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

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Why don't we understand the public health impact of developing STI services in primary care?

Sohal et al have attempted to evaluate the public health and economic impact of incentivized primary care services on 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 UK(1;2), and elsewhere(3)

Evaluating records for free text content

The PREP team is interested in electronic health records. This project aims to make data in records more usable for researchers. We work on electronic health records with a particular focus on free text (unstructured data) that is not directly amenable to statistical analysis. Our aim is to develop strategies for making available, for research and audit purpose, medical information that is “concealed” from researchers in the free text notes, using primary care electronic patient record (EPR) as an example

2008 sexual health in the South East: a collaborative report by Health Protection Agency South East and the South East Public Health Observatory

Surveillance of sexually transmitted infections (STIs) and HIV is undertaken byt he Health Protection Agency (HPA), but is usually presented in isolation from the variety of paublic health indicators which can help interpret these data. Deficits in surveillance data on sexually transmitted infections diagnosed and managed in primary care can present difficulties in the commissioning of services at local level. In this report, we attempt to bring together a range of routine data, and newly analysed data including estimates from primary care datasets, which we anticipate will assist public health professionals and commissioners in needs assessment and in the planning of services. The data presented here supplement and contextualise the routine surveillance data published by the Health Prtoection Agency, in its annual reports and in the quarterly Local Sexual Health Profiles provided to the region's NHS community

Chunking clinical text containing non-canonical language

Free text notes typed by primary care physicians during patient consultations typically contain highly non-canonical language. Shallow syntactic analysis of free text notes can help to reveal valuable information for the study of disease and treatment. We present an exploratory study into chunking such text using off-the-shelf language processing tools and pre-trained statistical models. We evaluate chunking accuracy with respect to part-of-speech tagging quality, choice of chunk representation, and breadth of context features. Our results indicate that narrow context feature windows give the best results, but that chunk representation and minor differences in tagging quality do not have a significant impact on chunking accuracy

Imported malaria in the UK, 2005 to 2016: estimates from primary care electronic health records

Objective To investigate trends in the incidence of imported malaria in the UK between 2005 and 2016. Design Analysis of longitudinal electronic health records (EHRs) in The Health Improvement Network (THIN) primary care database. Setting UK primary care Participants In total, we examined 12,349,003 individuals aged 0 to 99 years. Outcome measure The rate of malaria recordings in THIN was calculated per year between 2005 and 2016. Rate ratios exploring differences by age, sex, location of general practice, socioeconomic status and ethnicity were estimated using multivariable Poisson regression. Results A total of 1,474 individuals with a first diagnosis of malaria were identified in THIN between 2005 and 2016. The incidence of recorded malaria followed a decreasing trend dropping from a rate of 3.33 in 2005 to 1.36 cases per 100,000 person years at risk in 2016. Multivariable Poisson regression showed that adults of working age (20 to 69 years), men, those registered with a general practice in London, higher social deprivation and non-white ethnicity were associated with higher rates of malaria recordings. Conclusion There has been a decrease in the number of malaria recordings in UK primary care over the past decade. This decrease exceeds the rate of decline reported in national surveillance data; however there are similar associations with age, sex and deprivation. Improved geographic information on the distribution of cases and the potential for automation of case identification suggests that EHRs could provide a complementary role for investigating malaria trends over time

'MMR talk' and vaccination choices: an ethnographic study in Brighton

In the context of the high-profile controversy that has unfolded in the UK around the measles, mumps and rubella (MMR) vaccine and its possible adverse effects, this paper explores how parents in Brighton, southern England, are thinking about MMR for their own children. Research focusing on parents’ engagement with MMR has been dominated by analysis of the proximate influences on their choices, and in particular scientific and media information, which have led health policy to focus on information and education campaigns. This paper reports ethnographic work including narratives by mothers in Brighton.Our work questions such reasoning in showing how wider personal and social issues shape parents’ immunisation actions. The narratives by mothers show how practices around MMR are shaped by personal histories, by birth experiences and related feelings of control, by family health histories, by their readings of their child’s health and particular strengths and vulnerabilities, by particular engagements with health services,by processes building or undermining confidence,and by friendships and conversations with others,which are themselves shaped by wider social differences and transformations. Although many see vaccination as a personal decision which must respond to the particularities of a child’s immune system, ‘MMR talk’, which affirms these conceptualisations, has become a social phenomenon in itself. These perspectives suggest ways in which people’s engagements with MMR reflect wider changes in their relations with science and the state

What does validation of cases in electronic record databases mean? The potential contribution of free text

Electronic health records are increasingly used for research. The definition of cases or endpoints often relies on the use of coded diagnostic data, using a pre-selected group of codes. Validation of these cases, as ‘true’ cases of the disease, is crucial. There are, however, ambiguities in what is meant by validation in the context of electronic records. Validation usually implies comparison of a definition against a gold standard of diagnosis and the ability to identify false negatives (‘true’ cases which were not detected) as well as false positives (detected cases which did not have the condition). We argue that two separate concepts of validation are often conflated in existing studies. Firstly, whether the GP thought the patient was suffering from a particular condition (which we term confirmation or internal validation) and secondly, whether the patient really had the condition (external validation). Few studies have the ability to detect false negatives who have not received a diagnostic code. Natural language processing is likely to open up the use of free text within the electronic record which will facilitate both the validation of the coded diagnosis and searching for false negatives

The public health importance of scabies in community domiciliary care settings: an exploratory cross-sectional survey of health protection teams in England

Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies

Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review

Objective: To examine the effectiveness of methods to improve partner notification by patient referral (index patient has responsibility for informing sex partners of their exposure to a sexually transmitted infection). Design: Systematic review of randomised trials of any intervention to supplement simple patient referral. Data sources: Seven electronic databases searched (January 1990 to December 2005) without language restriction, and reference lists of retrieved articles. Review methods: Selection of trials, data extraction, and quality assessment were done by two independent reviewers. The primary outcome was a reduction of incidence or prevalence of sexually transmitted infections in index patients. If this was not reported data were extracted according to a hierarchy of secondary outcomes: number of partners treated; number of partners tested or testing positive; and number of partners notified, located, or elicited. Random effects meta-analysis was carried out when appropriate. Results: 14 trials were included with 12 389 women and men diagnosed as having gonorrhoea, chlamydia, non-gonococcal urethritis, trichomoniasis, or a sexually transmitted infection syndrome. All studies had methodological weaknesses that could have biased their results. Three strategies were used. Six trials examined patient delivered partner therapy. Meta-analysis of five of these showed a reduced risk of persistent or recurrent infection in patients with chlamydia or gonorrhoea (summary risk ratio 0.73, 95% confidence interval 0.57 to 0.93). Supplementing patient referral with information for partners was as effective as patient delivered partner therapy. Neither strategy was effective in women with trichomoniasis. Two trials found that providing index patients with chlamydia with sampling kits for their partners increased the number of partners who got treated. Conclusions: Involving index patients in shared responsibility for the management of sexual partners improves outcomes. Health professionals should consider the following strategies for the management of individual patients: patient delivered partner therapy, home sampling for partners, and providing additional information for partners