Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

<p>Abstract</p> <p>Background</p> <p>Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home.</p> <p>Methods</p> <p>A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts.</p> <p>Results</p> <p>Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers.</p> <p>Conclusions</p> <p>Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.</p

Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva

info:eu-repo/semantics/publishedVersio

Point-of-care testing versus standard practice for chlamydia: a new approach to assessing the public health effect of rapid testing and treatment at local level

Background Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection in Britain. Present standards specify treatment within 14 days of testing positive; point-of-care testing (POCT) can eliminate this delay and potentially reduce loss to follow-up; its greater convenience might increase testing. 90-min nucleic acid amplifi cation tests are the best available POCTs for chlamydia, with alternatives under development. However, cost-eff ectiveness depends on cost-per-test, sensitivity and specifi city, and the eff ect of POCT on transmission. Methods We developed a user-friendly web-based method, based on a transmission-dynamic model for chlamydia, to assess the epidemiological impact and cost-eff ectiveness of introducing POCT in diff erent local settings. The model uses behavioural and prevalence data from the National Survey of Sexual Attitudes and Lifestyles, and Public Health England surveillance data; these data inform on local-level variation, which is represented by sampling parameter values from within their ranges of uncertainty and selecting parameter sets that reproduce local coverage and diagnosis rates. The user can select diff erent local settings, and vary sensitivity and specifi city for the tests, specify costs (fi xed and unit costs, including staff time), and then assess the eff ect of introducing POCT in diff erent clinical services by comparison with a situation with no POCT. In the model, presumptive treatment is represented, which we expect to be reduced with the introduction of POCT because test results would be rapidly available to guide treatment. Findings Changes in numbers of infections and diagnoses occurring under diff erent scenarios (including conventional testing) were estimated, with uncertainty ranges, allowing calculation of total costs, and cost per infection (and serious sequelae) averted, while accommodating the considerable variation in chlamydia testing coverage, positivity, and diagnosis rates. Potential changes in sexual behaviour between test and treatment could determine the relative contribution of increased treatment rates and reduced treatment delay to the reduction in prevalence as a consequence of POCT. Interpretation The eff ect of POCT was dependent on both the test performance characteristics and the assumptions about the implementation of the test across local services. Exploration of many uncertainties surrounding chlamydia epidemiology and screening implementation is possible with this model. This method can complement local and national knowledge, and contribute to local-level management of chlamydia infection

P08.29 Web-tool to assess the cost-effectiveness of chlamydia point-of-care tests at the local level

Introduction Point-of-care tests (POCTs) can eliminate the delay between being tested for chlamydia and receiving the result and treatment, potentially reducing loss to follow-up. However, the cost-effectiveness of POCT implementation depends on multiple factors, including cost-per-test, clinic time, sensitivity and specificity, and the epidemiological impact of POC testing on transmission.Decision-makers consider a complex range of information when determining potential impact of introducing a POCT. To enable commissioners, providers, POCT manufacturers and others to assess the advantages, disadvantages and uncertainty of POCTs for chlamydia in different local settings, we developed a user-friendly web-based tool (POCTiC): www.poctic.uk.netMethods The web-tool is underpinned by a transmission-dynamic model for chlamydia, which uses behavioural and prevalence data from the National Survey of Sexual Attitudes and Lifestyle (Natsal), and reproduces local coverage and diagnosis rates from Public Health England datasets. A user group consisting of industry, sexual health facilitators, sexual health commissioners, clinicians, public health experts, and healthcare consultants, provided input throughout. The model is pre-run, but certain variables (e.g. costs) are user-determined.Results Users can estimate changes in the number of infections and diagnoses occurring under different scenarios, with uncertainty ranges. This allows total costs, and cost per infection averted, to be calculated, while accommodating the considerable variation in chlamydia testing coverage, positivity, and diagnosis rates observed at the local level across England. The epidemiological impact of POC testing is dependent on both test performance characteristics and assumptions about the implementation of the test across local services.Conclusion This tool enables the uncertainties surrounding chlamydia epidemiology and screening implementation to be explored. It also complements local and national knowledge, and contributes to local-level management of chlamydia infection. Users can use the tool to determine the epidemiological impact and cost-effectiveness of implementing POCTs in a particular setting.Disclosure of interest statement This work was funded by Innovate UK. Additional thanks are given to the UK Medical Research Council, the National Institute for Health Research and the Electronic Self-Testing Instruments for Sexually Transmitted Infection (eSTI2) Consortium funded under the UKCRC Translational Infection Research (TIR) Initiative supported by the Medical Research Council (Grant Number G0901608). The funding sources had no involvement in the study design or conduct; the collection, analysis and interpretation of data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or Public Health England.CED was employed for part of the project by the National Chlamydia Screening Programme. Atlas Genetics Ltd. develop POCTs for STIs. EHE, CL, STS and CAG have received funding from Atlas Genetics Ltd. for performance evaluations of STI POCTs.The other authors declare no competing interests