH), a new family-centered method has been implemented to identify these problems in early childhood. Its main features are consideration of the child's developmental context and empowerment of parents to enhance the developmental context. Methods/design: In a quasi-experimental study, embedded in routine PCH in the Netherlands, regions in which the family-centered method has been implemented (intervention condition) will be compared to "care as usual" regions (control condition). These regions are comparable in regard to socio-demographic characteristics. From more than 3,500 newborn babies, 18-month follow-up data on social-emotional and behavioral development will be obtained. PCH professionals will assess development during each routine well-child visit; participating parents will fill in standardized questionnaires. Primary outcomes in the study are the proportion of social-emotional and behavioral problems identified by PCH professionals in children aged 2-14 and 18 months in both conditions, and the proportion of agreement between the assessment of PCH professionals and parents. In addition, the added value of the family-centered approach will be assessed by comparing PCH findings with standardized questionnaires. The secondary outcomes are the degree to which the needs of parents are met and the degree to which they are willing to disclose concerns. Discussion: The family-centered method seems promising for early identification of social-emotional and behavioral problems. The results of this study will contribute to evidence-based public health. Trial registration: NTR2681

mRNA-1273 COVID-19 vaccination in patients receiving chemotherapy, immunotherapy, or chemoimmunotherapy for solid tumours:a prospective, multicentre, non-inferiority trial

BACKGROUND: Patients with cancer have an increased risk of complications from SARS-CoV-2 infection. Vaccination to prevent COVID-19 is recommended, but data on the immunogenicity and safety of COVID-19 vaccines for patients with solid tumours receiving systemic cancer treatment are scarce. Therefore, we aimed to assess the impact of immunotherapy, chemotherapy, and chemoimmunotherapy on the immunogenicity and safety of the mRNA-1273 (Moderna Biotech, Madrid, Spain) COVID-19 vaccine as part of the Vaccination Against COVID in Cancer (VOICE) trial. METHODS: This prospective, multicentre, non-inferiority trial was done across three centres in the Netherlands. Individuals aged 18 years or older with a life expectancy of more than 12 months were enrolled into four cohorts: individuals without cancer (cohort A [control cohort]), and patients with solid tumours, regardless of stage and histology, treated with immunotherapy (cohort B), chemotherapy (cohort C), or chemoimmunotherapy (cohort D). Participants received two mRNA-1273 vaccinations of 100 μg in 0·5 mL intramuscularly, 28 days apart. The primary endpoint, analysed per protocol (excluding patients with a positive baseline sample [>10 binding antibody units (BAU)/mL], indicating previous SARS-CoV-2 infection), was defined as the SARS-CoV-2 spike S1-specific IgG serum antibody response (ie, SARS-CoV-2-binding antibody concentration of >10 BAU/mL) 28 days after the second vaccination. For the primary endpoint analysis, a non-inferiority design with a margin of 10% was used. We also assessed adverse events in all patients who received at least one vaccination, and recorded solicited adverse events in participants who received at least one vaccination but excluding those who already had seroconversion (>10 BAU/mL) at baseline. This study is ongoing and is registered with ClinicalTrials.gov, NCT04715438. FINDINGS: Between Feb 17 and March 12, 2021, 791 participants were enrolled and followed up for a median of 122 days (IQR 118 to 128). A SARS-CoV-2-binding antibody response was found in 240 (100%; 95% CI 98 to 100) of 240 evaluable participants in cohort A, 130 (99%; 96 to >99) of 131 evaluable patients in cohort B, 223 (97%; 94 to 99) of 229 evaluable patients in cohort C, and 143 (100%; 97 to 100) of 143 evaluable patients in cohort D. The SARS-CoV-2-binding antibody response in each patient cohort was non-inferior compared with cohort A. No new safety signals were observed. Grade 3 or worse serious adverse events occurred in no participants in cohort A, three (2%) of 137 patients in cohort B, six (2%) of 244 patients in cohort C, and one (1%) of 163 patients in cohort D, with four events (two of fever, and one each of diarrhoea and febrile neutropenia) potentially related to the vaccination. There were no vaccine-related deaths. INTERPRETATION: Most patients with cancer develop, while receiving chemotherapy, immunotherapy, or both for a solid tumour, an adequate antibody response to vaccination with the mRNA-1273 COVID-19 vaccine. The vaccine is also safe in these patients. The minority of patients with an inadequate response after two vaccinations might benefit from a third vaccination. FUNDING: ZonMw, The Netherlands Organisation for Health Research and Development

COVID-19 vaccination: the VOICE for patients with cancer

Pathogenesis and treatment of chronic pulmonary disease