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- Association of Use of a Meningococcus Group B Vaccine With Group B Invasive Meningococcal Disease Among Children in PortugalPublication . Rodrigues, Fernanda M.P.; Marlow, Robin; Simões, Maria João; Danon, Leon; Ladhani, Shamez; Finn, AdamImportance: A 4-component meningococcus group B vaccine (4CMenB) is the only vaccine in use to prevent group B invasive meningococcal disease in young children, but no matched controlled studies have evaluated it. Objective: To determine the association between receipt of 4CMenB and invasive group B meningococcal disease. Design, setting, and participants: Matched incidence density case-control study. Patients presenting from October 2014 to March 2019 were ascertained, with follow-up until death or discharge (last follow-up in June 2019) in 31 pediatric services in Portugal. Children and adolescent residents in Portugal with laboratory-confirmed invasive meningococcal disease were included. Controls, usually 2 per case, with unrelated conditions who were at the same hospital at the same time were matched for sex, age, and residence. Exposures: Immunization with 4CMenB, ascertained from the national database (2-4 doses are recommended, depending on age). Main outcomes and measures: The primary outcome was group B invasive meningococcal disease in fully vaccinated cases compared with controls. The secondary outcomes were all serogroup invasive meningococcal disease in fully vaccinated cases compared with controls and group B and all serogroup invasive meningococcal disease in cases compared with controls who received at least 1 vaccine dose. Results: Of 117 patients with invasive meningococcal disease, 98 were eligible for inclusion and 82 had group B invasive meningococcal disease; 69 were old enough to have been fully vaccinated and considered protected. Among these 69 cases, the median (interquartile range) age was 24 (4.5-196) months, 42 were male, and the median (interquartile range) duration of hospitalization was 8 (0-86) days. Five of 69 cases (7.2%) and 33 of 142 controls (23.1%) were fully vaccinated (difference, -16.0% [95% CI, -26.3% to -5.7%]; odds ratio [OR], 0.21 [95% CI, 0.08-0.55]). For all serogroup invasive meningococcal disease, 6 of 85 cases (7.1%) and 39 of 175 controls (22.3%) were fully vaccinated (difference, -15.2% [95% CI, -24.3% to -6.1%]; OR, 0.22 [95% CI, 0.09-0.53]). For group B disease, 8 of 82 cases (9.8%) and 50 of 168 controls (29.8%) received at least 1 vaccine dose (difference, -20.0% [95% CI, -30.3% to -9.7%]; OR, 0.18 [95% CI, 0.08-0.44]) and for all serogroup invasive meningococcal disease, 11 of 98 cases (11.2%) and 61 of 201 controls (30.3%) received at least 1 vaccine dose (difference, -19.1% [95% CI, -28.8% to -9.5%]; OR, 0.23 [95% CI, 0.11-0.49]). Conclusions and relevance: During the first 5 years of vaccine availability in Portugal, vaccination with 4CMenB was less likely among children who developed invasive meningococcal disease compared with matched controls without invasive meningococcal disease. These findings may help inform the use of the 4CMenB vaccine in clinical practice. Trial registration: ISRCTN Identifier: ISRCTN10901628.
- Understanding influenza vaccination among Portuguese elderly: the social ecological frameworkPublication . Machado, Ausenda; Santos, Ana João; Kislaya, Irina; Larrauri, Amparo; Nunes, BaltazarThis study intended to identify and quantify the social ecological model (SEM) levels associated to seasonal IV uptake in the Portuguese elderly population. Data from the 2014 National Health Survey was restricted to individuals aged 65+ years (n = 5669). Twenty-three independent variables were allocated to the SEM levels: individual, interpersonal, organizational, community and policy. Sex stratified and age adjusted analysis using Poisson regression were performed for each level and for a fitted full model. Relative reduction in pseudo R magnitude measured marginal contribution of each level. For men and women, older groups (85+ vs. 65-69; men, PR = 1.59 and women, PR = 1.56); having 3+ chronic conditions (men, PR = 1.39 and women, PR = 1.35); previous 4 weeks GP and outpatient visits were associated to higher IV uptake. For men, only 2 SEM levels were associated (individual and organizational) while for women the community level was also relevant. Main marginal contribution came from individual (17.9% and 16.3%) and organizational (30.7% and 22.7%) levels. This study highlights the importance of individual characteristics, access and use of health care services for the IV uptake and the sex differential behaviour.
- Harmonized definition of occupational burnout: a systematic review, semantic analysis, and Delphi consensus in 29 countriesPublication . Guseva Canu, Irina; Marca, Sandy Carla; Dell'Oro, Francesca; Balázs, Ádám; Bergamaschi, Enrico; Besse, Christine; Bianchi, Renzo; Bislimovska, Jovanka; Koscec Bjelajac, Adrijana; Bugge, Merete; Busneag, Carmen Iliana; Çağlayan, Çiğdem; Cernițanu, Mariana; Costa Pereira, Cristiana; Dernovšček Hafner, Nataša; Droz, Nadia; Eglite, Maija; Godderis, Lode; Gündel, Harald; Hakanen, Jari J; Iordache, Raluca Maria; Khireddine-Medouni, Imane; Kiran, Sibel; Larese-Filon, Francesca; Lazor-Blanchet, Catherine; Légeron, Patrick; Loney, Tom; Majery, Nicole; Merisalu, Eda; Mehlum, Ingrid Sivesind; Michaud, Laurent; Mijakoski, Dragan; Minov, Jordan; Modenese, Alberto; Molan, Marija; van der Molen, Henk; Nena, Evangelia; Nolimal, Dusan; Otelea, Marina; Pletea, Elisabeta; Pranjic, Nurka; Rebergen, David; Reste, Jelena; Schernhammer, Eva; Wahlen, AnnyObjective: A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods: First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results: We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion: This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.