Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genito-urinary medicine clinic

Objectives: To compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services. Design: A retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007–April 2009). Participants: All 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM. Primary outcome measure: Whether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity). Results: 131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02). Conclusions: Community screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas

Barriers & facilitators to extended working life : a focus on a predominately female ageing workforce

Many countries are reforming their pension systems so people stay in work for longer to improve the long-term sustainability of public finances to support an increasing older population. This research aimed to explore the factors that enable or inhibit people to extend working life (EWL) in a large UK based retail organisation. Semi-structured interviews were carried out with a purposive sample (n=30): 15 employees aged ≥ 60 and 15 supervisors supporting these employees. Older workers were predominately female, reflecting the gender profile of the older workers in the organisation. Older workers and supervisors reported that key facilitators to EWL were: good health, the perception that older workers are of value; flexibility and choice; the need for an ongoing conversation across the life-course; the social and community aspect of work as a facilitator to EWL; and, the financial necessity to EWL. Perceived barriers to EWL included poor health, negative impacts of work on health, and a lack of respect and support

Health workers’ knowledge, attitude and practice towards Hepatitis B infection in Northern Nigeria

Background: Infection by hepatitis B virus is one of the many challenges in public health today and the tenth leading cause of mortality worldwide. Research has shown that health-care personnel are at higher risk of acquiring the disease than the general population. Aim: The aim of this study was to investigate the relationship between knowledge, attitude and practice among health workers towards hepatitis B infection in Northern Nigeria. Methods: This study used a cross-sectional survey with self-administered questionnaire to gather information from an Ear, Nose and Throat health-care professionals in a tertiary hospital in Northern Nigeria. The data collected was coded and analyzed using SPSS software version 20. Results: A similar numbers of males, 49.5% (53/107), and females, 50.5% (54/107) took part. The overall correctly answered knowledge questions by the professions was 76.9%. A one-way ANOVA between participants showed that there were significant difference between the profession groups in terms of knowledge scores (F4, 102 = 11.5, P< 0.001) and in terms of practice scores between the groups (F4, 102 = 4.1, P<0.01); however, there was no significant difference in attitude between the professional groups (F4, 102 = 0.6, P= 0.68). Multivariate analysis showed that health attendants had the best practice score and did not differ significantly to Doctors (β = −0.1, t =−0.9, P= 0.40). Conclusion: The findings suggest that there is a gap in knowledge and lack of compliance to infection control and preventive measures among health-care professionals. There should be an increased in awareness through campaigns geared towards educating health-care personnel on the dangers of hepatitis B infection. Keywords: Health care workers, Hepatitis B infection, prevention and control, Knowledge, attitude and practice, Developing countrie

Mobilising communities to address alcohol harm : an Alcohol Health Champion approach

In this article, Cathy Ure et al. look at engaging communities in order to reduce alcohol harms. By training Alcohol Health Champions, individuals can support vulnerable friends and family, and work within their communities to influence policy and promote change

Neurodevelopmental outcomes in individuals with fetal alcohol spectrum disorder (FASD) with and without exposure to neglect : clinical cohort data from a national FASD diagnostic clinic

Disentangling the relative developmental impact of prenatal alcohol exposure from postnatal neglect is clinically valuable for informing future service provision. In this study developmental outcomes across groups are compared in a ‘natural experiment’. Methods: Clinical data from 99 persons with fetal alcohol spectrum disorder (FASD) diagnoses were audited. Developmental outcomes (diagnosis of attention deficit hyperactivity disorder, ADHD; social and communication disorder, SCD; or autism spectrum disorder, ASD; Short Sensory Profile, SSP; Vineland II Adaptive Behaviour Scales) were compared across two exposure groups: prenatal alcohol only; and mixed prenatal alcohol and neglect. Results: ADHD (74%) and ASD/SCD (68%) were common, with no significant difference between groups (ADHD, P=0.924; ASD, P=0.742). Vineland age equivalence scores were lower than chronological age (11.1y—prenatal alcohol only—and 12.7y—neglect) across all domains, especially receptive language (3.7y for both groups). Age equivalence did not differ between groups, with the exception of domestic daily living (neglect: 7.7y vs prenatal alcohol only: 5.8y, P=0.027). A probable/definite difference on SSP was more common in the prenatal alcohol only (96% vs 67%, P=0.006). For the individual subscales of SSP, there were no significant differences by neglect category. Discussion: Postnatal neglect in this group did not make the developmental outcome any worse, suggesting that prenatal alcohol influences these outcomes independently. Professionals who support families looking after a child with both FASD and a history of neglect should be aware that the behavioural difficulties are likely to be related to prenatal alcohol exposure and not necessarily reflective of parenting quality

CONNECTING ARTS ACTIVISM, DIVERSE CREATIVITIES AND EMBODIMENT THROUGH PRACTICE AS RESEARCH

Environmental artists are ecologically and politically motivated to change the way we view our world. Artists undertake the production of art and activism, where the art-making becomes more than art; it becomes activism; a way that allows for raising awareness; a way to retrieve, express and communicate a political message. Here, diverse creativities (including intercultural, interdisciplinary, and artistic creativity) enable forms of authorship with particular kinds of power and capacity. In this chapter, We draw on three activist enquiry practices which embody: (i) intercultural creativity through an activist choreographic practice involving a Greenlandic and Scandinavian dance company; (ii) transdisciplinary creativity through an arts-based environmental education practice inspired by an activist sculpture involving a primary school in the UK; and (ii) artistic creativity inspired by an artist activist residency practice in a Higher Education setting in the UK. Each practice features artist-researcher collaborations. Each practice involves arts as activism. Each practice makes explicit an understanding of the body as inscriptor, where the relationship between the body, power and the authoring of diverse creativities is crucial in the embodiment of arts practice as research and arts education. Each practice as research stimulates reflection and discussion by teachers, students, artists, researchers and policy makers interested in what it might mean to live the arts-as-political-as-embodiment in creating practice as research where arts activism, diverse creativities and embodiment is manifest

Understanding and optimising an identification/brief advice (IBA) service about alcohol in the community pharmacy setting

This is the final report of an evaluation into the identification/brief advice (IBA) service about alcohol in community pharmacy settings in the North West of England. Since 2007, almost 100 pharmacies in the North West have - at some point - been commissioned to provide an identification and brief advice (IBA) service for alcohol. This evaluation sought to understand how the service had been adapted for and implemented in the community pharmacy setting, and how its potential might be maximised. Its aims were: 1. To characterise, consolidate and optimise both the constant and variable elements of the pharmacy alcohol identification/brief advice (IBA) service in NHS Northwest, and 2. To inform planning for current and future pharmacy based services promoting safe consumption of alcohol. The evaluation was split into three main workstreams, supported by a preliminary scoping phase, and combined quantitative and qualitative methods: • Descriptive and comparative statistical analysis of pharmacy alcohol IBA data; • In-pharmacy work, including observation of staff engagement with customers, recording consultations between staff and customers, follow-up telephone interviews with customers, and group feedback interviews with pharmacy staff; • Stakeholder engagement through self-completion surveys, semi-structured interviews and a workshop. This report gives the background to the project, and details the methods, results and implications

Using e-cigarettes for smoking cessation : evaluation of a pilot project in the North West of England

Aims: E-cigarettes have been advocated as an effective smoking cessation intervention, with evidence indicating that they are substantially less harmful than conventional cigarettes. As a result, a pilot to encourage people to swap from conventional cigarettes to e-cigarettes was conducted in 2018 in a socially deprived area in the North West of England. This evaluation highlights the key findings from the pilot. Methods: An analysis of secondary data at 4 weeks (n = 1022) was undertaken to predict those who used solely used e-cigarettes (i.e. had quit tobacco, as confirmed by a carbon monoxide test, CO < 10 ppm) from baseline characteristics, using chi-square tests and logistic regression. Baseline data were demographics, smoking levels and service provider type. Results: Of the 1022 participants who engaged with the pilot 614 were still engaged at 4 weeks, of whom 62% had quit; quitting was more likely in younger participants (aged 18–24) and less likely in those who were sick and disabled. Of those who still smoked tobacco at week 4 (n = 226), smoking had reduced from a baseline of 19.1 cigarettes/day to 8.7. Overall, 37% (381) of those initially enrolled were confirmed to be using an e-cigarette on its own at follow-up. Successful quit was associated with occupation (unemployed, 33% vs intermediate, 47%, p = .023) and residing in the less deprived quintiles of deprivation (50% vs 34% in the most deprived quintile, p = .016). Conclusions: Making the conservative assumption that all those not in contact at 4 weeks were still smoking tobacco, for every five people entering the scheme, three people stayed on the programme and reduced their cigarette smoking and one person cut out tobacco altogether. E-cigarettes appear to be an effective nicotine replacement therapy; however, further research is required to determine whether e-cigarette users are more likely to reduce their overall nicotine consumption in the longer term