Antibiotic use in the treatment of chronic wounds

Chronic wounds cause substantial morbidity and healthcare costs and prevalence is rising as the population ages and diabetes increases. Microbes are ubiquitous in chronic wounds, with Staphylococcus aureus and Pseudomonas aeruginosa commonplace. Antibiotic resistance is also widespread and increasing. Patients with chronic wounds are exposed to many antibiotic resistance risk factors. This study investigated antibiotic consumption by patients with chronic wounds and the prevalence of and risk factors for antibiotic resistant organisms in such wounds. Finally, the impact of resistance on the cost of treatment was investigated. Antibiotic consumption by patients with chronic wounds treated in primary care was significantly higher than matched patients without chronic wounds. This included greater quantities of flucloxacillin, co-amoxiclav, metronidazole, and ciprofloxacin. The prevalence of antibiotic resistant organisms in chronic wounds of patients attending a specialist wound-healing clinic was investigated. No patients carried vancomycin- resistant enterococci in their wounds. The prevalence of methicillin-resistant S. aureus (MRSA) was 10%. No wound characteristics were associated with MRSA. Carriage was associated with previous MRSA and 'other' systemic antibiotics. The prevalence of ciprofloxacin-resistant P. aeruginosa was 11%. Exploratory analysis identified previous antibiotics (specifically ciprofloxacin, 'other' topical antimicrobials and 'other' systemic antibiotics) and wound aetiology as risk factors. Healing wounds were less likely to carry ciprofloxacin-resistant P. aeruginosa. Treatment costs for venous leg ulcers were explored using Markov models: one year's treatment, following presentation, cost £1008. Antibiotic resistance prevalence had little impact on cost. The frequency of nursing visits (for healed and active ulcers), cost of hospital appointments and cost of nurses had the greatest impact. In summary, antibiotics are commonly used in primary care management of chronic wounds. However ciprofloxacin and 'other' systemic antibiotics may be associated with carriage of antibiotic resistant organisms. The impact of resistance on treatment costs of venous ulcers is small, provided effective alternatives are available

Using behavioural insights to improve the healthiness of children’s packed lunches.

Background Childhood obesity continues to rise in the UK from 9.3% in children aged 4-5 years to 19.8% by age 10-11. Only 1 in 100 school packed lunches meet national recommendations for school meals in England with 82% containing unhealthy snacks and 61% sugar sweetened drinks. Encouraging parents to identify healthier choices could reduce added sugar content and improve the healthiness of school lunches. Methods A cluster randomised controlled trial was implemented in 17 primary schools (8 intervention, 9 control) in England. The intervention comprised of 3 packs of materials delivered to parents who make children lunches (7-11 years). Materials were designed using behavioural-insights to raise awareness of added sugar and offer healthier options. The materials were delivered over a 4-week period in intervention schools. Photographs of the contents of the packed lunches were taken at 3 time points; 1719 pre-intervention, 1745 post-intervention & 1725 at 3 month follow-up. Visible items in each photograph were coded for nutritional content. A parental survey was conducted at post follow up to explore parental knowledge, attitudes and beliefs about healthier packed lunches. Results The coding and analysis is underway and findings will be presented in November. Presented data will describe group differences pre-intervention, post-intervention and follow up from the >5000 lunch boxes for 1) the number lunch boxes that contain surgery food; 2) the average number of sugary food items; 3) the average grams of sugar in lunch boxes; and 4) the proportion of lunch boxes that contain fruit or vegetables. Conclusions This study was funded by Public Health England to explore whether low cost, low intensive interventions can have a significant impact on changing health behaviours. There is a lack of evidence on improving the nutritional quality of packed lunches and if improvements are identified there are potential implications for child health, nutrition and obesity rates. Key messages: •The study aims to ascertain the effectiveness of a behavioural-insight informed intervention in changing the healthiness of packed lunches provided by parents of primary school aged children. •This low cost, low intensity intervention has the potential to improve the healthiness of primary school age children’s diets.Public Health Englan

"...they should be offering it": a qualitative study to investigate young peoples' attitudes towards chlamydia screening in GP surgeries

<p>Abstract</p> <p>Background</p> <p>Despite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP) to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP) surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group).</p> <p>Methods</p> <p>We undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically.</p> <p>Results</p> <p>GP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgemental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them.</p> <p>Conclusion</p> <p>Young people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgemental attitude and minimising barriers to screening such as embarrassment. The GP surgery is the ideal place to screen young people for chlamydia as it is not a threatening place for them and our study has shown that they think it is the normal place to go to discuss health matters.</p

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

<p>Abstract</p> <p>Background</p> <p>General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.</p> <p>Methods</p> <p>Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.</p> <p>Results</p> <p>Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.</p> <p>Conclusion</p> <p>The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.</p

Can uptake of childhood influenza immunisation through schools and GP practices be increased through behaviourally-informed invitation letters and reminders: two pragmatic randomized controlled trials

Background: The UK is rolling out a national childhood influenza immunisation programme for children, delivered through primary care and schools. Behaviourally-informed letters and reminders have been successful at increasing uptake of other public health interventions. Therefore, we investigated the effects of a behaviourally-informed letter on uptake of the vaccine at GP practices, and of a letter and a reminder (SMS/ email) on uptake at schools. Methods and results: Study 1 was a cluster-randomised parallel trial of 21,786 two- and three-year olds in 250 GP practices, conducted during flu season (September to January inclusive) 2016/7. The intervention was a centrally-sent behaviourally-informed invitation letter, control was usual care. The proportion of two- and three-year olds in each practice who received a vaccination by 31st January 2017 was 23.4% in the control group compared to 37.1% in the intervention group (OR = 1.93; 95% CI = 1.82, 2.05, p < 0.001). Study 2 was a 2 (behavioural letter vs standard letter) × 2 (reminder vs no reminder) factorial trial of 1108 primary schools which included 3010 school years 1–3. Letters were sent to parents from providers, and reminders sent to parents from the schools. In the standard-letter-no-reminder arm, an average of 61.6% of eligible children in each school year were vaccinated, compared to 61.9% in the behavioural-letter-no-reminder arm, 63.5% in the standard-letter-plus-reminder arm, and 62.9% in the behavioural-letter-plus reminder condition, F(3, 2990) = 2.68, p = 0.046. In a multi-level model, with demographic variables as fixed effects, the proportion of eligible students in the school year who were vaccinated increased with the reminder, β = 0.086 (0.041), p < 0.036, but there was no effect of the letter nor any interaction effect. Conclusion: Sending a behaviourally informed invitation letter can increase uptake of childhood influenza vaccines at the GP surgery compared to usual practice. A reminder SMS or email can increase uptake of the influenza vaccine in schools, but the effect size was minimal. Trial registration: Study 1: Trial registration: ClinicalTrials.gov Identifier: NCT02921633. Study 2: Trial registration: ClinicalTrials.gov Identifier: NCT02883972

Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study

Objective To investigate frequency and risk factors for prevalent, incident, and persistent carcinogenic human papillomavirus (HPV) in young women before the introduction of immunisation against HPV types 16 and 18 for schoolgirls

Acetyl-CoA synthetase 2 promotes acetate utilization and maintains cancer cell growth under metabolic stress

A functional genomics study revealed that the activity of acetyl-CoA synthetase 2 (ACSS2) contributes to cancer cell growth under low-oxygen and lipid-depleted conditions. Comparative metabolomics and lipidomics demonstrated that acetate is used as a nutritional source by cancer cells in an ACSS2-dependent manner, and supplied a significant fraction of the carbon within the fatty acid and phospholipid pools. ACSS2 expression is upregulated under metabolically stressed conditions and ACSS2 silencing reduced the growth of tumor xenografts. ACSS2 exhibits copy-number gain in human breast tumors, and ACSS2 expression correlates with disease progression. These results signify a critical role for acetate consumption in the production of lipid biomass within the harsh tumor microenvironment

Establishing the impact of COVID-19 on the health outcomes of domiciliary care workers in Wales using routine data: a protocol for the OSCAR study

Introduction Domiciliary care workers (DCWs) continued providing social care to adults in their own homes throughout the COVID-19 pandemic. Evidence of the impact of COVID-19 on health outcomes of DCWs is currently mixed, probably reflecting methodological limitations of existing studies. The risk of COVID-19 to workers providing care in people's homes remains unknown. Objectives To quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, to explore causes of variation, and to extrapolate to the rest of the UK DCW population. Methods Mixed methods design comprising cohort study of DCWs and exploratory qualitative interviews. Data for all registered DCWs in Wales is available via the SAIL Databank using a secured, privacy-protecting encrypted anonymisation process. Occupational registration data for DCWs working during the pandemic will be combined with EHR outcome data within the SAIL Databank including clinical codes that identify suspected and confirmed COVID-19 cases. We will report rates of suspected and confirmed COVID-19 infections and key health outcomes including mortality and explore variation (by factors such as age, sex, ethnicity, deprivation quintile, rurality, employer, comorbidities) using regression modelling, adjusting for clustering of outcome within Health Board, region and employer. A maximum variation sample of Welsh DCWs will be approached for qualitative interview using a strategy to include participants that vary across factors such as sex, age, ethnicity and employer. The interviews will inform the quantitative analysis modelling. We will generalise the quantitative findings to other UK nations. Discussion Using anonymised linked occupational and EHR data and qualitative interviews, the OSCAR study will quantify the risk of COVID-19 on DCWs' health and explore sources of variation. This will provide a secure base for informing public health policy and occupational guidance

A framework for the development of a global standardised marine taxon reference image database (SMarTaR-ID) to support image-based analyses

Video and image data are regularly used in the field of benthic ecology to document biodiversity. However, their use is subject to a number of challenges, principally the identification of taxa within the images without associated physical specimens. The challenge of applying traditional taxonomic keys to the identification of fauna from images has led to the development of personal, group, or institution level reference image catalogues of operational taxonomic units (OTUs) or morphospecies. Lack of standardisation among these reference catalogues has led to problems with observer bias and the inability to combine datasets across studies. In addition, lack of a common reference standard is stifling efforts in the application of artificial intelligence to taxon identification. Using the North Atlantic deep sea as a case study, we propose a database structure to facilitate standardisation of morphospecies image catalogues between research groups and support future use in multiple front-end applications. We also propose a framework for coordination of international efforts to develop reference guides for the identification of marine species from images. The proposed structure maps to the Darwin Core standard to allow integration with existing databases. We suggest a management framework where high-level taxonomic groups are curated by a regional team, consisting of both end users and taxonomic experts. We identify a mechanism by which overall quality of data within a common reference guide could be raised over the next decade. Finally, we discuss the role of a common reference standard in advancing marine ecology and supporting sustainable use of this ecosystem