BMC Public Health最新文献

Background: Although many studies have investigated COVID-19 outbreaks in long-term care facilities (LTCFs), evidence that combines multiple clustered levels is scarce. We aimed to describe individual, LTCF, and regional-level factors associated with COVID-19 infections.

Methods: We conducted a nationwide study using insurance claims data from Germany between 1st October 2020 and 31st March 2021. The sample comprised 284,186 residents over 60 years in 9,869 LTCFs across all of Germany's 400 districts. We used multilevel logistic regression to model associations between individual, LTCF, and district-level factors, and the probability of a COVID-19 infection.

Results: A total of 44,042 (15.5%) COVID-19 infections were recorded during the study period. On the individual level, male sex (OR 1.15; 95% CI 1.12-1.18), dementia (OR 1.09; CI 1.06-1.11), medium-severe care dependency level 3 and 4 (OR 1.17; CI 1.12-1.22 / OR 1.21; CI 1.16-1.26) were associated with greater risk of infection. At the LTCF level, infection risks increased with the mean age of residents (OR 1.09; CI 1.03-1.15) and higher resident numbers (OR 1.20; CI 1.14-1.27). On the district level, a higher proportion of public LTCFs was associated with lower infection risks (OR 0.90; CI 0.84-0.97), while a higher mean number of residents (OR 1.16; CI 1.05-1.28), and the district-level SARS-CoV-2 incidence rate among the general population (OR 1.54; CI 1.41-1.67) was associated with higher risks. A cross-level interaction between facility size and COVID-19 prevalence was not significant (p > 0.5).

Conclusion: We found evidence of individual, facility, and regional levels factors associated with COVID-19 infections among older adults in LTCFs. Future measures to combat infections, outbreaks, and pandemics should take an orchestrated multilevel approach.

Background: Field workers or research assistants (RAs) are commonly employed within community-based trials. Training provided for RAs, however, is often limited to the technical elements of research, with little-to-no training to help them navigate the ethical challenges they may encounter while working in community-based settings. The main objective of this study was to explore the challenges faced by RAs working as part of a novel housing initiative, to describe the impact these challenges had on their work and wellbeing, and to outline approaches taken by RAs in facing these challenges.

Methods: A qualitative interview guide was piloted and refined for key informant interviews (KIIs) with research assistants (RAs) working on the Star Homes intervention in Mtwara, southern Tanzania. A total of 16 KIIs were conducted with all available RAs. These data were supplemented with 47 documents that comprised 31 case studies and 16 observation notes. The interviews were conducted in Kiswahili, audio-recorded, transcribed verbatim, and translated into English. All transcripts underwent line-by-line coding in NVivo and were analysed using thematic analysis.

Results: Principal challenges included difficulties related to RAs' roles and responsibilities, including having to travel long distances for data collection. Most prominent, however, were ethical challenges, including witnessing the suffering of study participants. RAs unanimously expressed being most distressed by encountering children who were neglected or subjected to abuse, including several cases of child sexual abuse (CSA), as part of their work.

Conclusions: Clear engagement strategies with communities and authorities are essential to support RAs in reporting and follow-up. Training and resources are urgently needed to prepare field staff, mitigate moral distress, and protect research participants from harmful behaviours.