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BackgroundTo control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. ObjectiveThis study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. MethodsThis was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. ResultsCurrent behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31). ConclusionsSelf-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission.

Objective To understand the experiences and perceptions of people implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries, and the mechanisms by which this process can achieve its intended outcomes. Methods In June 2022, we systematically searched seven databases for qualitative studies of stakeholders implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries. Two reviewers independently screened articles and assessed their quality. We used thematic synthesis to derive descriptive themes and a realist approach to understand the context-mechanism--outcome configurations. Findings Fifty-nine studies met the inclusion criteria. Good outcomes (improved quality of care or reduced mortality) were underpinned by a functional action cycle. Mechanisms for effective death surveillance and response included learning, vigilance and implementation of recommendations which motivated further engagement. The key context to enable effective death surveillance and response was a blame-free learning environment with good leadership. Inadequate outcomes (lack of improvement in care and mortality and discontinuation of death surveillance and response) resulted from a vicious cycle of under-reporting, inaccurate data, and inadequate review and recommendations, which led to demotivation and disengagement. Some harmful outcomes were reported, such as inappropriate referrals and worsened staff shortages, which resulted from a fear of negative consequences, including blame, disciplinary action or litigation. Conclusion Conditions needed for effective maternal and/or perinatal death surveillance and response include: separation of the process from litigation and disciplinary procedures; comprehensive guidelines and training; adequate resources to implement recommendations; and supportive supervision to enable safe learning. Objectif Comprendre les experiences et perceptions des individus charges de mettre en oeuvre la surveillance des deces maternels et perinatals et la riposte dans les pays a revenu faible et intermediaire, ainsi que les mecanismes utilises pour que ce processus atteigne ses objectifs. Methodes En juin 2022, nous avons analyse systematiquement sept bases de donnees a la recherche d'etudes qualitatives sur les intervenants responsables du processus de surveillance des deces maternels et perinatals et de la riposte dans les pays a revenu faible et intermediaire. Deux reviseurs ont passe separement les articles en revue afin d'evaluer leur qualite. Nous avons ensuite utilise une synthese thematique pour extraire des themes descriptifs et une approche realiste permettant d'identifier les configurations contexte-mecanisme-resultat. Resultats Nous avons inclus 59 etudes correspondant aux criteres d'inclusion. Les resultats positifs (amelioration de la qualite des soins ou diminution de la mortalite) reposaient sur un cycle fonctionnel d'actions. Parmi les mecanismes favorisant la surveillance et la riposte contre les deces figuraient une experience instructive, la vigilance et l'application de recommandations, ce qui motivait les acteurs a participer. Un environnement educatif depourvu de culpabilisation et bien dirige offrait un contexte optimal pour garantir l'efficacite de la surveillance et de la riposte. Au contraire, les resultats insatisfaisants (absence d'amelioration des soins et de la mortalite, interruption du processus de surveillance et de riposte contre les deces) etaient lies a un cercle vicieux fait de sous-declaration des deces, de renseignements inexacts, mais aussi d'analyses et de recommandations inadequates, entrainant une demotivation et un manque d'engagement. Certains resultats nefastes ont egalement ete rapportes, tels que des references inappropriees et une aggravation du manque de personnel, suscites par la crainte de consequences negatives (blames, sanctions disciplinaires ou litiges). Conclusion Plusieurs conditions sont requises pour assurer une surveillance et une riposte efficaces contre les deces maternels et/ ou perinatals: separer ce processus des procedures disciplinaires et des litiges; proposer un ensemble de formations et de lignes directrices; fournir les ressources necessaires a la mise en reuvre des recommandations; et enfin, opter pour une supervision constructive, propice a un environnement educatif sans danger. Objetivo Comprender las experiencias y percepciones de las personas que implementan la vigilancia y la respuesta a la mortalidad materna o perinatal en los paises de ingresos bajos y medios, y los mecanismos por los que este proceso puede alcanzar los resultados previstos. Metodos En junio de 2022, se realizaron busquedas sistematicas en siete bases de datos para encontrar estudios cualitativos de las partes interesadas que implementan la vigilancia y la respuesta a la mortalidad materna o perinatal en paises de ingresos bajos y medios. Dos revisores analizaron de forma independiente los articulos y evaluaron su calidad. Se utilizo la sintesis tematica para derivar temas descriptivos y un enfoque realista para comprender las configuraciones de contexto, mecanismo y resultado. Resultados Cincuenta y nueve estudios cumplieron los criterios de inclusion. Los resultados satisfactorios (mejora de la calidad de la atencion o reduccion de la mortalidad) se sustentaron en un ciclo de accion funcional. Los mecanismos para una vigilancia y respuesta eficaces a la mortalidad incluyeron el aprendizaje, la vigilancia y la aplicacion de recomendaciones que motivaron un mayor compromiso. El contexto clave para hacer posible una vigilancia y respuesta eficaz a la mortalidad fue un entorno de aprendizaje libre de culpa con un buen liderazgo. Los resultados insuficientes (falta de mejora en la atencion y la mortalidad e interrupcion de la vigilancia y la respuesta a la mortalidad) fueron el resultado de un circulo vicioso de falta de notificacion, datos inexactos y revision y recomendaciones inadecuadas, que condujeron a la desmotivacion y la falta de compromiso. Se notificaron algunos desenlaces perjudiciales, como las derivaciones incorrectas y una mayor falta de personal, que se debieron al miedo a las consecuencias negativas, como la culpa, las medidas disciplinarias o los litigios. Conclusion Entre los requisitos necesarios para que la vigilancia y la respuesta a la mortalidad materna o perinatal sean eficaces se encuentran los siguientes: separacion del proceso de los litigios y los procedimientos disciplinarios; directrices y formacion exhaustivas; recursos adecuados para aplicar las recomendaciones; y una supervision de apoyo que permita el aprendizaje seguro., Introduction Many low- and middle-income countries are still far from attaining the sustainable development goals to reduce maternal and child mortality; one of the main obstacles is poor quality of [...]

Background: Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low‐ and middle‐income countries (LMICs). Objectives: To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation. Search Strategy: Terms for maternal or perinatal death reviews and qualitative studies. Selection Criteria: Qualitative studies regarding implementation of MPDSR in LMICs. Data Collection and Analysis: We coded the included studies using the Theoretical Domains Framework and COM‐B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR. Main Results: Fifty‐nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame‐free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action). Conclusions: Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders. Synopsis: Implementation of MPDSR could be improved by introducing changes to reduce negative consequences, strengthening data collection tools, mobilizing resources, and building capabilities of all stakeholders. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. Aim: To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. Design & setting: A qualitative study using semi-structured interviews with community pharmacists in England. Method: Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. Results: In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Conclusion: Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory tract infections (ARTIs) are the most common cause of morbidity and mortality worldwide, with most people experiencing at least one episode per year. Current treatment options are mainly symptomatic therapy. Antivirals, antibiotics, and glucocorticoids are of limited benefit for most infections. Traditional Chinese medicine has shown potential benefits in the treatment of ARTIs. Objective: The objective of this study was to determine the efficacy, effectiveness, and safety of Phragmites communis Trin. (P. communis, a synonym of Phragmites australis (Cav.) Trin. ex Steud) as monotherapy or as part of an herb mixture for ARTIs. Method: Eight databases and two clinical trial registries were searched from inception to 8 February 2023 for randomized controlled trials (RCTs) evaluating any preparation involving P. communis without language restrictions. The Risk of Bias Tool 2.0 was used to assess the risk of bias of the included trials. RevMan 5.3 software was used for data analyses with effects estimated as risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs) with 95% confidence intervals (CIs). The online GRADEpro tool was used to assess the certainty of the evidence, if available. Results: Forty-two RCTs involving 6,879 patients with ARTIs were included, with all trials investigating P. communis as part of an herbal mixture. Of the included trials, the majority (38/42) were considered high risk. Compared to the placebo, P. communis preparations improved the cure rate [RR = 1.60, 95% CI (1.13, 2.26)] and fever clearance time [MD = −2.73 h, 95% CI (−4.85, −0.61)]. Compared to usual care alone, P. communis preparations also significantly improved the cure rate [RR = 1.57, 95% CI (1.36, 1.81)] and fever clearance time [SMD = −1.24, 95% CI (−2.37, −0.11)]. P. communis preparations plus usual care compared to usual care alone increased the cure rate [RR = 1.55, 95% CI (1.35, 1.78)], shortened the fever clearance time [MD = −19.31 h, 95% CI (−33.35, −5.27)], and improved FEV1 [ MD = 0.19 L, 95% CI (0.13, 0.26)] and FVC [ MD = 0.16 L, 95% CI (0.03, 0.28)]. Conclusion: Low- or very low-certainty evidence suggests that P. communis preparations may improve the cure rate of ARTIs, shorten the fever clearance time in febrile patients, and improve the pulmonary function of patients with acute exacerbation of chronic obstructive pulmonary disease or chronic bronchitis. However, these findings are inconclusive and need to be confirmed in rigorously designed trials. [ABSTRACT FROM AUTHOR]