Why don’t young women go for Chlamydia testing? A qualitative study employing Goffman’s stigma framework

Many women who might be at risk of having the sexually transmitted infection(STI) Chlamydia trachomatis either delay going, or do not go, for testing. Weaimed to examine the factors that either prevent or discourage Irish young women from going for Chlamydia testing. We conducted in-depth interviews with 35 women in the Republic of Ireland who were between 18 and 29 years of age. Accounts were analysed using Goffman’s stigma framework. Study respondents strongly associated Chlamydia and Chlamydia testing with stigma and felt that only irresponsible, promiscuous risk takers were at risk of contracting the infection. Respondents saw themselves as responsible, moral actors who avoided risk and took good care of their bodies; they were therefore not at risk of having Chlamydia. Going for Chlamydia testing was seen as a risky activity that could shift respondents identities into a negative ‘Other’ category. Respondents feared that if they found themselves in this ‘Other’ category they would open themselves to bullying and ostracism. While a negative act from a medical perspective, for respondents the act of not testing was seen as a positive activity that helped to reinforce their identities as good, ‘worthy’ individuals and avoided negative social consequences that might otherwise arise from the testing process

Chlamydia Screening in Ireland: a pilot study of opportunistic screening for genital Chlamydia trachomatis infection in Ireland (2007-2009). Screening Intervention Report

This report summarises the findings of the Pilot Screening Intervention conducted in Ireland between 2008 and 2009 as part of the Chlamydia Screening in Ireland Pilot study. The studies aimed to pilot screening models and to evaluate their feasibility and effectiveness. The study was commissioned by the Health Protection Surveillance Centre (HPSC) and overseen by the Health Research Board (HRB). It was carried out by a team from the Division of Population Health Sciences at the Royal College of Surgeons (RSCI) in Ireland, the College of Medicine, Nursing and Health Sciences at the National University of Ireland Galway, and Consultants in Public Health Medicine from the Health Service Executive (HSE). ² Ethical approval for study components was provided by Research Ethics Committees of the RCSI, NUI Galway and the Irish College of General Practitioners (ICGP)

Chlamydia Screening in Ireland: a pilot study of opportunistic screening for genital Chlamydia trachomatis infection in Ireland (2007-2009). Summary Integrated Report

Genital Chlamydia trachomatis (CT) infection is the most common curable, bacterial sexually transmitted infection (STI) worldwide [1, 2]. The number of cases notified in Ireland increased from 3,353 in 2005 to 5,781 in 2009 [3]. Notifications have increased since 2004 when legislation requiring laboratory notification came into effect. Chlamydia is usually a ‘silent’ asymptomatic infection, spread without the knowledge of those transmitting and contracting it: most cases remain undetected and thus untreated. It is a major public health problem because it causes pelvic inflammatory disease (PID) in up to 30% of infected women who are not treated, which can lead to ectopic pregnancy and tubal factor infertility, and it also facilitates the transmission of HIV in both women and men [1, 4]. Prevalence studies in Ireland have detected chlamydia in 4–11% of young people [5, 6, 7], with positivity rates of over 10% in some settings [8]. Similar rates have been found in large studies in the United Kingdom (UK) [9], elsewhere in Europe [10] and North America [11]. A 2004 review estimated UK rates of 4–5% for women under 20 years in the general population, and 8–17% in women under 20 years attending sexual health services [9]. The authors of the review assumed, in the absence of data, that males had similar rates. Age under 25 years is considered a risk factor for infection in England [12]. In the English National Chlamydia Screening Programme (NCSP) overall chlamydia positivity rates have averaged 7.6% in men and 9.3% in women, based on a total of 370,012 screening tests reported [13]. Chlamydia screening has become more feasible due to the development of urinebased laboratory tests, which can be used in clinical and non-clinical settings, instead of more invasive and uncomfortable methods such as endocervical and urethral swabs. Urine testing is now the norm for screening men for chlamydia. For these reasons and because most cases are asymptomatic and undetected, especially in women, several countries have introduced chlamydia screening interventions [1]. A 2005 report prepared by the Health Protection Surveillance Centre (HPSC) [14] concluded that an investigation of the feasibility, acceptability and likely uptake of chlamydia screening in various settings in Ireland should be prioritised. It also concluded that agreement on best practice for the management of identified infections and partner notification was urgently needed. Following a competitive tendering process in late 2006, the HPSC, supported by the Health Research Board (HRB), contracted a team of population health and other specialists from the Royal College of Surgeons in Ireland (RCSI), the National University of Ireland Galway (NUIG) and the Health Service Executive (HSE) to conduct a pilot study of chlamydia screening.The study ran from 2007 to 2009. Since 2009, several articles and reports have been published internationally, including reviews and the results of screening studies, which question the case for chlamydia screening in the general population. A systematic review of screening programmes concluded that the available evidence did not justify the establishment of opportunistic chlamydia screening programmes in under-25 year olds in the general population, given methodological weaknesses in the trials cited as justification for screening [4]. A review of the three phases of the English National Chlamydia Screening Programme (NCSP) reported screening coverage levels in the target population of only 4.8% in 2007–2008 [13]; although by 2009–2010, 47% of sexually active young women and 25% of men had been tested [15]. A review by the English National Audit Office [16] concluded that the NCSP had not demonstrated value for money, citing lack of efficiencies in purchasing and logistics. Also, models had shown that annual testing rates of young people of between 26% and 43% would be needed in order to significantly reduce the prevalence of chlamydia [17]. The recent higher coverage levels achieved by the NCSP in reaching these recommended levels is a cause for optimism, and valuable lessons will be learned from the English national programme. However, the potential of opportunistic chlamydia screening to prevent serious morbidity (chiefly pelvic inflammatory disease in women) has been challenged by the results of an important randomised control trial of screening among young female students in London [18]. The trial found that most episodes of PID (30 of 38) would not have been prevented by annual screening as they occurred in women who had tested negative for chlamydia at the start of the 12 months

An outbreak of hepatitis A among injecting drug users

This descriptive study investigated an outbreak of hepatitis A virus (HAV) infection among injecting drug users (IDUs) and their contacts. Twenty-seven cases of acute HAV infection were identified in a 5-month period. Connections with the local injecting drug using (IDU) population were established for 25 of the cases of whom 14 admitted to injecting drug use. HAV RNA genotyping revealed two HAV variants, closely related to variants found in Scandinavian IDUs and in South East Asia. The study demonstrates that once HAV enters the IDU population extensive outbreaks are possible. We recommend that all IDUs should be tested for HAV and hepatitis B virus (HBV) infections and offered combined hepatitis A and B vaccines if non-immune

Intersectoral debate strengthens alliances, advocacy and action for maternal survival in Zambia.

The Health Promotion Research Centre of the National University of Ireland, Galway and the University of Zambia\u27s School of Medicine conducted operational research to understand and address the socio-cultural and gender contexts of maternal survival. Together with an analytical policy and programming review and qualitative research, the project process also involved the convening of ¿Interest Group¿ meetings involving intersectoral stakeholders at Central (Lusaka) and Provincial (Kasama) levels. These meetings aimed to catalyse debate and stimulate advocacy on the project theme by using discussion of qualitative research as entry point. Participants came from government departments, civil society groups, the indigenous health system, academia, technical provider associations, and media, advocacy and human rights organisations

Substance misuse among health care workers.

Substance misuse by healthcare professionals raises many concerns, including the threat to patient care. This review summarizes the recent literature concerning misuse by doctors (physicians), nurses, dentists, undergraduates and other healthcare workers. Self-medication is common among doctors. Specific specialities are noted to be at higher risk, including emergency medicine, psychiatry, anaesthetics, and nurses in high stress specialities. Most studies are descriptive cross-sectional prevalence studies of self-reported substance use. Dedicated treatment programmes are reviewed, including specific treatment services for addicted professionals created at national, regional and local levels. A recognition of the risk of substance misuse should be explicitly included early in the training of healthcare workers. Specialist treatment programmes should be holistic in approach, and should not concentrate solely on substance misuse issues but include the treatment of depression, anxiety, sexual disorders and adjustment disorders

Length of stay and associated costs of obesity related hospital admissions in Ireland.

Background - Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem. Methods - To estimate the length of stay and associated hospital costs for obesity related illnesses a cost of illness study was set up. All discharges from all acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected. A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care. Results - The discharge frequency of obesity related conditions increased from 1.14 in 1997 to 1.49 in 2004 for adults and from 0.81 to 1.37 for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults. Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase. Conclusion - The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda

"Pee-in-a-Pot": acceptability and uptake of on-site chlamydia screening in a student population in the Republic of Ireland

Background:The aim of the study was to explore the acceptability and uptake of on-campus screening using a youth friendly approach in two Third Level higher education institutions (HEIs). This study is part of wider research exploring the optimal setting for chlamydia screening in Ireland. Methods:Male and female students were given the opportunity to take a free anonymous test for chlamydia during a one week programme of "pee-in-a-pot" days at two HEI campuses in the West of Ireland. The study was set up after extensive consultation with the two HEIs and advertised on the two campuses using a variety of media in the two weeks preceding the screening days. Screening involved the provision and distribution of testing packs at communal areas and in toilet facilities. In Ireland, chlamydia notifications are highest amongst 20-29 year olds and hence the screening criterion was aimed at 18-29 year olds. Urine samples were tested using a nucleic acid amplification test (NAAT). Following the screening days, qualitative in-depth interviews were conducted with participants about their experiences of the event. Results:Out of 1,249 test kits distributed in two HEIs, 592 specimens were collected giving a return rate of 47.5%. Tests excluded (54) were due to labelling errors or ineligibility of participants\u27 age. Two thirds of those tested were females and the mean age was 21 years. Overall,3.9% (21/538) of participants tested positive, 5% (17/336) among females and 2% (4/191) among males. Participant interviews identified factors which enhanced student participation such as anonymity, convenience, accessibility of testing, and the informal and non-medical approach to testing. Conclusions:Screening for chlamydia using on-campus "pee-in-a-pot" days is an acceptable strategy in this population. This model can detect and treat asymptomatic cases of chlamydia and avoid many of the barriers associated with testing for sexually transmitted infections (STIs) in clinical settings

Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study

Objectives - To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic. Design - Comparisons before and after the legislation in intervention and control regions. Setting - Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control). Participants - 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up. Main outcome - measures Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms. Results - In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, ¿26.1% to ¿7.3%) but not in Northern Ireland (0% difference, ¿32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great. Conclusion - The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke

Length of stay and associated costs of obesity related hospital admissions in ireland

Background: Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem. Methods: To estimate the length of stay and associated hospital costs for obesity related illnesses a cost of illness study was set up. All discharges from all acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected. A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care. Results: The discharge frequency of obesity related conditions increased from 1.14 in 1997 to 1.49 in 2004 for adults and from 0.81 to 1.37 for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults. Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase. Conclusion: The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda