Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy
The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC). The Bambino Gesù Children's...
Gespeichert in:
| Veröffentlicht in: | BMC public health 2015-07, Vol.15 (1), p.697-697, Article 697 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 697 |
|---|---|
| container_issue | 1 |
| container_start_page | 697 |
| container_title | BMC public health |
| container_volume | 15 |
| creator | Cozza, Vanessa Alfonsi, Valeria Rota, Maria Cristina Paolini, Valerio Ciofi degli Atti, Marta Luisa |
| description | The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC).
The Bambino Gesù Children's Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants' characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009-2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator.
Out of 191 HCWs who participated in the survey, 35.6% reported at least one influenza vaccination during their life; 6.8% adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to |
| doi_str_mv | 10.1186/s12889-015-2067-9 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4513703</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A541413187</galeid><sourcerecordid>A541413187</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-1c073867ddce426fd9671bfd437b572bc670c227b5b4fb4bf0fb97b779eb48ce3</originalsourceid><addsrcrecordid>eNptUktvFSEYJUZja_UHuDEkLnQzFRiGhwuTpvHRpIkudE2AgTtUBq4wU62_Xq631tYYFh_wnXO-Rw4ATzE6xliwVxUTIWSH8NARxHgn74FDTDnuCB3E_Vv3A_Co1guEMBcDeQgOCCOICskOwY9PJc95CTnB7GFIPq4u_dTwUlsbkv6d0HNOGzg5HZcJWl0c_J7LV1fqa-hDGkPaVOibDNRwcWUJulztYXYKcSwuvahwynUbFh1bCXjW4tVj8MDrWN2T63gEvrx7-_n0Q3f-8f3Z6cl5Z6mkS4ct4r1gfByto4T5UTKOjR9pz83AibGMI0tIexjqDTUeeSO54Vw6Q4V1_RF4s9fdrmZ2TSUtRUe1LWFufaqsg7qbSWFSm3yp6IB7jvom8PJaoORvq6uLmkO1LkadXF6rwkxKKhGWskGf_wO9yGtJbTzVNt8GGXjf_0VtdHSqrTy3unYnqk4GiinuseANdfwfVDujm4PNyfnQ_u8Q8J5gS661OH8zI0ZqZxe1t4tqdlE7u6hdw89uL-eG8ccf_S-pWbxw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1780735733</pqid></control><display><type>article</type><title>Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Springer Nature OA/Free Journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Cozza, Vanessa ; Alfonsi, Valeria ; Rota, Maria Cristina ; Paolini, Valerio ; Ciofi degli Atti, Marta Luisa</creator><creatorcontrib>Cozza, Vanessa ; Alfonsi, Valeria ; Rota, Maria Cristina ; Paolini, Valerio ; Ciofi degli Atti, Marta Luisa</creatorcontrib><description>The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC).
The Bambino Gesù Children's Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants' characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009-2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator.
Out of 191 HCWs who participated in the survey, 35.6% reported at least one influenza vaccination during their life; 6.8% adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to < 5 years of service; adjusted-OR: 2.6 for physicians compared to nurses). Patient protection was the main reported reason for vaccination (34.3%); considering influenza a mild disease was the main reason for non-vaccination (36.9%); poor vaccine effectiveness was the main reason for missed annual revaccination (28.8%). Overall, 75% of respondents saw at least one promotion tool; 65.6% of them found the information useful. Hospital VC decreased from 30% in 2009, to 5% in 2012. In 2013, VC was 14%.
Satisfactory influenza VC in HCWs is hard to achieve. In 2013, along with the toolkit implementation, we observed an increase in HCWs' vaccination coverage, nevertheless, it remained unsatisfactory. Tailored information strategies targeting nurses and recently employed HCWs should be implemented. Institution of declination statements, adding influenza vaccination to financial incentive systems, or vaccination requirements should also be considered to increase influenza VC among HCWs.</description><identifier>ISSN: 1471-2458</identifier><identifier>EISSN: 1471-2458</identifier><identifier>DOI: 10.1186/s12889-015-2067-9</identifier><identifier>PMID: 26204896</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Attitude of Health Personnel ; Cross-Sectional Studies ; Female ; Health Personnel - statistics & numerical data ; Health Promotion - organization & administration ; Hospitals, Pediatric ; Humans ; Influenza Vaccines - administration & dosage ; Influenza, Human - prevention & control ; Italy ; Male ; Middle Aged ; Public health ; Surveys and Questionnaires ; Tertiary Healthcare</subject><ispartof>BMC public health, 2015-07, Vol.15 (1), p.697-697, Article 697</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2015</rights><rights>Cozza et al. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-1c073867ddce426fd9671bfd437b572bc670c227b5b4fb4bf0fb97b779eb48ce3</citedby><cites>FETCH-LOGICAL-c494t-1c073867ddce426fd9671bfd437b572bc670c227b5b4fb4bf0fb97b779eb48ce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513703/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513703/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26204896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cozza, Vanessa</creatorcontrib><creatorcontrib>Alfonsi, Valeria</creatorcontrib><creatorcontrib>Rota, Maria Cristina</creatorcontrib><creatorcontrib>Paolini, Valerio</creatorcontrib><creatorcontrib>Ciofi degli Atti, Marta Luisa</creatorcontrib><title>Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy</title><title>BMC public health</title><addtitle>BMC Public Health</addtitle><description>The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC).
The Bambino Gesù Children's Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants' characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009-2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator.
Out of 191 HCWs who participated in the survey, 35.6% reported at least one influenza vaccination during their life; 6.8% adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to < 5 years of service; adjusted-OR: 2.6 for physicians compared to nurses). Patient protection was the main reported reason for vaccination (34.3%); considering influenza a mild disease was the main reason for non-vaccination (36.9%); poor vaccine effectiveness was the main reason for missed annual revaccination (28.8%). Overall, 75% of respondents saw at least one promotion tool; 65.6% of them found the information useful. Hospital VC decreased from 30% in 2009, to 5% in 2012. In 2013, VC was 14%.
Satisfactory influenza VC in HCWs is hard to achieve. In 2013, along with the toolkit implementation, we observed an increase in HCWs' vaccination coverage, nevertheless, it remained unsatisfactory. Tailored information strategies targeting nurses and recently employed HCWs should be implemented. Institution of declination statements, adding influenza vaccination to financial incentive systems, or vaccination requirements should also be considered to increase influenza VC among HCWs.</description><subject>Adult</subject><subject>Attitude of Health Personnel</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Health Personnel - statistics & numerical data</subject><subject>Health Promotion - organization & administration</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Influenza Vaccines - administration & dosage</subject><subject>Influenza, Human - prevention & control</subject><subject>Italy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Public health</subject><subject>Surveys and Questionnaires</subject><subject>Tertiary Healthcare</subject><issn>1471-2458</issn><issn>1471-2458</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNptUktvFSEYJUZja_UHuDEkLnQzFRiGhwuTpvHRpIkudE2AgTtUBq4wU62_Xq631tYYFh_wnXO-Rw4ATzE6xliwVxUTIWSH8NARxHgn74FDTDnuCB3E_Vv3A_Co1guEMBcDeQgOCCOICskOwY9PJc95CTnB7GFIPq4u_dTwUlsbkv6d0HNOGzg5HZcJWl0c_J7LV1fqa-hDGkPaVOibDNRwcWUJulztYXYKcSwuvahwynUbFh1bCXjW4tVj8MDrWN2T63gEvrx7-_n0Q3f-8f3Z6cl5Z6mkS4ct4r1gfByto4T5UTKOjR9pz83AibGMI0tIexjqDTUeeSO54Vw6Q4V1_RF4s9fdrmZ2TSUtRUe1LWFufaqsg7qbSWFSm3yp6IB7jvom8PJaoORvq6uLmkO1LkadXF6rwkxKKhGWskGf_wO9yGtJbTzVNt8GGXjf_0VtdHSqrTy3unYnqk4GiinuseANdfwfVDujm4PNyfnQ_u8Q8J5gS661OH8zI0ZqZxe1t4tqdlE7u6hdw89uL-eG8ccf_S-pWbxw</recordid><startdate>20150724</startdate><enddate>20150724</enddate><creator>Cozza, Vanessa</creator><creator>Alfonsi, Valeria</creator><creator>Rota, Maria Cristina</creator><creator>Paolini, Valerio</creator><creator>Ciofi degli Atti, Marta Luisa</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M1P</scope><scope>M7S</scope><scope>PATMY</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150724</creationdate><title>Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy</title><author>Cozza, Vanessa ; Alfonsi, Valeria ; Rota, Maria Cristina ; Paolini, Valerio ; Ciofi degli Atti, Marta Luisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-1c073867ddce426fd9671bfd437b572bc670c227b5b4fb4bf0fb97b779eb48ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Attitude of Health Personnel</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Health Personnel - statistics & numerical data</topic><topic>Health Promotion - organization & administration</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Influenza Vaccines - administration & dosage</topic><topic>Influenza, Human - prevention & control</topic><topic>Italy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Public health</topic><topic>Surveys and Questionnaires</topic><topic>Tertiary Healthcare</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cozza, Vanessa</creatorcontrib><creatorcontrib>Alfonsi, Valeria</creatorcontrib><creatorcontrib>Rota, Maria Cristina</creatorcontrib><creatorcontrib>Paolini, Valerio</creatorcontrib><creatorcontrib>Ciofi degli Atti, Marta Luisa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Engineering Database</collection><collection>Environmental Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cozza, Vanessa</au><au>Alfonsi, Valeria</au><au>Rota, Maria Cristina</au><au>Paolini, Valerio</au><au>Ciofi degli Atti, Marta Luisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy</atitle><jtitle>BMC public health</jtitle><addtitle>BMC Public Health</addtitle><date>2015-07-24</date><risdate>2015</risdate><volume>15</volume><issue>1</issue><spage>697</spage><epage>697</epage><pages>697-697</pages><artnum>697</artnum><issn>1471-2458</issn><eissn>1471-2458</eissn><abstract>The aims of this study were: a) to evaluate attitudes and practices of health care workers (HCWs) towards influenza vaccination and their opinion regarding a vaccination promotion toolkit; b) to estimate hospital HCWs' influenza vaccination coverage rates (VC).
The Bambino Gesù Children's Hospital (OPBG) is an academic hospital in Italy. Since 2009, free influenza vaccination is offered to HCWs during working hours. In October-December 2013, a communication campaign based on a standardized toolkit was conducted. In December 2013, we performed a cross-sectional survey in a sample of hospital wards, based on a self-administered questionnaire including participants' characteristics; self-reported influenza vaccination history; reasons for vaccination or missed vaccination; opinion regarding the toolkit. Multivariable logistic analysis was used to assess independent predictors of influenza vaccination status. Annual VC for years 2009-2013 was estimated by using the number of seasonal influenza vaccine doses administered to HCWs as numerator, and the number of hospital HCWs as denominator.
Out of 191 HCWs who participated in the survey, 35.6% reported at least one influenza vaccination during their life; 6.8% adhered to annual revaccination. Years of service and professional category were significantly and independently associated with vaccination (adjusted-OR: 2.4 for > 10 years of service, compared to < 5 years of service; adjusted-OR: 2.6 for physicians compared to nurses). Patient protection was the main reported reason for vaccination (34.3%); considering influenza a mild disease was the main reason for non-vaccination (36.9%); poor vaccine effectiveness was the main reason for missed annual revaccination (28.8%). Overall, 75% of respondents saw at least one promotion tool; 65.6% of them found the information useful. Hospital VC decreased from 30% in 2009, to 5% in 2012. In 2013, VC was 14%.
Satisfactory influenza VC in HCWs is hard to achieve. In 2013, along with the toolkit implementation, we observed an increase in HCWs' vaccination coverage, nevertheless, it remained unsatisfactory. Tailored information strategies targeting nurses and recently employed HCWs should be implemented. Institution of declination statements, adding influenza vaccination to financial incentive systems, or vaccination requirements should also be considered to increase influenza VC among HCWs.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>26204896</pmid><doi>10.1186/s12889-015-2067-9</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1471-2458 |
| ispartof | BMC public health, 2015-07, Vol.15 (1), p.697-697, Article 697 |
| issn | 1471-2458 1471-2458 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4513703 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Springer Nature OA/Free Journals; SpringerLink Journals - AutoHoldings |
| subjects | Adult Attitude of Health Personnel Cross-Sectional Studies Female Health Personnel - statistics & numerical data Health Promotion - organization & administration Hospitals, Pediatric Humans Influenza Vaccines - administration & dosage Influenza, Human - prevention & control Italy Male Middle Aged Public health Surveys and Questionnaires Tertiary Healthcare |
| title | Promotion of influenza vaccination among health care workers: findings from a tertiary care children's hospital in Italy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T16%3A26%3A08IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Promotion%20of%20influenza%20vaccination%20among%20health%20care%20workers:%20findings%20from%20a%20tertiary%20care%20children's%20hospital%20in%20Italy&rft.jtitle=BMC%20public%20health&rft.au=Cozza,%20Vanessa&rft.date=2015-07-24&rft.volume=15&rft.issue=1&rft.spage=697&rft.epage=697&rft.pages=697-697&rft.artnum=697&rft.issn=1471-2458&rft.eissn=1471-2458&rft_id=info:doi/10.1186/s12889-015-2067-9&rft_dat=%3Cgale_pubme%3EA541413187%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1780735733&rft_id=info:pmid/26204896&rft_galeid=A541413187&rfr_iscdi=true |