HIV Epidemics in the European Region: Vulnerability and Response

This report provides a systematic review of the evidence on HIV vulnerability and response in all 53 countries of the WHO European Region, stretching from Iceland to the borders of China. It focuses on key populations most at risk of HIV infection: people who inject drugs, sex workers and men who have sex with men. It confirms that these populations are disproportionately affected by the growing HIV epidemic in Europe. Twenty-five percent of HIV diagnoses in Europe are associated with injecting drug use, with much higher proportions in Eastern Europe (33%) than in Western Europe (5%) and Central Europe (7%). Sex between men accounted for 10% of all HIV diagnoses, with higher rates reported in Western Europe (36%), followed by Central Europe (22%) and Eastern Europe (0.5%). HIV remains relatively low among female sex workers who do not inject drugs, (less than 1%), but higher among those who inject drugs (over 10%) as well as among male and transgender sex workers. The analysis highlights the pivotal role of social and structural factors in shaping HIV epidemics and HIV prevention responses. Poverty, marginalization and stigma contribute to the HIV epidemic in Europe and Central Asia. Economic volatility and recession risks are increasing vulnerability to HIV and infections. Barriers to successful HIV responses include the criminalization of sex work, of sex between men, and of drug use combined with social stigmatization, violence and rights violations. HIV prevention requires social and environmental change. The report calls for policymakers and HIV program implementers to target the right policies and programs to maximize the health and social impacts of Europe’s HIV responses and get higher returns on HIV-related investments. The report is a product of a collaboration between the World Bank, the London School of Hygiene and Tropical Medicine, the WHO Regional Office for Europe and UNAIDS

Midwest Cancer Alliance: Partnership to Support Quality Cancer Care

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionOver 85% of cancer patients nationwide receive care in the community setting (NCI, 2007). In 2008, the Midwest Cancer Alliance (MCA) launched with a vision of marshaling the exceptional cancer resources of the region to support the system of care provided to patients while keeping them “close to home”. With an emphasis on education and research, the MCA was developed to connect hospitals and physician groups across Kansas and western Missouri with the purpose of: Providing strong support to community cancer care professionals; Enhancing cancer care for patients across the region; Advancing access to innovative, investigator-initiated and cooperative group clinical trials; Advancing access to newly developed therapies and prevention strategies; Providing continuing professional and community education opportunities; Facilitating second opinion and consultation services; and Providing patient navigator technical assistance across the network. A membership-based organization, the MCA currently has 14 partners spanning the region including: Children's Mercy Hospital and Clinics; Goodland Regional Medical Center; Hays Medical Center; Kansas Bioscience Authority; Kansas State University; Mt. Carmel Regional Medical Center; Promise Regional Medical Center; Saint Luke's Health; Salina Regional Health Center; St. Francis Health Center; Stormont-Vail HealthCare; Stowers Institute for Medical Research; Truman Medical Center; The University of Kansas Hospital. Methods: In collaboration with members, the MCA facilitates a wide-array of cancer related services. Activities range from developing clinical trial infrastructure including, a centralized Institutional Review Board (IRB), online Velos clinical trials management software to facilitate enrollment and trial data management, and access to Southwest Oncology Group (SWOG), Clinical Trials Support Unit (CTSU) sponsored trials, and research initiated by The University of Kansas Cancer Center's Investigators. MCA provides professional and community education specific to the needs of the community. Members have access to The University of Kansas Cancer Center Tumor Boards as well as continuing education such as chemotherapy and oncology nurse certification curricula. Results: Numerous cancer-related activities have occurred since the inception of the MCA. Over 11,450 individuals attended MCA community education and screening events. 6,200 cancer screenings resulted in 470+ referrals back to local physicians for follow-up on abnormal results. Over 3,096 Continuing Nursing Education (CNE) credits and 296 Continuing Medical Education (CME) credits. Five members have capacity to enroll patients through MCA sponsored trials with access to SWOG and CTSU. 7 cases have been presented at tumor boards. 9 second opinion consultations occurred through the use of telemedicine technology. Discussion: Less than three percent of adult cancer patients participate in clinical trials (Christian & Trimble, 2003). The MCA was established, in part, to address disparities such as this, in an effort to enhance the excellent cancer care provided across the region. The MCA appears to hold great promise of achieving this vision, by leveraging region's collective cancer resources and cancer expertise

Replacement of Enterococcus faecalis by Enterococcus faecium as the predominant enterococcus in UK bacteraemias

Objectives To review temporal changes in the proportions of different Enterococcus species recorded in two UK bacteraemia surveillance systems. Antibiotic resistance trends were also considered. Methods We reviewed data for enterococci from 2001 to 2019 in: (a) the BSAC Resistance Surveillance Programme, which collected up to 7–10 bloodstream enterococci every year from each of 23–39 hospitals in the UK and Ireland and tested these centrally; and (b) PHE bacteraemia surveillance, using routine results from NHS microbiology laboratories in England. Results BSAC surveillance, based upon 206–255 enterococci each year (4486 in total), indicated that the proportion of Enterococcus faecium rose from 31% (212/692) in the period 2001–3 to 51% (354/696) in the period 2017–19, balanced by corresponding falls in the proportion of Enterococcus faecalis. PHE surveillance provided a larger dataset, with >5000 enterococcus reports per year; although its identifications are less precise, it too indicated a rise in the proportion of E. faecium. BSAC surveillance for E. faecium indicated no consistent trends in resistance to ampicillin (≥86% in all years), vancomycin (annual rates 19%–40%) or high-level resistance to gentamicin (31%–59%). Resistance to vancomycin remained <4% in E. faecalis in all years, whilst high-level resistance to gentamicin fell, perhaps partly reflecting the decline of two initially prevalent gentamicin- and ciprofloxacin-resistant clones. Conclusions Both surveillance systems indicate a growing proportion of E. faecium in enterococcal bloodstream infections. This is important because fewer therapeutic options remain against this frequently multiresistant species than against E. faecalis

Curriculum-based outdoor learning for children aged 9-11: A qualitative analysis of pupils’ and teachers’ views

The relationship between child health, wellbeing and education demonstrates that healthier and happier children achieve higher educational attainment. An engaging curriculum that facilitates children in achieving their academic potential has strong implications for educational outcomes, future employment prospects, and health and wellbeing during adulthood. Outdoor learning is a pedagogical approach used to enrich learning, enhance school engagement and improve pupil health and wellbeing. However, its non-traditional means of achieving curricular aims are not yet recognised beyond the early years by education inspectorates. This requires evidence into its acceptability from those at the forefront of delivery. This study aimed to explore headteachers’, teachers’ and pupils’ views and experiences of an outdoor learning programme within the key stage two curriculum (ages 9–11) in South Wales, United Kingdom. We examine the process of implementation to offer case study evidence through 1:1 interviews with headteachers (n = 3) and teachers (n = 10) and focus groups with pupils aged 9–11 (n = 10) from three primary schools. Interviews and focus groups were conducted at baseline and six months into implementation. Schools introduced regular outdoor learning within the curriculum. This study found a variety of perceived benefits for pupils and schools. Pupils and teachers noticed improvements in pupils’ engagement with learning, concentration and behaviour, as well as positive impacts on health and wellbeing and teachers’ job satisfaction. Curriculum demands including testing and evidencing work were barriers to implementation, in addition to safety concerns, resources and teacher confidence. Participants supported outdoor learning as a curriculum-based programme for older primary school pupils. However, embedding outdoor learning within the curriculum requires education inspectorates to place higher value on this approach in achieving curricular aims, alongside greater acknowledgment of the wider benefits to children which current measurements do not capture