Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database

Objective: To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990-2000, in the context of increasing incidence of infections in genitourinary medicine clinics. Design: Population based study. Setting: UK primary care. Participants: Patients registered in the UK general practice research database. Main outcome measures: Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. Results: An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998-2000, along with 49.2% cases of non-specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. Conclusions: A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics. Large numbers of men are treated in primary care for presumptive sexually transmitted infections

Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995-2005

Objectives: To provide nationally representative data on trends in HIV testing in primary care and to estimate the proportion of diagnosed HIV positive individuals known to general practitioners (GPs). Methods: We undertook a retrospective cohort study between 1995 and 2005 of all general practices contributing data to the UK General Practice Research Database (GPRD), and data on persons accessing HIV care (Survey of Prevalent HIV Infections Diagnosed). We identified all practice-registered patients where an HIV test or HIV positive status is recorded in their general practice records. HIV testing in primary care and prevalence of recorded HIV positive status in primary care were estimated. Results: Despite 11-fold increases in male testing and 19-fold increases in non-pregnant female testing between 1995 and 2005, HIV testing rates remained low in 2005 at 71.3 and 61.2 tests per 100 000 person years for males and females, respectively, peaking at 162.5 and 173.8 per 100 000 person years at 25–34 years of age. Inclusion of antenatal tests yielded a 129-fold increase in women over the 10-year period. In 2005, 50.7% of HIV positive individuals had their diagnosis recorded with a lower proportion in London (41.8%) than outside the capital (60.1%). Conclusion: HIV testing rates in primary care remain low. Normalisation of HIV testing and recording in primary care in antenatal testing has not been accompanied by a step change in wider HIV testing practice. Recording of HIV positive status by GPs remains low and GPs may be unaware of HIV-related morbidity or potential drug interactions

Primary care consultations and costs among HIV-positive individulas in UK primary care 1995-2005: a cohort study

Objectives: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence. Methods: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record. Results: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications. Conclusion: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways

Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations

Background: Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. Methods: Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. Results: Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. Conclusions: Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses

Resistance training practices of Brazilian Olympic sprint and jump coaches: toward a deeper understanding of their choices and insights (part III)

In the final part of this three-article collection on the training strategies of Brazilian Olympic sprint and jump coaches, we provide a detailed description of the resistance training methods and exercises most commonly employed by these speed experts. Always with the objective of maximizing the sprint and jump capabilities of their athletes, these experienced coaches primarily utilize variable, eccentric, concentric, machine-based, isometric, complex, and isoinertial resistance training methods in their daily practices. Squats (in their different forms), Olympic weightlifting, ballistics, hip thrusts, lunges, calf raises, core exercises, leg curls, stiff-leg deadlifts, and leg extension are the most commonly prescribed exercises in their training programs, during both the preparatory and competitive periods. Therefore, the current manuscript comprehensively describes and examines these methods, with the additional aim of extrapolating their application to other sports, especially those where sprint speed is a key performance factor

Strength and conditioning practices of Brazilian Olympic sprint and jump coaches

Olympic coaches are likely to have adequate knowledge and implement effective training programs. This study aimed to describe and critically examine the strength and conditioning practices adopted by Brazilian Olympic sprint and jump coaches. Nineteen Olympic coaches (age: 50.2 ± 10.8 years; professional experience: 25.9 ± 13.1 years) completed a survey consisting of eight sections: 1) background information; 2) strength-power development; 3) speed training; 4) plyometrics; 5) flexibility training; 6) physical testing; 7) technology use; and 8) programming. It was noticed that coaches prioritized the development of explosiveness, power, and sprinting speed in their training programs, given the specific requirements of sprint and jump events. Nevertheless, unexpectedly, we observed: (1) large variations in the number of repetitions performed per set during resistance training in the off-season period, (2) a higher volume of resistance training prescribed during the competitive period (compared to other sports), and (3) infrequent use of traditional periodization models. These findings are probably related to the complex characteristics of modern competitive sports (e.g., congested competitive schedule) and the individual needs of sprinters and jumpers. Identification of training practices commonly used by leading track and field coaches may help practitioners and sport scientists create more effective research projects and training programs

Automated Device to Enable Passive Pronation and Supination Activities of the Hand for Experimental Testing with Cadaveric Specimens: A Collaboration Between The University of New Mexico and New Mexico Institute of Mining and Technology

In cadaveric research, reproducing physiological conditions under which the specimens would be loaded in vivo is essential to achieve clinical applicability. This is a collaborative study bringing together engineers from The University of New Mexico and New Mexico Institute of Mining and Technology. We describe development of an automated device to enable passive pronation and supination of the hand (rotation achieved through direct manipulation) for use in cadaveric experimental testing of the hand, wrist, forearm, or elbow. We present a brief motivation for development of this device, design details, an overview of one possible application, and ways to use this device for active pronation and supination activities (rotation achieved through tendon loading). We aim to provide the necessary information for reproduction of this device by other institutions for similar testing purposes

A burst search for gravitational waves from binary black holes

Compact binary coalescence (CBC) is one of the most promising sources of gravitational waves. These sources are usually searched for with matched filters which require accurate calculation of the GW waveforms and generation of large template banks. We present a complementary search technique based on algorithms used in un-modeled searches. Initially designed for detection of un-modeled bursts, which can span a very large set of waveform morphologies, the search algorithm presented here is constrained for targeted detection of the smaller subset of CBC signals. The constraint is based on the assumption of elliptical polarisation for signals received at the detector. We expect that the algorithm is sensitive to CBC signals in a wide range of masses, mass ratios, and spin parameters. In preparation for the analysis of data from the fifth LIGO-Virgo science run (S5), we performed preliminary studies of the algorithm on test data. We present the sensitivity of the search to different types of simulated CBC waveforms. Also, we discuss how to extend the results of the test run into a search over all of the current LIGO-Virgo data set.Comment: 12 pages, 4 figures, 2 tables, submitted for publication in CQG in the special issue for the conference proceedings of GWDAW13; corrected some typos, addressed some minor reviewer comments one section restructured and references updated and correcte