Developing regional surveillance of sexually transmitted infection: a survey of the views of healthcare professionals in north west England

Current surveillance of sexually transmitted infections in England and Wales relies on aggregated data collected by genitourinary medicine clinics. This system only allows limited analysis especially at a local level. A change to a disaggregate form of data collection could provide additional outputs at a local level. We undertook a survey of the views of those working in the prevention and control of sexually transmitted infections in the North West to determine what additional surveillance outputs would facilitate their work. Of respondents, 89% believed surveillance should deliver between four and nine types of analyses that can only be delivered by a surveillance system that is based on disaggregate data. Respondents indicated that it was acceptable for clinics to provide the data items required but that currently it was not feasible to do so because of workload constraints.     

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos,Nigeria

Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children.Methods: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013.Results: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1–4 years and 186 (58.1%) 5–14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05).Conclusion: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.     

Relationship between the use of hospital services and deprivation score of place of residence among HIV-positive individuals in the north west of England

We used routine surveillance data to investigate whether deprivation relates to hospital admission in a HIV-positive population. HIV-positive individuals living in the poorest areas were more likely to have spent one or more nights in hospital for HIV-related care (adjusted odds ratio = 1.6, p = 0.009, after controlling for infection route, disease stage and demographic variables). This implies that healthcare networks in poorer areas may incur disproportionately greater costs.     

Exploring the influence of family level and socio-demographic factors on women’s decision-making ability over access to reproductive health care services in Balkh province,Afghanistan

Abstract

In this paper, we analyze the family level and socio-demographic factors affecting women’s decision-making ability over access to reproductive health care services in rural communities of Balkh province, Afghanistan. A questionnaire survey was conducted with a total of 176 married women. Using logistic regression analysis, we found that four out of seven variables significantly influenced women’s decision-making ability over access to Reproductive Health Care Services (RHCS): extended family structure (OR = 14.31, p?<?0.01), husbands accompanying their wives to RHCS (OR = 4.12, p?<?0.05), discussing issues related to reproductive health with partner (OR = 3.57, p?<?0.05), and distance from home to a health facility (OR =0.86, p?<?0.01). Therefore, some policies or programs designed to improve husband-wife communication, in particular fostering discussions related to reproductive health and encouraging husbands to accompany their wives to health centers, are recommended to improve women’s decision-making ability over access to RHCS.     

Prioritising elective care: a cost utility analysis of orthopaedics in the north west of England.

STUDY OBJECTIVE: To produce a priority list for purchasers to use when purchasing elective care in the speciality of orthopaedics so that efficiency in health care purchasing (that is, maximising the benefit per unit of resource available for the resident population) can be achieved. DESIGN: The study used cost utility analysis in the elective speciality of orthopaedics. The diagnostic groups in the study were chosen on the basis of those conditions that constituted the greatest proportion of the orthopaedic waiting list, and consequently the greatest proportion of activity within the speciality. Costs were derived by two methods: the extra contractual referral tariff (ECR) and individual patient based costings. Outcome was assessed before surgery and again approximately six months afterwards. The outcome of the procedures was derived in two ways: Rosser and EuroQol indices. SETTING: The study took place at Wrightington hospital, a specialist orthopaedic hospital in north west England. PATIENTS: Prospective assessments were obtained from 99 patients for nine orthopaedics procedures. All the patients were individually interviewed on each occasion. Rosser and EuroQol assessments were completed for each patient by the patient and the patient's consultant before and after surgery. MAIN RESULTS: Priority lists presenting cost utility rankings for each of the procedures were derived from the patients' and consultants' assessments. CONCLUSIONS: It is feasible to generate priority lists in a systematic way. Purchasers may then use the results from these priority lists to help them maximise the benefits per unit of resource for their resident population.     

美沙酮维持治疗门诊受治者艾滋病病毒与丙型肝炎病毒共感染相关因素及交互作用分析

目的 了解美沙酮维持治疗（MMT）门诊受治者HIV/HCV共感染情况,探讨HIV/HCV共感染的相关因素及交互作用。方法 2014年9－11月从广西壮族自治区2所MMT门诊招募MMT受治者750人,进行面对面问卷调查及查阅病例资料,收集一般人口学特征、HIV和HCV感染情况、既往吸毒史、吗啡尿检、高危性行为、共用针具、脱失等信息。采用EpiData 3.1软件和SAS 9.2软件进行数据录入和统计学分析,采用χ²检验单因素分析、logistic回归多因素分析和交互作用,分析HIV/HCV共感染的相关因素。结果 共调查MMT受治者691人,HIV/HCV共感染率为18.31%（127/691）,共用针具者和MMT有脱失者的HIV/HCV共感染率分别为35.84%（81/226）和19.88%（64/322）,均高于非共用针具者（9.89%,46/465）和MMT无脱失者（17.07%,63/369）。控制混杂因素后,共用针具者HIV/HCV共感染的风险是非共用针具者的4.50倍（95% CI：2.72～7.43）,治疗期间有脱失者HIV/HCV共感染的风险较大（OR=1.71,95% CI：1.04～2.80）。共用针具和脱失存在相加交互作用（RERI=4.21,AP=0.44,SI=1.95）,未发现相乘交互作用。结论 MMT受治者存在共用针具和脱失行为,均与HIV/HCV共感染具有明显的相关性,应加强健康教育、心理辅导等措施,减少共用针具和脱失行为。     

Distance,rurality and the need for care: access to health services in South West England

Background  

This paper explores the geographical accessibility of health services in urban and rural areas of the South West of England, comparing two measures of geographical access and characterising the areas most remote from hospitals.     

Down''s syndrome: prevalence and ionising radiation in an area of north west England 1957-91.

OBJECTIVE--To analyse the prevalence of Down's syndrome in a specific, geographical area and seek to explain variations with particular reference to ionising radiation. DESIGN--Cases were ascertained by one paediatrician as part of a prospective survey of major congenital malformations in children born to residents of an area of Lancashire between 1957 and 1991. Temporal changes in prevalence rates were detected by a grid search technique using Poisson log linear models. These models were also used to determine the association between prevalence and ionising radiation from atomic fall out. SETTING--The Fylde district of Lancashire in the north west of England. PATIENTS--There were 167 cases, including five stillbirths and eight terminations, among 124,015 total births in a population which increased from about 250,000 to over 300,000 during the study period. MAIN RESULTS--There was significant increase in the prevalence of all cases conceived in 1963 and 1964, and a lesser peak in 1958 which did not quite reach statistical significance. There was no evidence that the increased prevalence in 1963-64 was a result of changes in the maternal age distribution in the population. Babies of mothers aged 35 years and over accounted for more of the variation, especially in 1958 when their increase was significant. There was a highly significant association between prevalence and radiation from fallout produced by atmospheric testing of atomic weapons. The 1963-64 peak coincided with the maximum estimated radiation dose. The lesser peak in 1958 also coincided with increased exposure to radiation from fallout, possibly enhanced by ground deposits after a fire at the Windscale reactor in October 1957. CONCLUSION--This study provides further support for low dose ionising radiation as one aetiological factor in Down's syndrome.     

Male commuters in north and south England: risk factors for the presence of faecal bacteria on hands

Background  

A previous study found that the prevalence of contamination with bacteria of faecal-origin on the hands of men differed across UK cities, with a general trend of increased contamination in northern cities. The aim of this study was to (1) confirm the north-south trend (2) identify causes for the trend.     

Associations between alcohol related hospital admissions and alcohol consumption in Victoria: Influence of socio-demographic factors

OBJECTIVE: To examine the cross-sectional ecologic associations between apparent per-capita alcohol consumption, alcohol-related hospital admission rates, and the distributions of socio-demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995-1996 fiscal year. METHOD: Visitor-adjusted per-capita alcohol consumption was obtained from wholesale sales data from the Liquor Licensing Commission Victoria. Alcohol-related hospital admission rates were extracted from the Victorian Inpatient Minimum Dataset, and adjusted by the appropriate aetiologic fractions. Summary socio-demographic measures were derived from the 1996 Census. Their associations were analysed using multiple linear regression. RESULTS: Per-capita alcohol consumption ranged from 4 to 14 litres absolute alcohol/year and alcohol-related hospital admission rates ranged from 5 to 25 per 10,000 residents/year (external-cause diagnoses) and 8-37 per 10,000 residents/year (disease diagnoses). Higher levels of per-capita consumption were associated with higher admission rates (r = 0.45 for external cause diagnoses, r = 0.66 for disease diagnoses, and r = 0.70 for all diagnoses), each per-capita increase of one litre/year corresponding to increased admission rates of 0.6, 1.5 and 2.1 per 10,000 person-years, respectively. Further adjustments by summary socio-demographic measures reduced, but did not modify, the associations between per-capita consumption and admission rates. CONCLUSIONS AND IMPLICATIONS: Summary measures of sales-based per-capita alcohol consumption and socio-demographic environments may provide useful indicators of alcohol-related morbidity in Victorian communities.     

Access to quality health services: determinants of access

Access to health care has been the focus of national health policy in recent years, but little attention has been given to local communities and their access issues. This study offers a conceptual framework and an empirical analysis to identify the independent effect of predisposing, enabling, and medical need factors on access to care in a local community. In addition, access limitations related to the health plan and individual providers are incorporated into the access model. A hierarchical logistic regression is used in which the dichotomous dependent variable-residents' overall satisfaction with access to health care is regressed on five blocks of predictor variables. The most influential variables on access are enabling and health plan variables.     

Patient related factors in frequent readmissions: the influence of condition,access to services and patient choice

Background  

People use emergency department services for a wide variety of health complaints, many of which could be handled outside hospitals. Many frequent readmissions are due to problems with chronic disease and are preventable. We postulated that patient related factors such as the type of condition, demographic factors, access to alternative services outside hospitals and patient preference for hospital or non-hospital services would influence readmissions for chronic disease. This study aimed to explore the link between frequent readmissions in chronic disease and these patient related factors.     

Cost of access to health services in Zambia

Equity is an important policy objective in the health care field. The importance of equity in health care provision can be argued from various points of view. As a result governments in all countries attempt to provide health care systems that enable equal access for everyone. Zambia is no exception. In the health care reforms the objective of the national health strategy is to provide Zambians with equity of access to health care. We focus on access defined as the costs (both monetary and time) an individual incurs when visiting a health care facility. Using a survey of 900 households, this article explores equality of access to health care among Zambians. Four areas are compared: urban high cost, urban low cost, townships and rural areas. The results of the analysis indicate that there are inequalities among residential areas, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility. Large distances make it very costly for rural dwellers to seek medical care, especially during the high season for farming. The analysis suggests that obtaining equality of access to health care poses a challenge for the Zambian Government.     

The problems of tracing a geographically widespread outbreak of salmonellosis from a commonly eaten food: Salmonella typhimurium DT193 in north west England and north Wales in 1991.

Geographically widespread outbreaks involving commonly isolated organisms and where the vehicles of infection are commonly eaten foodstuffs pose particular difficulties at a technical and organizational level. An outbreak of Salmonella typhimurium infection, affecting 39 people, spread over a wide area in North West England and North Wales in April and May 1991, was detected thanks to the practice of sending specimens to the national reference laboratory where phage typing and characterizing of antibiotic resistance patterns enabled the identification of a cluster of distinctive isolates (S. typhimurium DT193 resistant to sulphonamides, trimethoprim and furazolidone). An investigation, involving twenty environmental health departments in addition to health authorities and the Public Health Laboratory Service, showed an association between the illness and eating loose sliced cooked ham (P = 0.004). Detailed tracing of the chain of supply of the ham showed this to be particularly cooked ham originating from a single small local producer (P = 0.00003). Further investigation of that producer revealed that a batch of ham distributed on one day in early April was undercooked due to a malfunction in cooking equipment.