Integration of medical service provision and nature conservation worldwide 1980–2022: collaborative evidence mapping of 43 projects across 22 countries

Background Biodiversity protection is fundamental to human wellbeing, and, in turn, serving human health in medically underserved areas can sometimes strengthen conservation. We aimed to collaboratively map the evidence on projects worldwide that are, or have been, providing health services with the intention of producing conservation outcomes in addition to health improvements. Methods Scoping indicated many NGO projects are never published in the academic literature. To avoid missing such interventions we asked conservation staff worldwide to contribute data online or through zoom calls. Advertising to join the collaboration was through formal networks (International Union for Conservation of Nature, Planetary Health Alliance, etc.), professional contacts, funders, and a call in The Lancet Planetary Health. Additionally, data and literature were synthesised from libraries and datasets of collaborators at Population Reference Bureau, Sussex Sustainability Research Programme, and Ecological Levers for Health. Findings Forty-three projects from 22 countries fitted inclusion criteria. Around half had not been published in the collected literature, with data only available through direct submission. Tropical wet forest was by far the most common habitat, followed by tropical dry forest, coral reefs, and tropical grasslands. The most represented region was Sub-Saharan Africa with 27 projects, followed by South-East Asia (five), South Asia (five), Oceania (two), South America (two), Central America (one), Europe (one). Projects ranged from basic health interventions bolted on to pre-existing conservation programmes to generate goodwill (e.g., vaccination rounds bordering national parks) to complex schemes jointly acting on health and biodiversity driven (and funded) by concerns for human welfare as much as conservation. Interpretation Synergistic action on biodiversity conservation and health service provision is very often effective and the approach is more widespread than literature would indicate. However, funding was usually provided on a siloed basis for either health or conservation, and this remains a barrier to wider adoption

Against medical ethics: opening the can of worms

In a controversial paper, David Seedhouse argues that medical ethics is not and cannot be a distinct discipline with it own field of study. He derives this claim from a characterization of ethics, which he states but does not defend. He claims further that the project of medical ethics as it exists and of moral philosophy do not overlap. I show that Seedhouse's views on ethics have wide implications which he does not declare, and in the light of this argue that Seedhouse owes us a defence of his characterization of ethics. Further, I show that his characterization of ethics, which he uses to attack medical ethics, is a committed position within moral philosophy. As a consequence of this, it does not allow the relation between moral philosophy and medical ethics to be discussed without prejudice to its outcome. Finally, I explore the relation between Seedhouse's position and naturalism, and its implications for medical epistemology. I argue that this shows us that Seedhouse's position, if it can be defended, is likely to lead to a fruitful and important line of inquiry which reconnects philosophy and medical ethics

Chlamydia screening - benefits and strategy need to be re-evaluated?

No description supplie

How can chlamydia diagnoses increase when their complications are declining?

No description supplie

Commentary on"The impact of establishing a local-enhanced service for treating sexually transmitted infections in primary care"

Sohal et al have attempted to evaluate the public health and economic impact of incentivised primary care services on sexually transmitted infection (STI) diagnoses across a population. In doing so, they have illustrated the difficulties in obtaining information that bedevil the planning of sexual health services in the United Kingdom and elsewhere. A key public health motive for developing such services is the provision of improved access to testing and care. This should be measured in terms of outcomes with potential impact on transmission dynamics, particularly the duration of infectivity.5 How can we tell whether this has been achieved? Measures of access, detailed trends in testing and diagnosis rates and—importantly—measures of partner notification outcomes are essential in making any such assessment. Real challenges still exist describing whole sexual health economies and therefore in comparing them between areas or across time

Why we should not seek individual informed consent for participation in health services research

Ethics committees now require that individuals give informed consent to much health services research, in the same way as for clinical research. This is misguided. Existing ethical guidelines do not help us decide how to seek consent in these cases, and have allowed managerial experimentation to remain largely unchecked. Inappropriate requirements for individual consent can institutionalise health inequalities and reduce access to services for vulnerable groups. This undermines the fundamental purpose of the National Health Service (NHS), and ignores our rights and duties as its members, explored here. Alternative forms of community consent should be actively pursued

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people

Human, economic and organisational challenges in the management of scabies outbreaks in residential care homes

No description supplie

Sex differences in the experience of testing positive for genital chlamydia infection: a qualitative study with implications for public health and for a national screening programme

OBJECTIVES: To explore men's and women's accounts of chlamydia testing, with a view to understanding sex differences in attitudes and in behaviours of public health importance. METHODS: Semistructured interviews with 24 heterosexual patients (12 men; 12 women) diagnosed with genital chlamydia infection, at a large sexual health clinic in central London were transcribed and analysed using qualitative thematic analysis. RESULTS: Participants' expressions revealed important sex differences. Women felt anxious about their future reproductive health, feared stigmatisation, and blamed themselves for contracting chlamydia; whereas men generally reported less concern, were unwilling to disclose their condition to sexual partners, and some men projected attributions of blame onto their partners. Delays in seeking care appeared to be related to perceptions of chlamydia as a relatively minor infection, particularly in men. CONCLUSIONS: Health promotion needs to reflect sex and age differences, emphasising the negative consequences of delayed clinic attendance and exposure to repeat infections. For health professionals to respond appropriately and effectively to increasing numbers of chlamydia infections, there is a need to understand men's avoidant attitudes and behaviours in relation to sexual and reproductive health

“Giving something back”: a systematic review and ethical enquiry into public views on the use of patient data for research in the United Kingdom and the Republic of Ireland

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of dat