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Miller S, Ainsworth B, Yardley L, Milton A, Weal M, Smith P, Morrison L. A Framework for Analyzing and Measuring Usage and Engagement Data (AMUsED) in Digital Interventions: Viewpoint. J Med Internet Res 2019; 21:e10966. [PMID: 30767905 PMCID: PMC6396072 DOI: 10.2196/10966] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 01/23/2023] Open
Abstract
Trials of digital interventions can yield extensive, in-depth usage data, yet usage analyses tend to focus on broad descriptive summaries of how an intervention has been used by the whole sample. This paper proposes a novel framework to guide systematic, fine-grained usage analyses that better enables understanding of how an intervention works, when, and for whom. The framework comprises three stages to assist in the following: (1) familiarization with the intervention and its relationship to the captured data, (2) identification of meaningful measures of usage and specifying research questions to guide systematic analyses of usage data, and (3) preparation of datasheets and consideration of available analytical methods with which to examine the data. The framework can be applied to inform data capture during the development of a digital intervention and/or in the analysis of data after the completion of an evaluation trial. We will demonstrate how the framework shaped preparation and aided efficient data capture for a digital intervention to lower transmission of cold and flu viruses in the home, as well as how it informed a systematic, in-depth analysis of usage data collected from a separate digital intervention designed to promote self-management of colds and flu. The Analyzing and Measuring Usage and Engagement Data (AMUsED) framework guides systematic and efficient in-depth usage analyses that will support standardized reporting with transparent and replicable findings. These detailed findings may also enable examination of what constitutes effective engagement with particular interventions.
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Affiliation(s)
- Sascha Miller
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Lucy Yardley
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Alex Milton
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Mark Weal
- Web and Internet Science Group, School of Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Peter Smith
- Department of Social Statistics and Demography, School of Economic, Social and Political Sciences, University of Southampton, Southampton, United Kingdom
| | - Leanne Morrison
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.,Primary Care and Population Sciences, School of Medicine, University of Southampton, Southampton, United Kingdom
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Eley CV, Young VL, Hayes CV, Verlander NQ, McNulty CAM. Young People's Knowledge of Antibiotics and Vaccinations and Increasing This Knowledge Through Gaming: Mixed-Methods Study Using e-Bug. JMIR Serious Games 2019; 7:e10915. [PMID: 30707096 PMCID: PMC6376338 DOI: 10.2196/10915] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background e-Bug, led by Public Health England, educates young people about important topics: microbes, infection prevention, and antibiotics. Body Busters and Stop the Spread are 2 new e-Bug educational games. Objective This study aimed to determine students’ baseline knowledge, views on the games, and knowledge improvement. Methods Students in 5 UK educational provisions were observed playing 2 e-Bug games. Before and after knowledge and evaluation questionnaires were completed, and student focus groups were conducted. Results A total of 123 junior and 350 senior students completed the questionnaires. Vaccination baseline knowledge was high. Knowledge increased significantly about antibiotic use, appropriate sneezing behaviors, and vaccinations. In total, 26 student focus groups were conducted. Body Busters was engaging and enjoyable, whereas Stop the Spread was fast-paced and challenging but increased vaccination and health behavior intentions. Conclusions e-Bug games are an effective learning tool for students to enhance knowledge about microbes, infection prevention, and antibiotics. Game-suggested improvements should help increase enjoyment.
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Moncion K, Young K, Tunis M, Rempel S, Stirling R, Zhao L. Effectiveness of hand hygiene practices in preventing influenza virus infection in the community setting: A systematic review. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2019; 45:12-23. [PMID: 31015816 PMCID: PMC6461122 DOI: 10.14745/ccdr.v45i01a02] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hand hygiene is known to be an effective infection prevention and control measure in health care settings. However, the effectiveness of hand hygiene practices in preventing influenza infection and transmission in the community setting is not clear. OBJECTIVE To identify, review and synthesize available evidence on the effectiveness of hand hygiene in preventing laboratory-confirmed or possible influenza infection and transmission in the community setting. METHODS A systematic review protocol was established prior to conducting the review. Three electronic databases (MEDLINE, Embase and the Cochrane Library) were searched to identify relevant studies. Two reviewers independently screened the titles, abstracts and full-texts of studies retrieved from the database searches for potential eligibility. Data extraction and quality assessment of included studies were performed by a single reviewer and validated by a second reviewer. Included studies were synthesized and analyzed narratively. RESULTS A total of 16 studies were included for review. Studies were of low methodological quality and there was high variability in study design, setting, context and outcome measures. Nine studies evaluated the effectiveness of hand hygiene interventions or practices in preventing laboratory-confirmed or possible influenza infection in the community setting; six studies showed a significant difference, three studies did not. Seven studies assessed the effectiveness of hand hygiene practices in preventing laboratory-confirmed or possible influenza transmission in the community setting; two studies found a significant difference and five studies did not. CONCLUSION The effectiveness of hand hygiene against influenza virus infection and transmission in the community setting is difficult to determine based on the available evidence. In light of its proven effectiveness in other settings, there is no compelling evidence to stop using good hand hygiene practice to reduce the risk of influenza infection and transmission in the community setting.
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Affiliation(s)
- K Moncion
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - K Young
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - M Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - S Rempel
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - R Stirling
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - L Zhao
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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Hay AD, Anderson E, Ingle S, Beck C, Hollingworth W. Respiratory Tract Infections in Children in the Community: Prospective Online Inception Cohort Study. Ann Fam Med 2019; 17:14-22. [PMID: 30670390 PMCID: PMC6342588 DOI: 10.1370/afm.2327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/09/2018] [Accepted: 09/27/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Describe the duration of symptoms, proportion of parents seeking primary care consultations, and costs for respiratory tract infections (RTIs) of children in the community. METHODS Community-based, online, prospective inception cohort study. General practitioners from socioeconomically diverse practices posted study invitations to parents of 10,310 children aged ≥3 months and <15 years. RESULTS One parent of 485 (4.7%) children in 331 families consented, completed baseline data and symptom diaries, and agreed to medical record review. Compared with nonresponders, responding parent's children were younger (aged 4 vs 6 years) and less socioeconomically deprived. Between February and July 2016, 206 parents reported 346 new RTIs in 259 children. Among the 197 first RTIs reported per family, it took 23 days for 90% (95% CI, 85%-94%) of children to recover. Median symptom duration was longer: in children with primary care consultations (9 days) vs those without consultations (6 days, P = 0.06); children aged <3 years (11 days) vs >3 years (7 days, P <.01); and among children with reported lower RTI symptoms (12 days) vs those with only upper RTI symptoms (8 days, P <.001). Sixteen (8.1%; 95% CI, 4.7%-12.8%) of 197 children had primary care consultations at least once (total 19 consultations), and a similar proportion had time off school or nursery. Sixty of 188 (32%; 95% CI, 25%-39%) parents reported paying for medications for their child's illness. CONCLUSIONS Parents can be advised that RTI symptoms last up to 3 weeks. Policy makers should be aware that parents may seek primary care support in at least 1 in 12 illnesses.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom .,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom
| | - Emma Anderson
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom
| | - Sue Ingle
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom.,Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Charles Beck
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Anderson EC, Ingle S, Muir P, Beck CR, Leeming JP, Kesten J, Cabral C, Hay AD. Population-based paediatric respiratory infection surveillance: a prospective inception feasibility cohort study. Pilot Feasibility Stud 2018; 4:182. [PMID: 30555712 PMCID: PMC6287344 DOI: 10.1186/s40814-018-0371-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a need to reduce unnecessary general practitioner (GP) consultations and improve antibiotic stewardship in primary care. Respiratory tract infections (RTIs) in children are the most common reason for consulting and prescribing. Most RTI research is conducted at the point of consultation, leaving a knowledge gap regarding the population burden of RTIs. Methods Community-based, online prospective inception cohort study with nested qualitative study, to evaluate the feasibility and acceptability of collecting RTI symptom and microbiological data from children recruited prior to RTI onset. Results Parents of 10,310 children were invited. Three hundred thirty-one parents of 485 (4.7%) children responded and completed baseline data. Respondents were less socioeconomically deprived (p < 0.001) with younger (median ages 4 vs. 6 years, p < 0.001) children than non-respondents. The same parents reported 346 RTI episodes in 259 children, and 305 RTIs (in 225 children) were retained to parent-reported symptom resolution. Restricting analyses to the first RTI episode per family (to account for clustering effects), parents fully completed symptom diaries for 180 (87%) of 192 first illness episodes. Research nurses conducted home visits for 199 RTI episodes, collecting complete (symptomatic) swab sets in 195 (98%). Parents collected 194 (98% of 199 possible) symptomatic (during the nurse visit) and 282 (92% of 305 possible) asymptomatic swab sets (on symptom resolution, no nurse present). Interviews with 30 mothers and 11 children indicated study acceptability. Conclusions Invitation response rates were in the expected range. The high retention and qualitative evidence suggest that community-based paediatric syndromic and microbiological surveillance research is feasible. Electronic supplementary material The online version of this article (10.1186/s40814-018-0371-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma C Anderson
- 1Centre for Academic Child Health, Population Health Sciences (PHS), Bristol Medical School (BRMS), University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU UK
| | - Suzanne Ingle
- 2NIHR Health Protection Research Unit in Evaluation of Interventions (HPRU) and Centre for Academic Primary Care (CAPC), PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Peter Muir
- 3Public Health England, Bristol, UK.,4HPRU, PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Charles R Beck
- 4HPRU, PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK.,5Field Service, National Infection Service, Public Health England, 2 Rivergate, Temple Quay, Bristol, BS1 6EH UK
| | - John P Leeming
- 6Bristol Centre for Antimicrobial Research and Evaluation (BCARE), Pathology Sciences, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Joanna Kesten
- 4HPRU, PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK.,7The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christie Cabral
- 2NIHR Health Protection Research Unit in Evaluation of Interventions (HPRU) and Centre for Academic Primary Care (CAPC), PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Alastair D Hay
- 2NIHR Health Protection Research Unit in Evaluation of Interventions (HPRU) and Centre for Academic Primary Care (CAPC), PHS, BRMS, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Eley CV, Young VL, Hayes CV, Parkinson G, Tucker K, Gobat N, McNulty CAM. A mixed methods pilot of Beat the Bugs: A community education course on hygiene, self-care and antibiotics. J Infect Prev 2018; 19:278-286. [PMID: 38617883 PMCID: PMC11009556 DOI: 10.1177/1757177418780990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/23/2018] [Indexed: 04/16/2024] Open
Abstract
Background e-Bug is an international health education resource which support World Health Organization (WHO) public health recommendations by educating young people about microbes, hygiene and antibiotics use. The e-Bug team collaborated with Kingfisher Treasure Seekers to develop a six-session course for community groups called Beat the Bugs covering: microbes; hygiene; antibiotic use; and self-care. A pilot was used to inform further development and evaluation. Methods Pilot courses with 9-12 adults with learning difficulties and young parents were delivered by community leaders and observed by researchers. Participants completed before and after knowledge questionnaires. Two participant focus groups and two course leader interviews explored views on the course and retention of knowledge. Results Completed questionnaires and qualitative results showed an improvement in participant knowledge in each session; microbes and antibiotics sessions showed the greatest knowledge improvement. Self-care showed the greatest knowledge retention and participants reported behaviour change including an increase in appropriate hand-washing and tooth-brushing. Conclusion The Beat the Bugs course is a useful intervention for communities to give individuals the knowledge and confidence to manage their own infection and change behaviour around hygiene, self-care and antibiotics. Beat the Bugs is freely available to download.
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Affiliation(s)
- Charlotte Victoria Eley
- Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - Vicki Louise Young
- Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - Catherine Victoria Hayes
- Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | | | | | - Nina Gobat
- Cardiff University, School of Medicine, Cardiff
| | - Cliodna Ann Miriam McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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Short KR, Kedzierska K, van de Sandt CE. Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front Cell Infect Microbiol 2018; 8:343. [PMID: 30349811 PMCID: PMC6187080 DOI: 10.3389/fcimb.2018.00343] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 01/02/2023] Open
Abstract
2018 marks the 100-year anniversary of the 1918 influenza pandemic, which killed ~50 million people worldwide. The severity of this pandemic resulted from a complex interplay between viral, host, and societal factors. Here, we review the viral, genetic and immune factors that contributed to the severity of the 1918 pandemic and discuss the implications for modern pandemic preparedness. We address unresolved questions of why the 1918 influenza H1N1 virus was more virulent than other influenza pandemics and why some people survived the 1918 pandemic and others succumbed to the infection. While current studies suggest that viral factors such as haemagglutinin and polymerase gene segments most likely contributed to a potent, dysregulated pro-inflammatory cytokine storm in victims of the pandemic, a shift in case-fatality for the 1918 pandemic toward young adults was most likely associated with the host's immune status. Lack of pre-existing virus-specific and/or cross-reactive antibodies and cellular immunity in children and young adults likely contributed to the high attack rate and rapid spread of the 1918 H1N1 virus. In contrast, lower mortality rate in in the older (>30 years) adult population points toward the beneficial effects of pre-existing cross-reactive immunity. In addition to the role of humoral and cellular immunity, there is a growing body of evidence to suggest that individual genetic differences, especially involving single-nucleotide polymorphisms (SNPs), contribute to differences in the severity of influenza virus infections. Co-infections with bacterial pathogens, and possibly measles and malaria, co-morbidities, malnutrition or obesity are also known to affect the severity of influenza disease, and likely influenced 1918 H1N1 disease severity and outcomes. Additionally, we also discuss the new challenges, such as changing population demographics, antibiotic resistance and climate change, which we will face in the context of any future influenza virus pandemic. In the last decade there has been a dramatic increase in the number of severe influenza virus strains entering the human population from animal reservoirs (including highly pathogenic H7N9 and H5N1 viruses). An understanding of past influenza virus pandemics and the lessons that we have learnt from them has therefore never been more pertinent.
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Affiliation(s)
- Kirsty R. Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
| | - Carolien E. van de Sandt
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
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58
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Young VL, Cole A, Lecky DM, Fettis D, Pritchard B, Verlander NQ, Eley CV, McNulty CAM. A mixed-method evaluation of peer-education workshops for school-aged children to teach about antibiotics, microbes and hygiene. J Antimicrob Chemother 2018; 72:2119-2126. [PMID: 28333334 PMCID: PMC5890736 DOI: 10.1093/jac/dkx083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Delivering health topics in schools through peer education is known to be beneficial for all students involved. In this study, we have evaluated a peer-education workshop that aims to educate primary and secondary school students on hygiene, the spread of infection and antibiotics. Methods Four schools in south-west England, in a range of localities, took part in peer-education workshops, with students completing before, after and knowledge-retention questionnaires. Mixed-effect logistic regression and mixed-effect linear regression were used to analyse the data. Data were analysed by topic, region and peer/non-peer-educator status. Qualitative interviews and focus groups with students and educators were conducted to assess changes in participants' skills, confidence and behaviour. Results Qualitative data indicated improvements in peer-educator skills and behaviour, including confidence, team-working and communication. There was a significant improvement in knowledge for all topics covered in the intervention, although this varied by region. In the antibiotics topic, peer-educators' knowledge increased in the retention questionnaire, whereas non-peer-educators' knowledge decreased. Knowledge declined in the retention questionnaires for the other topics, although this was mostly not significant. Conclusions This study indicates that peer education is an effective way to educate young people on important topics around health and hygiene, and to concurrently improve communication skills. Its use should be encouraged across schools to help in the implementation of the National Institute for Health and Care Excellence (NICE) guidance that recommends children are taught in an age-appropriate manner about hygiene and antibiotics.
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Affiliation(s)
- Vicki L Young
- Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | - Amy Cole
- Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | - Donna M Lecky
- Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | - Dennis Fettis
- Environmental Health Department, Forest of Dean District Council, Coleford GL16 8HG, UK
| | - Beth Pritchard
- Environmental Health Department, Forest of Dean District Council, Coleford GL16 8HG, UK
| | - Neville Q Verlander
- Statistics, Modelling and Economics Department, Public Health England, Colindale, London NW9 5EQ, UK
| | - Charlotte V Eley
- Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | - Cliodna A M McNulty
- Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
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Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users? Ann Behav Med 2018; 51:423-431. [PMID: 27909944 PMCID: PMC5440485 DOI: 10.1007/s12160-016-9866-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom—including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. Purpose We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior. Method Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users. Results We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education. Conclusions Our well-powered analysis has implications for intervention development. We were able to determine a ‘minimum threshold’ of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.
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Bloomfield SF, Rook GA, Scott EA, Shanahan F, Stanwell-Smith R, Turner P. Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene. Perspect Public Health 2018; 136:213-24. [PMID: 27354505 PMCID: PMC4966430 DOI: 10.1177/1757913916650225] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: To review the burden of allergic and infectious diseases and the evidence for
a link to microbial exposure, the human microbiome and immune system, and to
assess whether we could develop lifestyles which reconnect us with exposures
which could reduce the risk of allergic disease while also protecting
against infectious disease. Methods: Using methodology based on the Delphi technique, six experts in infectious
and allergic disease were surveyed to allow for elicitation of group
judgement and consensus view on issues pertinent to the aim. Results: Key themes emerged where evidence shows that interaction with microbes that
inhabit the natural environment and human microbiome plays an essential role
in immune regulation. Changes in lifestyle and environmental exposure, rapid
urbanisation, altered diet and antibiotic use have had profound effects on
the human microbiome, leading to failure of immunotolerance and increased
risk of allergic disease. Although evidence supports the concept of immune
regulation driven by microbe–host interactions, the term ‘hygiene
hypothesis’ is a misleading misnomer. There is no good evidence that
hygiene, as the public understands, is responsible for the clinically
relevant changes to microbial exposures. Conclusion: Evidence suggests a combination of strategies, including natural childbirth,
breast feeding, increased social exposure through sport, other outdoor
activities, less time spent indoors, diet and appropriate antibiotic use,
may help restore the microbiome and perhaps reduce risks of allergic
disease. Preventive efforts must focus on early life. The term ‘hygiene
hypothesis’ must be abandoned. Promotion of a risk assessment approach
(targeted hygiene) provides a framework for maximising protection against
pathogen exposure while allowing spread of essential microbes between family
members. To build on these findings, we must change public, public health
and professional perceptions about the microbiome and about hygiene. We need
to restore public understanding of hygiene as a means to prevent infectious
disease.
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Affiliation(s)
- Sally F Bloomfield
- London School of Hygiene & Tropical Medicine and International Scientific Forum on Home Hygiene, The Old Dairy Cottage, Montacute, Somerset TA15 6XL, UK
| | - Graham Aw Rook
- Centre for Clinical Microbiology, Department of Infection, University College London (UCL), London, UK
| | - Elizabeth A Scott
- Center for Hygiene and Health, Department of Biology, Simmons College, Boston, MA, USA
| | - Fergus Shanahan
- APC Microbiome Institute, University College Cork - National University of Ireland, Cork, Ireland
| | | | - Paul Turner
- Section of Paediatrics (Allergy & Infectious Diseases) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
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Morrison D, Mair FS, Yardley L, Kirby S, Thomas M. Living with asthma and chronic obstructive airways disease: Using technology to support self-management - An overview. Chron Respir Dis 2017; 14:407-419. [PMID: 27512084 PMCID: PMC5729728 DOI: 10.1177/1479972316660977] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are common, and cause high levels of morbidity and mortality. Supporting self-management is advocated for both asthma and increasingly so for COPD, and there is growing interest in the potential role of a range of new technologies, such as smartphone apps, the web or telehealth to facilitate and promote self-management in these conditions. Treatment goals for both asthma and COPD include aiming to control symptoms, maintain activities, achieve the best possible quality of life and minimize risks of exacerbation. To do this, health professionals should be (a) helping patients to recognize deteriorating symptoms and act appropriately; (b) promoting adherence to maintenance therapy; (c) promoting a regular review where triggers can be established, and strategies for managing such triggers discussed; and (d) promoting healthy lifestyles and positive self-management of symptoms. In particular, low uptake of asthma action plans is a modifiable contributor to morbidity and possibly also to mortality in those with asthma and should be addressed as a priority. Using technology to support self-management is an evolving strategy that shows promise. This review provides an overview of self-management support and discusses how newer technologies may help patients and health professionals to meet key treatment goals.
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Affiliation(s)
- Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Sarah Kirby
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Mike Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, UK
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Riis PT, Ring HC, Kjaersgaard Andersen R, Jemec GB. Self-reported minor infections in patients with hidradenitis suppurativa and healthy controls. Clin Exp Dermatol 2017; 43:144-148. [DOI: 10.1111/ced.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- P. T. Riis
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
| | - H. C. Ring
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
| | | | - G. B. Jemec
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
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Papadopoulos NG, Megremis S, Kitsioulis NA, Vangelatou O, West P, Xepapadaki P. Promising approaches for the treatment and prevention of viral respiratory illnesses. J Allergy Clin Immunol 2017; 140:921-932. [PMID: 28739285 PMCID: PMC7112313 DOI: 10.1016/j.jaci.2017.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 02/09/2023]
Abstract
Viral respiratory tract infections are the most common human ailments, leading to enormous health and economic burden. Hundreds of viral species and subtypes have been associated with these conditions, with influenza viruses, respiratory syncytial virus, and rhinoviruses being the most frequent and with the highest burden. When considering prevention or treatment of viral respiratory tract infections, potential targets include the causative pathogens themselves but also the immune response, disease transmission, or even just the symptoms. Strategies targeting all these aspects are developing concurrently, and several novel and promising approaches are emerging. In this perspective we overview the entire range of options and highlight some of the most promising approaches, including new antiviral agents, symptomatic or immunomodulatory drugs, the re-emergence of natural remedies, and vaccines and public health policies toward prevention. Wide-scale prevention through immunization appears to be within reach for respiratory syncytial virus and promising for influenza virus, whereas additional effort is needed in regard to rhinovirus, as well as other respiratory tract viruses.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece.
| | - Spyridon Megremis
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Nikolaos A Kitsioulis
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
| | - Olympia Vangelatou
- Department of Nutritional Physiology & Feeding, Agricultural University of Athens, Athens, Greece
| | - Peter West
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
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van Vugt VA, van der Wouden JC, Bosmans JE, Smalbrugge M, van Diest W, Essery R, Yardley L, van der Horst HE, Maarsingh OR. Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial. BMJ Open 2017; 7:e015479. [PMID: 28110290 PMCID: PMC5253547 DOI: 10.1136/bmjopen-2016-015479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages. METHODS AND ANALYSIS A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support ('blended care') with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale-Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners. ETHICS AND DISSEMINATION The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Pre-results, NTR5712.
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Affiliation(s)
- Vincent A van Vugt
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Willianne van Diest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Rosie Essery
- Department of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Offenbächer M, Weber A, van Dyck M, Taverna M, Stahler A, Kohls N, Schelling J. [Protection against common cold]. MMW Fortschr Med 2017; 159:43-47. [PMID: 28097555 DOI: 10.1007/s15006-017-9159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Martin Offenbächer
- Institut für Allgemeinmedizin, Klinikum der Univ. München, Campus Innenstadt, Pettenkoferstr. 8a, D-80336, München, Deutschland.
| | - Annemarie Weber
- Hochschule für angewandte Wissenschaften Coburg, Bereich Integrative Gesundheitsförderung, Coburg, Deutschland
| | | | - Mara Taverna
- Institut für Allgemeinmedizin, München, Deutschland
| | | | - Niko Kohls
- Hochschule für angewandte Wissenschaften Coburg, Bereich Integrative Gesundheitsförderung, Coburg, Deutschland
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McNamee P, Murray E, Kelly MP, Bojke L, Chilcott J, Fischer A, West R, Yardley L. Designing and Undertaking a Health Economics Study of Digital Health Interventions. Am J Prev Med 2016; 51:852-860. [PMID: 27745685 DOI: 10.1016/j.amepre.2016.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/15/2022]
Abstract
This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.
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Affiliation(s)
- Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Michael P Kelly
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Laura Bojke
- Centre for Health Economics, University of York, York, United Kingdom
| | - Jim Chilcott
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alastair Fischer
- Public Health and Social Care Section, National Institute for Health and Care Excellence, London, United Kingdom
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
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Chen LH, Han PV, Wilson ME, Stoney RJ, Jentes ES, Benoit C, Ooi WW, Barnett ED, Hamer DH. Self-reported illness among Boston-area international travelers: A prospective study. Travel Med Infect Dis 2016; 14:604-613. [PMID: 27687076 PMCID: PMC5695040 DOI: 10.1016/j.tmaid.2016.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Boston Area Travel Medicine Network surveyed travelers on travel-related health problems. METHODS Travelers were recruited 2009-2011 during pre-travel consultation at three clinics. The investigation included pre-travel data, weekly during-travel diaries, and a post-travel questionnaire. We analyzed demographics, trip characteristics, health problems experienced, and assessed the relationship between influenza vaccination, influenza prevention advice, and respiratory symptoms. RESULTS Of 987 enrolled travelers, 628 (64%) completed all surveys, of which 400 (64%) reported health problems during and/or after travel; median trip duration was 12 days. Diarrhea affected the most people during travel (172) while runny/stuffy nose affected the most people after travel (95). Of those with health problems during travel, 25% stopped or altered plans; 1% were hospitalized. After travel, 21% stopped planned activities, 23% sought physician or other health advice; one traveler was hospitalized. Travelers who received influenza vaccination and influenza prevention advice had lower rates of respiratory symptoms than those that received influenza prevention advice alone (18% vs 28%, P = 0.03). CONCLUSIONS A large proportion of Boston-area travelers reported health problems despite pre-travel consultation, resulting in inconveniences. The combination of influenza prevention advice and influenza immunization was associated with fewer respiratory symptoms than those who received influenza prevention advice alone.
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Affiliation(s)
- Lin H Chen
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Pauline V Han
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary E Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine Benoit
- Children's Hospitals and Clinics of Minnesota, Department of Research and Sponsored Programs, Minneapolis, MN, USA
| | - Winnie W Ooi
- Travel and Tropical Medicine Clinic, Lahey Clinic Medical Center, Burlington, MA, USA
| | - Elizabeth D Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Davidson H Hamer
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.
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Vuichard Gysin D, Dao D, Gysin CM, Lytvyn L, Loeb M. Effect of Vitamin D3 Supplementation on Respiratory Tract Infections in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2016; 11:e0162996. [PMID: 27631625 PMCID: PMC5025082 DOI: 10.1371/journal.pone.0162996] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Vitamin D supplementation may be a simple preventive measure against respiratory tract infections (RTIs) but evidence from randomized controlled trials is inconclusive. We aimed to systematically summarize results from interventions studying the protective effect of vitamin D supplementation on clinical and laboratory confirmed RTIs in healthy adults and children. Methods Medline, EMBASE, CENTRAL, and CINAHL were screened from inception until present (last updated in January 2016) completed by a search of the grey literature, clinical trial registers and conference abstracts. We included randomized trials comparing vitamin D versus placebo or no treatment. Two independent reviewers were responsible for study selection and data extraction. Cochrane’s risk of bias tool and the GRADE approach were used for quality assessment. Estimates were pooled with random-effects models. Heterogeneity was explored by sub-group and meta-regression analyses. Results Of 2627 original hits, 15 trials including 7053 individuals were ultimately eligible. All used oral cholecalciferol. We found a 6% risk reduction with vitamin D3 supplementation on clinical RTIs, but the result was not statistically significant (RR 0.94; 95% CI 0.88 to 1.00). Heterogeneity was large (I-square 57%) and overall study quality was low. There were too few studies to reliably assess a potential risk reduction of laboratory confirmed RTI. Evidence was insufficient to demonstrate an association between vitamin D supplementation and risk of clinical RTI in sub-groups with vitamin D deficiency. Conclusions In previously healthy individuals vitamin D supplementation does not reduce the risk of clinical RTIs. However, this conclusion is based on a meta-analysis where the included studies differed with respect to population, baseline vitamin D levels and study length. This needs to be considered when interpreting the results. Future trials should focus on vitamin D deficient individuals and apply more objective and standardized outcome measurements.
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Affiliation(s)
- Danielle Vuichard Gysin
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Dyda Dao
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Lyubov Lytvyn
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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While A. ‘No action today means no cure tomorrow’: The threat of antimicrobial resistance. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/npre.2016.14.8.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison While
- Emeritus professor, community nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London; Fellow, Queen's Nursing Institute
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Abstract
Antimicrobial resistance is a major concern for UK healthcare professionals, following growing evidence of multi-resistant pathogens. Poor prescribing practices, partly driven by patient demand, and poor patient adherence to prescribed regimens are two of the causes of growing antimicrobial resisitance. Improved infection prevention and control practices will not only reduce healthcare-acquired infections, but also reduce the necessity for antimicrobials. Community nurses can also support their clients to promote their own health and wellbeing, increasing resilience to infections through a healthy lifestyle which includes a well-balanced diet, good personal hygiene and the take up of offered vaccinations.
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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71
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Little P. Effectiveness of an internet-delivered handwashing intervention - Author's reply. Lancet 2016; 387:338. [PMID: 26842448 DOI: 10.1016/s0140-6736(15)01343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul Little
- Primary Medical Care Group, Community Clinical Sciences Division, Aldermoor Health Centre, University of Southampton, Southampton SO16 5ST, UK.
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Cowling BJ, Leung GM. Effectiveness of an internet-delivered handwashing intervention. Lancet 2016; 387:337. [PMID: 26842447 DOI: 10.1016/s0140-6736(16)00109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Dale A, Hartley P, Drysdale H, Goldacre B, Heneghan C. Effectiveness of an internet-delivered handwashing intervention. Lancet 2016; 387:337. [PMID: 26842446 DOI: 10.1016/s0140-6736(16)00108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron Dale
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford OX2 6GG, UK
| | - Philip Hartley
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford OX2 6GG, UK
| | - Henry Drysdale
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford OX2 6GG, UK
| | - Ben Goldacre
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford OX2 6GG, UK.
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford OX2 6GG, UK
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van Weel C. Handwashing and community management of infections. Lancet 2015; 386:1603-4. [PMID: 26256073 DOI: 10.1016/s0140-6736(15)60460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Netherlands; Australian National University, Canberra, Australia.
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