The Hepatitis C Awareness Through to Treatment (HepCATT) study: improving the cascade of care for hepatitis C virus-infected people who inject drugs in England.

BACKGROUND AND AIMS: Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention [Hepatitis C Awareness Through to Treatment (HepCATT)] in drug and alcohol clinics-primarily, on engagement of HCV-positive PWID with therapy and, secondarily, on testing for HCV, referral to hepatology services and start of HCV treatment. DESIGN AND SETTING: A non-randomized pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics. PARTICIPANTS: Analysis included all attendees at the intervention and control specialist addiction clinics identified as PWID. INTERVENTION: The intervention comprised the placement of a half-time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engagement of diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments and introduction of dried blood-spot testing. MEASUREMENTS: For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV-positive, engaged with HCV therapy or treated. FINDINGS: Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (P < 0.001) more in the HepCATT centres than controls, up + 31 percentage points [95% confidence interval (CI) = 19-43] versus -12 (CI = -31 to + 6) and odds ratio (OR) = 9.99 (CI = 4.42-22.6) versus 0.35 (CI = 0.08-1.56). HepCATT centres also had greater increases in HCV testing (OR = 3.06 versus 0.78, P < 0.001), referral to hepatology (OR = 9.60 versus 0.56, P < 0.001) and treatment initiation (OR = 9.5 versus 0.74, P < 0.001). CONCLUSIONS: Introducing a half-time facilitator into drug and alcohol clinics in England increased engagement of HCV-positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.

Evaluación del estado de salud mental de los cuidadores de pacientes con enfermedades crónicas no transmisibles de la comunidad de El Llano, provincia Peravia, República Dominicana, durante el período noviembre-diciembre 2019 / Evaluation of mental health status in caregivers of patients with chronic non-communicable diseases of the community of El Llano, Peravia Province, Dominican Republic, during the period November-December 2019

Introducción: el Síndrome del cuidador (CIE-11 QF27) se define como una respuesta inadecuada al estrés emocional crónico, que no aparece exclusivamente en los cuidadores y cuyas principales características son el agotamiento físico y/o psicológico1. Es una entidad de gran prevalencia en la actualidad, y ello se debe tanto al aumento de la esperanza de vida como al auge de las enfermedades crónicas no transmisibles, estas últimas incapacitando a la población y aumentando el número de cuidadores formales e informales, que surgen para atender las necesidades de los afectados2. Objetivos: evaluar el estado de salud mental en cuidadores de pacientes con enfermedades crónicas no transmisibles de la comunidad de El Llano, provincia de Peravia, República Dominicana. Metodología: estudio transversal, prospectivo, observacional y analítico. Se seleccionó una muestra de 115 personas, con un nivel de confianza del 95 % y un margen de error del 8 %, a las que se les aplicaron los cuestionarios. Las variables del cuestionario incluyeron edad, sexo, fecha de la información recolectada, así como los cuestionarios estandarizados de Goldberg para depresión y ansiedad en atención primaria, Cuestionario para la sobrecarga de Zarit y fragmentos del Cuestionario para cuidadores primarios. Además, se incluyó un formulario para adquirir el consentimiento informado. Resultados: se encontró que el 63 % de los cuidadores podía sufrir depresión, el 52 % podía sufrir ansiedad y el 71 % de los cuidadores no presentaba sobrecarga. Sin embargo, la sobrecarga no es suficiente para explicar el comportamiento de depresión (r2=-0,27) o ansiedad (r2=-0,14), ya que ambos demostraron una correlación positiva muy baja. Se demostró que un 76 %, correspondiente a 87 cuidadores, eran del sexo femenino. También la edad fue una variable importante, el 45 % de los cuidadores se encontraron entre las edades de 41-60 años. Conclusiones: la sobrecarga presentada por los encuestados no fue suficiente para explicar los niveles de depresión y ansiedad, por lo tanto, se debe correlacionar con más variables.

Introduction: The Caregiver Stress Syndrome (ICD-11 QF27) is defined as an inadequate response to chronic emotional stress, which does not appear exclusively in caregivers and whose main features are physical and/or psychological exhaustion1. It is an entity of great prevalence nowadays, and this is due both to the increase in life expectancy and to the rise of chronic non-communicable diseases, the latter disabling the population and increasing the number of formal and informal caregivers, who emerge to meet the needs of those affected2. Objectives: Evaluate the mental health status in caregivers of patients with chronic non-communicable diseases of the community of El Llano, Peravia province, Dominican Republic. Methodology: Cross-sectional, prospective, observational, and analytical study. A sample of 115 people was selected, with a 95% confidence level and 8% margin of error, to which the questionnaires were applied. The questionnaire variables included age, gender, date of collected information, as well as Goldberg's standardized questionnaires for depression and anxiety in primary care, Zarit Burden Interview, and fragments of the Primary Caregivers Questionnaire. Additionally, a form to acquire informed consent was included. Results: It was found that 63% of caregivers could suffer from depression, 52% could suffer from anxiety, and 71% of caregivers did not present burden. Meanwhile, the overload is not enough to explain the behavior of depression (r2=-0.27), or anxiety (r2=-0.14) since both demonstrated a very low positive correlation. It was shown that 76% corresponding to 87 caregivers were female. Age was also an important variable, 45% of the caregivers were between the ages of 41-60 years. Conclusions: The overload presented by the respondents was not sufficient to explain the levels of depression and anxiety, hence should be correlated with other variables.

Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments.

OBJECTIVES: To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine. DESIGN: Analysis of replies to postal questionnaire surveys. SETTING: United Kingdom. PARTICIPANTS: 1326 doctors who qualified in 1999. MAIN OUTCOME MEASURE: Reasons for considering leaving. RESULTS: Of 1047 doctors who indicated that they would stay in medicine but not necessarily in the United Kingdom, 65% (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41% (433) gave reasons concerning working conditions in UK medicine; and 18% (184) gave positive work related reasons, such as wanting to work in developing countries. Of 279 doctors considering leaving medicine, 75% (210) cited working conditions, 23% (63) cited lifestyle reasons, and 9% (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78% (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67% (28) cited working conditions. CONCLUSIONS: The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine. The preference for a different lifestyle, particularly to live outside the United Kingdom, is not readily amenable to policy changes to the medical working environment. The smaller numbers of doctors who gave work experience as a reason for considering leaving medicine might be influenced to stay by improvements in working lives.

Pre-registration house officers' comments on working in the NHS: a qualitative study of the views of UK medical graduates of 1999.

The authors aimed to report the views of pre-registration house officers (PRHOs) on their experience of working in the UK National Health Service (NHS). All doctors who qualified from UK medical schools in 1999 were surveyed towards the end of their pre-registration year. Structured questions concerning career choices and experiences were accompanied by a form inviting free-text comment. Comments were transcribed and coded by topic. Those related to working conditions were selected for analysis. Respondents commented that aspects of the PRHO year had been enjoyable but were critical of working conditions. For instance: heavy workloads caused working hours to regularly contravene contractual limits, out-of-hours pay did not accurately reflect responsibilities, out-of-hours facilities were sometimes poor. A few respondents' experiences had deterred them from continuing their NHS hospital training. Most PRHOs had enjoyed the year despite poor working conditions; for a few, their educational experience was marred.