The Role of Physicians During Hunger Strikes of Undocumented Migrant Workers in a Non-Custodial Setting.

Since the beginning of the 21st century, the living conditions of undocumented migrant workers in Belgium have deteriorated drastically. In Brussels, after various social actions, undocumented people began squatting and occupying public buildings to make their struggle visible to society. Desperate, some seized the possibility of a loophole in Belgian law that permits ill persons to have access to a temporary residence permit and started hunger striking. Confronted with consecutive strikes, medical teams of voluntary health professionals faced a big dilemma. A search of the medical literature yielded information about the overall and specific tasks of health professionals during hunger strikes in custodial and hospital settings, but no scientific guidelines were found to address the specific problems the team was confronted with. Information was collected about 15 hunger strikes over a period of seven years, involving the participation of 1,158 strikers. This article describes the medical, organizational, and ethical difficulties encountered in the follow-up of hunger strikes in non-custodial settings, including those associated with the establishment of a health-care structure, operation with very limited resources, and communication with the media and other health professionals.

Association between feeling threatened by a terrorist attack and subjective health: a web survey a week after the attacks of 22 March 2016 in Belgium.

Background: The wave of terrorist attacks over the past years in Europe and other regions may cause problems such as anxiety and depressive symptoms. Some studies suggest that perceived threat might also trigger physical health problems. Objective: To investigate the association between feeling threatened and subjective health during the week following a terrorist attack. Method: Online survey with a self-selected sample in the Belgian population one week after the terrorist attacks in 2016. Participants were invited through the Belgian media to fill in a questionnaire in Dutch, French or English on a website. The main outcomes were the association between 'feeling threatened' and subjective health problems. Perceived threat was measured with the question 'During the week after the attacks … Did you feel threatened?' Subjective health was measured by using standardized scales (ACSA, PHQ-4, PHQ-15). Results: A total of 2620 respondents completed the questionnaire, of whom 69.8% were female, 27.7% lived and 43.1% worked in Brussels. Gender, age, place of living and working, media exposure, religiousness and religious affiliation were associated significantly with higher perceived threat. A total of 21% of the respondents felt much or very much threatened during the week after the attacks. They reported significantly higher levels of mental and physical health problems. The most frequently reported problems were anxiety and depressive symptoms. The health problems that differentiated most markedly between those with low and high levels of perceived threat were fainting spells, chest pain and shortness of breath. Conclusion: In a self-selected sample of respondents, 'feeling threatened' was strongly associated with lower level of wellbeing and higher levels of mental and physical health problems. The most prevalent health problems were mental health problems but the most pronounced differences between people with low versus high levels of perceived threat were physical health problems.

Antecedentes: La ola de ataques terroristas en los últimos años en Europa y otras regiones puede causar problemas, tales como síntomas ansiosos y depresivos. Algunos estudios sugieren que la percepción de amenaza puede gatillar problemas de salud física.Objetivo: Investigar la asociación entre el sentimiento de amenaza y la salud subjetiva durante la semana siguiente a un ataque terrorista.Método: Una encuesta en línea con una muestra auto- seleccionada en la población Belga una semana después del ataque terrorista del 2016. Los participantes fueron invitados a través de los medios belgas a llenar un cuestionario en holandés, francés o inglés en un sitio web. Los resultados principales fueron la asociación entre 'el sentirse amenazado' y problemas de salud subjetivos. La amenaza percibida fue medida con la pregunta ¿"Durante la semana posterior a los ataques.se sintió amenazado?". La salud subjetiva fue medida usando escalas estandarizadas (ACSA, PHQ-4, PHQ-15).Resultados: 2.620 encuestados completaron el cuestionario, de los cuales 69,8% eran mujeres, 27,7% vivía en Bruselas y 43,1% trabajaba en esa ciudad. El género, la edad, lugar donde vive y trabaja, la exposición a los medios, religiosidad y pertenencia a una religión estuvieron asociados significativamente con mayor percepción de amenaza. Veintiún por ciento de los encuestados se sentían muy o mucho más amenazado durante la semana posterior a los ataques. Ellos reportaron niveles significativamente más elevados de problemas de salud mental y física. Los problemas más frecuentemente reportados fueron síntomas de ansiedad y depresivos. Los problemas de salud que diferenciaba más marcadamente entre aquellos con niveles bajos y altos de percepción de amenaza fueron desmayos, dolor en el pecho, y dificultades para respirar.Conclusiones: En una muestra auto-seleccionada de encuestados, el 'sentirse amenazado' se asoció fuertemente con niveles más bajos de bienestar y niveles más altos de problemas de salud mental y física. Los problemas de salud más prevalentes fueron los problemas de salud mental, pero las diferencias más pronunciadas entre las personas con niveles bajos versus niveles altos de amenaza percibida fueron los problemas de salud físicos.

Pilot Health Promoting Hospital in rural South Africa: evidence-based approach to systematic hospital transformation.

This project aimed at transforming a rural District Hospital in the Limpopo Province of South Africa into a Health Promoting Hospital according to standards developed by WHO-Europe. The intervention used a diagnostic approach and baseline needs assessment of hospital staff, patients, and their relatives to identify health education and promotion needs. Activities included empowerment training and skills development, implementation of health education and promotion activities, and the integration of health-promoting standards and values in the hospital structure and culture. The project indicated applicability of the model in a resource-limited setting, based on staff empowerment, local leadership, and stakeholder engagement.

Contacts between general practitioners and migrants without a residence permit and the use of "urgent" medical care.

AIMS: To examine the extent to which general practitioners (GPs) are consulted by migrants without a residence permit (MRP), their use of the government sponsored reimbursement system and the difficulties encountered therewith. To study what hurdles the care recipients (MRP) experience in using healthcare and the reimbursement system. METHODS: A written survey of GPs in the Brussels Capital region and semi-structured interviews with MRP in the same area. Bivariate analysis of the GP data (two-sided independent t-test, two-sided Fisher's exact test). Recording, transcription, coding and categorizing of MRP interviews. RESULTS: Overall GP response rate was 71%. The average number of MRP contacts per month was 1.1 for all, representing 0.26% of all GP contacts. GPs working in community health centres (CHC) 4.4 MRP per month (p=0.042). The mean probability that the GP will not use the reimbursement programme is 0.66--there is less non-use in CHC (p=0.042). The main barrier for GPs is insufficient knowledge of the system, followed by its complex and time consuming paperwork. Barriers experienced by MRP include fear of deportation, lack of funds, insufficient healthcare related knowledge and communication barriers. CONCLUSIONS: Primary care is an active channel in healthcare for MRP, with CHC taking the lead. With the reimbursement system, there should hardly be financial barriers to access the healthcare system. However, due to the high probability of non-use (0.66), this system cannot substantially contribute to lowering financial barriers. The complexity of the system prevents it from being used properly and leads to undesirable alternatives.

Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey.

AIM: This paper is a report of a correlational study of the relationships between demographic variables, job satisfaction, and turnover intent among primary healthcare nurses in a rural area of South Africa. BACKGROUND: Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described. METHOD: A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, anova, Spearman's rank correlation, and logistic regression were applied. RESULTS: Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job satisfaction was statistically significantly associated with unit tenure (P < 0·05), professional rank (P < 0·01) and turnover intent (P < 0·01). Turnover intent was statistically significantly explained by job satisfaction, age and education (P < 0·001), with younger and higher educated nurses being more likely to show turnover intent. Satisfaction with supervision was the only facet significantly explaining turnover intent when controlling for age, education, years of nursing and unit tenure (P < 0·001). CONCLUSION: Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions but also on adequate human resource management.

Advances in health promotion in Africa: promoting health through hospitals.

A district hospital in a rural area of the Limpopo Province in South Africa has recently been launched as a 'Health Promoting Hospital', based on the principles of the Ottawa Charter and according to standards developed by WHO-Europe. The initiative was conceived as a project in partnership with stakeholders from the local community and is considered a pilot by Provincial health authorities, representing an advance in health promotion practice in the region. The project was designed as a research intervention, guided by the principles of critical action research integrated with the Precede-Proceed model for the systematic evaluation of health promotion and education. This commentary reports on the process undertaken in successfully transforming this community-based hospital into a Health Promoting Hospital by integrating the concept, values and standards of health promotion into its structure and culture, thereby creating a healthy setting and promoting the health and wellbeing of the hospital's staff, its patients, and their relatives.

Coverage of recommended vaccines in children at 7-8 years of age in Flanders, Belgium.

AIM: Evaluation of the coverage of primary diphtheria-tetanus-pertussis (DTP), poliomyelitis, hepatitis B (HBV) and measles-mumps-rubella (MMR) vaccine doses recommended before the age of 18 months in 7-year-old school children in Flanders, Belgium. Meningococcal serogroup C and DT-polio vaccines offered respectively as catch-up and booster vaccinations were also evaluated. METHODS: Parents of 792 children born in Flanders in 1997 and selected by cluster sampling were interviewed at home in 2005. Vaccination data since infancy were collected retrospectively from vaccination documents and school health records. RESULTS: Coverage rates were 88.0% for the first dose of MMR, and 72.0%, 84.2% and 91.4% for the recommended HBV, DTP and poliomyelitis primary vaccine doses, respectively. These rates included catch-up of missed infant MMR (4.9%) and HBV (6.4%) vaccinations. In addition, 88.3% of the target group received the DT-polio booster dose recommended at 6 years of age and 83.1% a meningococcal C vaccine dose. Preventive public health services as well as private physicians were involved to a varying extent. A lower socioeconomic status of the family was associated with a higher risk of nonvaccination. CONCLUSION: Vaccinators in Flanders reach children relatively well during infancy and at school age, but catch-up of missed infant vaccine doses, especially MMR, should be optimized.

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa.

AIM: This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. BACKGROUND: Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. METHOD: A cross-sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews. FINDINGS: Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0.05), but less HIV/AIDS training when compared to PHC nurses (P < 0.001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0.001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0.01) and training (P < 0.05). Three out of four nurses reported that they practised universal precautions (76.1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. CONCLUSION: There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.

Vaccination coverage in 14-year-old adolescents: documentation, timeliness, and sociodemographic determinants.

OBJECTIVE: The objective of this study was to measure the coverage and influencing determinants of hepatitis B virus, measles-mumps-rubella, and Meningococcus serogroup C vaccination in 14-year-old adolescents in Flanders, Belgium, in 2005. METHODS: A total of 1500 adolescents who were born in 1991 and were living in Flanders were selected with a 2-stage cluster sampling technique. Home visits to copy vaccination documents and complete a questionnaire on sociodemographic and other related factors were conducted by trained interviewers. Only documented vaccination dates were accepted. Missing data were, when possible, retrieved through medical charts of the School Health System. RESULTS: For 1344 (89.6%) adolescents, a home visit was performed. Vaccination coverage was 75.7% for the third dose of hepatitis B virus, 80.6% for the first dose and 83.6% for the second dose of measles-mumps-rubella, and 79.8% for Meningococcus serogroup C. Only 74.6% of the adolescents had proof of 2 measles-mumps-rubella vaccines. Although 1006 (74.8%) adolescents had vaccination data available at home at the time of the interview, only 427 (31.8%) were able to show written proof of all studied vaccines. The probably underestimated coverage rates are well below World Health Organization recommendations, but timeliness of vaccinations was respected. Univariate logistic regression showed that unemployment of the father as proxy measure of socioeconomic status was detrimental for vaccination status, in contrast to partial employment of the mother, which was a favorable factor. Previously unreported determinants of lower coverage rates inferred from this study are single divorced parents, larger families (> or = 4 children), lower adolescent educational level, enrollment in special education, and repeating a grade. CONCLUSIONS: Insufficient documentation is a major barrier in this vaccination coverage study. More attention should go to those with the lowest coverage rates, such as adolescents from large families, with separated parents, and with a lower socioeconomic background.

Infant vaccination coverage in 2005 and predictive factors for complete or valid vaccination in Flanders, Belgium: an EPI-survey.

To assess changes in infant vaccination coverage in Flanders since 1999, an EPI-survey was performed in 2005. The parents of 1354 children aged 18-24 months were interviewed at home and the vaccination documents were checked. Several factors possibly related to vaccination status were examined with parametric and non-parametric methods. The coverage rate of recommended vaccines, i.e. poliomyelitis, tetanus-diphtheria-pertussis, H. influenzae type b (Hib), hepatitis B, measles-mumps-rubella (MMR) and meningococcal C, reached at least 92.2%, which is a significant rise for MMR, hepatitis B and Hib since 1999. The vaccinating physician, the employment situation of the mother and the family income were significant predictive factors for having received all recommended vaccine doses (complete schedule), also when considering only doses that were according to minimal age and interval criteria (valid schedule).

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital.

BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with.

Introduction of assistive devices: home nurses' practices and beliefs.

AIMS: This paper reports a study describing home nurses' intention and current practices regarding introducing assistive devices, and investigating whether their practice is related to social cognitive factors (attitudes, subjective norms and self-efficacy). BACKGROUND: Home nurses not only care for patients in particular medical domains, but also educate and guide them towards more independence. Patients with age-related disabilities in mobility and self-care might benefit from the use of assistive devices. A home nurse might be the first and only person to discuss the disability and use of an assistive device. Therefore, home nurses' beliefs about the introduction of assistive devices could affect their daily practices. METHODS: A cross-sectional study was conducted with a convenience sample of 64 home nurses chosen from a random sample of home nursing departments. The home nurses completed a self-administered questionnaire. The Theory of Planned Behaviour framework was used to develop the social cognitive measures regarding each of the six steps distinguished in the introduction of assistive devices. RESULTS: Home nurses had positive attitudes and high levels of intention, subjective norm and self-efficacy towards most steps of the decision process to introduce assistive devices. In a multiple linear regression analysis, attitude and self-efficacy predicted intention to introduce assistive devices to older clients with disabilities. Intention was correlated to home nurses' current practices. CONCLUSIONS: The findings suggest that conditions are present to involve home nurses more explicitly in the introduction of assistive devices to their patients. Social cognitive factors should be taken into account when developing interventions that aim to support home nurses to do this.

Implementing evidence-based medicine in general practice: a focus group based study.

BACKGROUND: Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. METHODS: We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. RESULTS: A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. CONCLUSION: In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.