Self-organising in primary care in the first wave of Covid-19: a qualitative study conducted in Wallonia, Belgium

peer reviewedBackground The first wave of the Covid-19 pandemic demanded rapid adaptation to the delivery of routine, and covid-19 related, primary care. This study aims to describe the adaptations implemented at local level in primary healthcare centres in Wallonia, Belgium in response to the first wave of the evolving crisis. Questions/Methods Qualitative data were collected in the form of weekly semi-structured interviews with general practitioners, nurses and receptionists. Interviews focussed on evolving changes taking place in their practices between April and June 2020. The participants worked at three community health centres in the province of Liège, Belgium. Data were analysed using thematic content analysis through the lens of a complex adaptive system model focussing on the level of self-organisation. Results Nine participants participated in the study and 90 interviews were conducted. Adaptations described by the participants included the transition from in-person to telephone consultations, managing protective clothing stock, setting up testing procedures, following up on chronic patients, collaboration with pharmacists, specialists and local government actors. Discussion The results describe the way primary care in Wallonia, Belgium has had to adapt to the fast-moving crisis at a time when little information or directives were available. Using a complex adaptive system lens allows a deep analysis of the way self-organising at the local level in a highly decentralised system took place and contributes to our understanding of health system resilience and pandemic management as a whole and at the local level in Wallonia, Belgium

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

peer reviewedThe discrepancy between official guidelines and clinical practice is hardly more pronounced than in the case of benzodiazepines and Z-drugs, also known as benzodiazepine receptor agonists (BZRA). Using social-constructionist positioning theory, we unravel how health care professionals deal with the dilemma of prescribing this medication. Our results reveal a prescribing spectrum that is discursively organised around four different storylines used by professionals. The storylines are organised along three axes that are related to a) prescribers' opinions on prescribing and the negotiation of the related risks, b) the power dynamics between provider and patient in the prescribing process and c) the rhetorical use of arguments. The discerned storylines allow us to explore the emotional and moral side of prescribing and demarcate clinical mindlines -internalised tacit guidelines-that professionals adhere to when they prescribe. By relying on Annemarie Mol's conceptualisation of ontological politics, we explain how these storylines enact multiple versions of this class of medication and justify seemingly contradictory prescribing practices

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills

Prevalence and incidence of antibodies against SARS-CoV-2 among primary healthcare providers in Belgium during 1 year of the COVID-19 epidemic: prospective cohort study protocol.

peer reviewed[en] INTRODUCTION: National SARS-CoV-2 seroprevalence data provide essential information about population exposure to the virus and help predict the future course of the epidemic. Early cohort studies have suggested declines in levels of antibodies in individuals associated with, for example, illness severity, age and comorbidities. This protocol focuses on the seroprevalence among primary healthcare providers (PHCPs) in Belgium. PHCPs manage the vast majority of (COVID-19) patients and therefore play an essential role in the efficient organisation of healthcare. Currently, evidence is lacking on (1) how many PHCPs get infected with SARS-CoV-2 in Belgium, (2) the rate at which this happens, (3) their clinical spectrum, (4) their risk factors, (5) the effectiveness of the measures to prevent infection and (6) the accuracy of the serology-based point-of-care test (POCT) in a primary care setting. METHODS AND ANALYSIS: This study will be set up as a prospective cohort study. General practitioners (GPs) and other PHCPs (working in a GP practice) will be recruited via professional networks and professional media outlets to register online to participate. Registered GPs and other PHCPs will be asked at each testing point (n=9) to perform a capillary blood sample antibody POCT targeting IgM and IgG against the receptor-binding domain of SARS-CoV-2 and complete an online questionnaire. The primary outcomes are the prevalence and incidence of antibodies against SARS-CoV-2 in PHCPs during a 12-month follow-up period. Secondary outcomes include the longevity of antibodies against SARS-CoV-2. ETHICS AND DISSEMINATION: Ethical approval has been granted by the ethics committee of the University Hospital of Antwerp/University of Antwerp (Belgian registration number: 3002020000237). Alongside journal publications, dissemination activities include the publication of monthly reports to be shared with the participants and the general population through the publicly available website of the Belgian health authorities (Sciensano). TRIAL REGISTRATION NUMBER: NCT04779424

Validation of a rapid SARS-CoV-2 antibody test in general practice.

peer reviewed[en] OBJECTIVES: To validate a rapid serological test (RST) for SARS-CoV-2 antibodies used in seroprevalence studies in healthcare providers, including primary healthcare providers (PHCPs) in Belgium. DESIGN: A phase III validation study of the RST (OrientGene) within a prospective cohort study. SETTING: Primary care in Belgium. PARTICIPANTS: Any general practitioner (GP) working in primary care in Belgium and any other PHCP from the same GP practice who physically manages patients were eligible in the seroprevalence study. For the validation study, all participants who tested positive (376) on the RST at the first testing timepoint (T1) and a random sample of those who tested negative (790) and unclear (24) were included. INTERVENTION: At T2, 4 weeks later, PHCPs performed the RST with fingerprick blood (index test) immediately after providing a serum sample to be analysed for the presence of SARS-CoV-2 immunoglobulin G antibodies using a two-out-of-three assay (reference test). PRIMARY AND SECONDARY OUTCOME MEASURES: The RST accuracy was estimated using inverse probability weighting to correct for missing reference test data, and considering unclear RST results as negative for the sensitivity and positive for the specificity. Using these conservative estimates, the true seroprevalence was estimated both for T2 and RST-based prevalence values found in a cohort study with PHCPs in Belgium. RESULTS: 1073 paired tests (403 positive on the reference test) were included. A sensitivity of 73% (a specificity of 92%) was found considering unclear RST results as negative (positive). For an RST-based prevalence at T1 (13.9), T2 (24.9) and T7 (70.21), the true prevalence was estimated to be 9.1%, 25.9% and 95.7%, respectively. CONCLUSION: The RST sensitivity (73%) and specificity (92%) make an RST-based seroprevalence below (above) 23% overestimate (underestimate) the true seroprevalence. TRIAL REGISTRATION NUMBER: NCT04779424

SARS-CoV-2 seroprevalence among vaccinated nursing home residents and staff in Belgium in August 2021

The SCOPE study assesses the prevalence of anti-SARS-CoV-2 antibodies among a representative sample of residents and staff in Belgian NH (nursing homes). Starting from February 1st 2021, a cohort of 1,640 residents and 1.368 staff members in 69 Belgian NHs are being tested every two months on the presence of anti-SARS-CoV-2 antibodies. This brief communication reports on the prevalence of anti-SARS-CoV-2 antibodies among vaccinated nursing home residents and staff. At the end of April 2021, the large scale vaccination campaign in Belgian nursing homes, which took place between January 5th and March 24th 2021, resulted in a vaccination coverage of 97% in NH residents and 84% in staff members. For these vaccinated groups, we describe the prevalence of anti-SARS-CoV-2 antibodies immediately following the vaccination campaign (April, 2021) and the seroprevalence evolution over the two following testing periods (in June and August 2021). Data collection of the August 2021 testing period was not finished at the time of compiling this brief communication. The August 2021 testing period comprises the data from 65 out of the 69 nursing homes. Additionally, some antibody test results are expected the coming weeks in case of self-sampling (for staff in particular). Results given here are preliminary. Small adaptations in some data might occur in future reports.SCOP

Prevalence of SARS-CoV-2 antibodies among Belgian nursing home residents and staff during the primary COVID-19 vaccination campaign.

peer reviewed[en] BACKGROUND: Nursing home residents (NHR) and staff have been disproportionally affected by the COVID-19 pandemic and were therefore prioritised in the COVID-19 vaccination strategy. However, frail older adults, like NHR, are known to have decreased antibody responses upon vaccination targeting other viral antigens. OBJECTIVES: As real-world data on vaccine responsiveness, we assessed the prevalence of SARS-CoV-2 antibodies among Belgian NHR and staff during the primary COVID-19 vaccination campaign. METHODS: In total, we tested 1629 NHR and 1356 staff across 69 Belgian NHs for the presence of SARS-CoV-2 IgM/IgG antibodies using rapid tests. We collected socio-demographic and COVID-19-related medical data through questionnaires. Sampling occurred between 1 February and 24 March 2021, in a randomly sampled population that received none, one or two BNT162b2 vaccine doses. RESULTS: We found that during the primary vaccination campaign with 59% of the study population fully vaccinated, 74% had SARS-CoV-2 antibodies. Among fully vaccinated individuals only, fewer residents tested positive for SARS-CoV-2 antibodies (77%) than staff (98%), suggesting an impaired vaccine-induced antibody response in the elderly, with lowest seroprevalences observed among infection naïve residents. COVID-19 vaccination status and previous SARS-CoV-2 infection were predictors for SARS-CoV-2 seropositivity. Alternatively, age ≥ 80 years old, the presence of comorbidities and high care dependency predicted SARS-CoV-2 seronegativity in NHR. CONCLUSION: These findings highlight the need for further monitoring of SARS-CoV-2 immunity upon vaccination in the elderly population, as their impaired humoral responses could imply insufficient protection against COVID-19. TRIAL REGISTRATION: This study was retrospectively registered on ClinicalTrials.gov (NCT04738695)

Perlindungan Konsumen Undang-Undang No.8 tahun 1999 terhadap Pelecehan oleh Mitra Grab Jasa Transportaasi Online

Hasil penelitian ini menunjukkan bahwa masyarakat dapat memahami terkait dengan perlindungan konsumen atas pelecehan seksual yang terjadi pada konsumen pengguna jasa transportasi online. Dan terhadap pelaku pelecehan seksual teersebut dapat dihukum dengan ketentuan hukum yang berlaku serta dapat diberikan sanksi oleh pihak perusahaan berupa pembekuan akun mitra bahkan bisa saja sampai pada putus mitra sesuai dengan kode etik perusahaan jasa transportasi online

The Research to Practice Gap in Child Safety: Tools to promote the implementation of Evidence-Based Practice in Europe

Introduction Although average injury rates are decreasing, large inequalities continue to exist between countries within the European Union. Mortality rates from injury for children aged 0-19 in Lithuania in 2014 were 19/100,000 whereas in Spain the rate was 4/100,000. Within countries the picture is mixed and children’s injury risk is related to factors such as their socio-economic status or the education level and employment status of their parents. The impact of these factors means that important inequalities exist within countries in localised pockets of poverty and deprivation but also in wealthy areas. Better prevention of child injury is thus needed; however, it is a multi-sectoral undertaking. Risk factors are multi-faceted: social, environmental, and economic. Responsibility for controlling these risk factors transcends traditional policy sectors. Child injury prevention also occurs at multiple levels of governance; from local action to initiatives at international (European or global) level. Furthermore, injury prevention requires participation from the public and private sector and from civil society. This thesis explores the space between research and practice in the field of child safety in Europe. The research focuses upon the challenges for decision makers to analyse their local situation, choose interventions and put them into practice. Method The thesis focuses on four domains of child injury: road; water and home safety; and intentional injury prevention. Data collection for Chapters Three, Four and Six occurred between 2011 and 2014 within the framework of the EU-funded project; ‘Tools to Address Childhood Trauma and Children’s Safety’ (TACTICS). Participants were also involved in the TACTICS project and came from 27 countries of the WHO European Region. Chapters Two and Five are based on literature reviews conducted outside the framework of the TACTICS project. The theoretical underpinning of the thesis is based first: upon the Public Health Approach to injury prevention from Sleet et al., that underlines the importance of both an evidence-based approach and evidence-based practice within injury prevention. Second: the governance for health framework by Kickbusch and Gleicher which proposes the whole-of-government and whole-of-society approach to effective health governance. Third: the six stages of implementation proposed by Fixsen et al., theoretically guides the process of implementation. A combination of research methods was used throughout. Literature reviews guided the direction of the thesis and informed the content of the models and tools proposed. Quantitative and qualitative data was generated to identify the different sectors implicated in child injury prevention. A public health ethical framework was applied to an existing child safety intervention to explore ethical considerations. Finally, qualitative data was analysed using thematic content analysis to explore the process of implementation. Results A practical tool for use at the local level to address the cross-cutting nature of child injury prevention was developed. The tool is based on Haddon’s matrix and takes a life-course approach to injury prevention. It was developed for use by multi-sector stakeholders at the local level to better understand the complexity of child injury and develop multi-sectoral solutions. Twenty-seven different policy sectors were found to be implicated in child safety. Of these 27 sectors nine sectors were identified as ‘core’ sectors: Education; Health; Home Affairs; Justice; Media; Recreation; Research; Social/Welfare Services; Consumers Core sectors were considered applicable across the whole of child safety. Child safety reference frameworks (CSRF) were developed for use at the sub-national level. CSRF, can be used to inform policy makers about possible evidence-based child safety interventions, to assess the state of affairs in the region and to compare the situation regionally, nationally, internationally or over time. An ethical assessment of an intervention for child safety in the home highlights the relevance of public health ethics to child safety interventions. A thematic content analysis of facilitators and barriers for the adoption, implementation and monitoring of child safety interventions resulted in the identification of eight themes found to be applicable, to a varying degree, throughout the three phases of the process: Management and collaboration; Resources; Leadership; Nature of the intervention; Political, social and cultural environment; Visibility; Nature of the injury problem; Analysis and interpretation. Conclusion The findings demonstrate the multi-sectoral nature of child injury prevention and the challenges of implementation within an issue of such complexity. With a greater uptake of interventions it is hoped that the inequalities between and within countries could be reduced. The findings and tools presented in this thesis may help stakeholders at the local and regional levels to take action to protect children from injury