Drop-in clinics for teenagers in Primary Care: a study to determine their acceptability, effectiveness and cost

OBJECTIVE 1) To investigate teenagers views on and use of sexual health services, and to explore barriers to accessing contraception. 2)To see whether the introduction of dedicated nurse-run general practice-based teenage drop-in clinics for sexual health would increase the uptake of contraceptive services by young people as compared to traditional GP servicesDESIGN Qualitative data was collected via Focus Group Discussions and questionnaires. Attendance data for teenagers was obtained from the Health Authority and Family Planning service. Effectiveness and cost were investigated by means of a cluster randomised controlled trial in general practice.SETTING Rural and urban communities in the North and East Devon Health Authority area of South West England.OUTCOME MEASURES .Qualitative data was analysed thematically (perceptions of service providers, sources of advice and guidance, barriers to service use). Quantative data was used to build up a picture ofteenage sexual activity and sevice use. The controlled trial used the proportion of registered teenagers obtaining contraception as its outcome, with an aim to increase this by 10%RESULTS The qualitative data confirmed that many sexually active teenagers are not regularly using contraception in the project area and that serious barriers exist that impede access to contraceptive services. These are explored. The controlled trail results showed that the proportion ofteenagers obtaining contraceptive services was higher overall in case as compared to control practices (an increase of 2.03% against a decrease of 2.22% in control practices), however the target of a 10% increase in contraceptive provision was not met. Case practices showed very great variation in the numbers attending the drop-ins. Those attending the clinics were younger (25% under 16 years) than those using normal GP services and 42% had not previously attended any service.CONCLUSIONS Most teenagers obtain contraceptive services from general practice (especially in rural areas) but issues such as transport, confidentiality and anonymity should be addressed to improve access. This is crucial if government targets to reduce the high rates of teenage pregnancy in the UK are to be achieved. A weekly, hour long nurse-run drop-in sexual health service for teenagers in general practice produced a small increase in the proportion of teenagers obtaining contraception and was popular among teenagers and staff. Longer opening times and other locations might further improve effectivenes

Expanding the Use of Environmental Trading Programs into New Areas of Environmental Regulation

This article identifies the fundamental policy issues that must be dealt with in designing market-based pollution control systems. Market- based pollution control systems are now well established in America air and water pollution control programs. So far, however, the benefits of such systems have been limited by the unease of regulators and others about quality assurance, environmental justice, and other design issues. In order to realize the full potential benefits of market-based programs these issues must be addressed as part of the program design

A study of the elements copper through uranium in Sirius A: Contributions from STIS and ground-based spectra

We determine abundances or upper limits for all of the 55 stable elements from copper to uranium for the A1 Vm star Sirius. The purpose of the study is to assemble the most complete picture of elemental abundances with the hope of revealing the chemical history of the brightest star in the sky, apart from the Sun. We also explore the relationship of this hot metallic-line (Am) star to its cooler congeners, as well as the hotter, weakly- or non-magnetic mercury-manganese (HgMn) stars. Our primary observational material consists of {\em Hubble Space Telescope} ($HST$) spectra taken with the Space Telescope Imaging Spectrograph (STIS) in the ASTRAL project. We have also used archival material from the %\citep/{ayr10}. $COPERNICUS$ satellite, and from the $HST$ Goddard High-Resolution Spectrograph (GHRS), as well as ground-based spectra from Furenlid, Westin, Kurucz, Wahlgren, and their coworkers, ESO spectra from the UVESPOP project, and NARVAL spectra retrieved from PolarBase. Our analysis has been primarily by spectral synthesis, and in this work we have had the great advantage of extensive atomic data unavailable to earlier workers. We find most abundances as well as upper limits range from 10 to 100 times above solar values. We see no indication of the huge abundance excesses of 1000 or more that occur among many chemically peculiar (CP) stars of the upper main sequence. The picture of Sirius as a hot Am star is reinforced.Comment: With 6 Figures and 4 Tables; accepted for publication in Ap

Core intended learning outcomes for tackling health inequalities in undergraduate medicine Curriculum development

© 2015 Williamson et al.; licensee BioMed Central. Background: Despite there being a concerted effort in recent years to influence what doctors can do to tackle health inequalities in the UK, there has been limited policy focus on what undergraduate students need to learn at medical school in preparation for this. This project led by members of the Health Inequalities Group of the Royal College of General Practitioners in collaboration with the Institute of Health Equity, University College London sought to fill this gap. Discussion: We conducted a Delphi poll using our teaching and stakeholder networks. We identified 5 areas for learning focusing on key knowledge and skills. These were population concepts, health systems, marginalised patient groups, cultural diversity and ethics. Summary: These intended learning outcomes about health inequalities represent the best available evidence to date for colleagues seeking to develop core undergraduate medical curricula on the topic

Acute bilateral angle closure glaucoma induced by methazolamide

PURPOSE: To report a case of bilateral acute myopia and angle closure glaucoma after ingestion of methazolamide. METHODS: An interventional case report of a 70-year-old male who developed bilateral, acute myopia and angle closure glaucoma after ingesting methazolamide tablets for the treatment of normal tension glaucoma. RESULTS: Bilateral anterior chamber shallowing associated with ciliary body edema, supraciliary effusions, and shallow posterior choroidal effusions were documented with slit-lamp photography and high-frequency ultrasonography. Near complete resolution of these signs after discontinuation of methazolamide were also documented. CONCLUSION: Methazolamide may be associated with secondary myopia and angle closure glaucoma. Discontinuation of methazolamide leads to resolution of this process, as documented by slit-lamp photography and high-frequency ultrasonography

Nitrogen Budgets of Phloem-Feeding Bark Beetles with and without Symbiotic Fungi

The nitrogen content of plant tissue is low relative to that of herbivores; as a consequence, dietary N can limit the growth and reproduction of herbivores and select for attributes that increase N acquisition. Bark beetles face a particularly severe challenge because the phloem that they consume is very low in nitrogen and phosphorus relative to their requirements. We quantified variation in the phloem concentrations of N and P in the host tree, Pinus taeda, and evaluated the following hypotheses regarding the role of symbiotic fungi in nutrient budgets of the herbivore Dendroctonus frontalis: D. frontalis experience variation in phloem nutrient concentrations across several spatial scales (H1); mycangial fungi enhance the diet of D. frontalis larvae by contributing to the acquisition of N and P (H2); Ophiostoma minus, an apparently antagonistic fungal symbiont, hinders D. frontalis larvae because it does not enhance nutrient concentrations of the phloem as much as mycangial fungi do (H3); and larvae of bark beetle species that lack mycangial fungi must consume more phloem to accomplish the same growth as larvae of D. frontalis (H4). In addition, we developed a general model for the N budgets of herbivorous insects that identifies the possible combinations of dietary and physiological parameters that can allow developmental success on low‐nutrient diets. Spatial variation in phloem N was mostly at the level of trees within sites (a scale of meters) while P mostly varied among sites (a scale of kilometers). Trees with higher N content produced larger D. frontalis adults. Prior to infestation by beetles, phloem nutrient concentrations were very uniform within trees and very low relative to that of the bark beetles (N and P concentrations of D. frontalis adults were 28 and 8 times greater, respectively). During infestation, phloem nutrient concentrations increased overall and became highly variable within trees. Nitrogen concentrations increased from 0.40 ± 0.01% (mean ± 1 se) in uninfested phloem to 0.86 ± 0.03% in the phloem surrounding successfully developing D. frontalis larvae, which are typically associated with one or two species of mutualistic mycangial fungi. Nitrogen concentrations were intermediate in other microhabitats within infested trees, including regions with no adult colonization, with failed larval development, or colonized by the antagonistic bluestain fungus O. minus. We parameterized a general nutrient‐budget model for D. frontalis and a sympatric non‐mycangial bark beetle, Ips grandicollis, which indicated that (1) mycangial fungi provide their benefits by concentrating dietary N for larvae; (2) O. minus may exert its antagonistic effects on D. frontalis larvae by failing to concentrate dietary N as much as mycangial fungi do; (3) non‐mycangial bark beetles meet their N budgets through high consumption of unaltered, low‐N phloem; and (4) larvae should easily meet their P requirements with any combination of consumption rate and development time that allows them to meet their N requirements. Alternative strategies for N acquisition may have general consequences for the population dynamics and community interactions of bark beetles

Public health matters: Innovative approaches for engaging medical students

Background: Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern. Methods: We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline. Results: Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level. Conclusions: The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student–teacher interface

Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs:A qualitative study with service users and providers

BACKGROUND: People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England). METHODS: Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. RESULTS: The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination. CONCLUSIONS: The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries