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1.
Emerg Infect Dis ; 29(1): 127-132, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36529456

RESUMEN

A single SARS-CoV-2 vaccine dose reduces onward transmission from case-patients. We assessed the potential effects of receiving 2 doses on household transmission for case-patients in England and their household contacts. We used stratified Cox regression models to calculate hazard ratios (HRs) for contacts becoming secondary case-patients, comparing contacts of 2-dose vaccinated and unvaccinated index case-patients. We controlled for age, sex, and vaccination status of case-patients and contacts, as well as region, household composition, and relative socioeconomic condition based on household location. During the Alpha-dominant period, HRs were 0.19 (0.13-0.28) for contacts of 2-dose BNT162b2-vaccinated case-patients and 0.54 (0.41-0.69) for contacts of 2-dose Ch4dOx1-vaccinated case-patients; during the Delta-dominant period, HRs were higher, 0.74 (0.72-0.76) for BNT162b2 and 1.06 (1.04-1.08) for Ch4dOx1. Reduction of onward transmission was lower for index case-patients who tested positive ≥2 months after the second dose of either vaccine.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , Vacuna BNT162 , SARS-CoV-2 , COVID-19/epidemiología , COVID-19/prevención & control , Vacunación , Inglaterra/epidemiología
2.
J Public Health (Oxf) ; 43(2): 425-432, 2021 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-31828318

RESUMEN

BACKGROUND: Local authorities have a crucial role in preparing for the impacts of climate change. However, the extent to which health impacts are being prioritized and acted on is not well understood. METHODS: We investigated the role of public health in adapting to climate change through: (i) a content analysis of local authority climate change adaptation strategies in South West England and (ii) semi-structured telephone interviews with local authority public health consultants and sustainability officers and a regional Public Health England representative (n = 11). RESULTS: Adaptation strategies/plans varied in existence and scope. Public health consultants did not have an explicit remit for climate change adaptation, although related action often aligned with public health's emergency planning functions. Key barriers to health-related adaptation were financial constraints, lack of leadership and limited public and professional awareness about health impacts. CONCLUSIONS: Local authorities in South West England have differing approaches to tackling health impacts of climate change, and the prominence of public health arguments for adaptation varies. Improved public health intelligence, concise communications, targeted support, visible local and national leadership and clarity on economic costs and benefits of adaptation would be useful for local authorities in preparing for the health impacts of climate change.


Asunto(s)
Cambio Climático , Salud Pública , Inglaterra , Humanos , Liderazgo
3.
Sex Transm Infect ; 94(6): 421-426, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29511067

RESUMEN

OBJECTIVES: It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin. METHODS: Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013-2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013-2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012-2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin. RESULTS: Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients. CONCLUSIONS: We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.


Asunto(s)
Antibacterianos/farmacología , Azitromicina/farmacología , Ceftriaxona/farmacología , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Adulto , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Estudios Transversales , Farmacorresistencia Bacteriana/efectos de los fármacos , Inglaterra , Femenino , Gonorrea/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Vigilancia de Guardia
4.
Sex Transm Infect ; 94(5): 320-326, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29431148

RESUMEN

OBJECTIVES: Chlamydia trachomatis is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI). DESIGN: Systematic review and four meta-analyses conducted using random-effects modelling. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017. ELIGIBILITY CRITERIA: Studies reporting rectal chlamydia positivity in heterosexual women aged ≥15 years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics. RESULTS: Fourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95% CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95% CI 0.75 to 1.10). CONCLUSIONS: High levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Coito , Enfermedades del Recto/epidemiología , Recto/microbiología , Australia/epidemiología , Canadá/epidemiología , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/genética , Europa (Continente)/epidemiología , Femenino , Heterosexualidad , Humanos , Tamizaje Masivo , Prevalencia , Enfermedades del Recto/tratamiento farmacológico , Enfermedades del Recto/microbiología , Factores de Riesgo , Parejas Sexuales , Factores Socioeconómicos , Estados Unidos/epidemiología
5.
Sex Transm Infect ; 93(1): 18-24, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27288417

RESUMEN

BACKGROUND: Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark). METHODS: From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values. RESULTS: Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412. CONCLUSIONS: There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.


Asunto(s)
Infecciones por Chlamydia/economía , Epididimitis/economía , Infertilidad Femenina/economía , Tamizaje Masivo , Enfermedad Inflamatoria Pélvica/economía , Embarazo Ectópico/economía , Australia , Canadá , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/terapia , Análisis Costo-Beneficio , Costos y Análisis de Costo , Dinamarca , Epididimitis/etiología , Femenino , Humanos , Infertilidad Femenina/etiología , Irlanda , Masculino , Tamizaje Masivo/economía , Países Bajos , Enfermedad Inflamatoria Pélvica/etiología , Embarazo , Embarazo Ectópico/etiología , Suecia , Reino Unido
6.
Sex Transm Infect ; 93(4): 276-283, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-27979910

RESUMEN

BACKGROUND: Following widespread rollout of chlamydia testing to non-specialist and community settings in the UK, many individuals receive a chlamydia test without being offered comprehensive STI and HIV testing. We assess sexual behaviour among testers in different settings with a view to understanding their need for other STI diagnostic services. METHODS: A probability sample survey of the British population undertaken 2010-2012 (the third National Survey of Sexual Attitudes and Lifestyles). We analysed weighted data on chlamydia testing (past year), including location of most recent test, and diagnoses (past 5 years) from individuals aged 16-44 years reporting at least one sexual partner in the past year (4992 women, 3406 men). RESULTS: Of the 26.8% (95% CI 25.4% to 28.2%) of women and 16.7% (15.5% to 18.1%) of men reporting a chlamydia test in the past year, 28.4% of women and 41.2% of men had tested in genitourinary medicine (GUM), 41.1% and 20.7% of women and men respectively tested in general practice (GP) and the remainder tested in other non-GUM settings. Women tested outside GUM were more likely to be older, in a relationship and to live in rural areas. Individuals tested outside GUM reported fewer risk behaviours; nevertheless, 11.0% (8.6% to 14.1%) of women and 6.8% (3.9% to 11.6%) of men tested in GP and 13.2% (10.2% to 16.8%) and 9.6% (6.5% to 13.8%) of women and men tested in other non-GUM settings reported 'unsafe sex', defined as two or more partners and no condom use with any partner in the past year. Individuals treated for chlamydia outside GUM in the past 5 years were less likely to report an HIV test in that time frame (women: 54.5% (42.7% to 65.7%) vs 74.1% (65.9% to 80.9%) in GUM; men: 23.9% (12.7% to 40.5%) vs 65.8% (56.2% to 74.3%)). CONCLUSIONS: Most chlamydia testing occurred in non-GUM settings, among populations reporting fewer risk behaviours. However, there is a need to provide pathways to comprehensive STI care to the sizeable minority at higher risk.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/terapia , Tamizaje Masivo/estadística & datos numéricos , Salud Reproductiva , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Muestreo , Conducta Sexual/estadística & datos numéricos , Reino Unido/epidemiología , Adulto Joven
7.
Euro Surveill ; 22(5)2017 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-28183393

RESUMEN

To inform mathematical modelling of the impact of chlamydia screening in England since 2000, a complete picture of chlamydia testing is needed. Monitoring and surveillance systems evolved between 2000 and 2012. Since 2012, data on publicly funded chlamydia tests and diagnoses have been collected nationally. However, gaps exist for earlier years. We collated available data on chlamydia testing and diagnosis rates among 15-44-year-olds by sex and age group for 2000-2012. Where data were unavailable, we applied data- and evidence-based assumptions to construct plausible minimum and maximum estimates and set bounds on uncertainty. There was a large range between estimates in years when datasets were less comprehensive (2000-2008); smaller ranges were seen hereafter. In 15-19-year-old women in 2000, the estimated diagnosis rate ranged between 891 and 2,489 diagnoses per 100,000 persons. Testing and diagnosis rates increased between 2000 and 2012 in women and men across all age groups using minimum or maximum estimates, with greatest increases seen among 15-24-year-olds. Our dataset can be used to parameterise and validate mathematical models and serve as a reference dataset to which trends in chlamydia-related complications can be compared. Our analysis highlights the complexities of combining monitoring and surveillance datasets.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis , Tamizaje Masivo/estadística & datos numéricos , Vigilancia de la Población , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Modelos Teóricos , Prevalencia , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Adulto Joven
8.
Euro Surveill ; 22(5)2017 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-28183392

RESUMEN

Between July 2016 and January 2017, 37 confirmed cases of hepatitis A with two unique IA genotype strains primarily among men who have sex with men, were reported across eight areas in England and Northern Ireland. Epidemiological and laboratory investigations indicate that these strains may have been imported several times from Spain, with secondary sexual transmission in the United Kingdom. Local and national public health services are collaborating to control this ongoing outbreak.


Asunto(s)
Brotes de Enfermedades , Virus de la Hepatitis A/genética , Virus de la Hepatitis A/aislamiento & purificación , Hepatitis A/epidemiología , Homosexualidad Masculina , Adulto , Trazado de Contacto , Notificación de Enfermedades , Brotes de Enfermedades/prevención & control , Inglaterra/epidemiología , Genotipo , Hepatitis A/diagnóstico , Hepatitis A/virología , Virus de la Hepatitis A/clasificación , Humanos , Irlanda/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , ARN Viral/sangre , Análisis de Secuencia de ADN , España , Viaje
9.
Sex Transm Infect ; 92(3): 218-27, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26290483

RESUMEN

BACKGROUND: In the context of widespread opportunistic chlamydia screening among young adults, we aimed to quantify chlamydia testing and diagnosis among 16-24 year olds in Britain in relation to risk factors for prevalent chlamydia infection. METHODS: Using data from sexually experienced (≥1 lifetime sexual partner) 16-year-old to 24-year-old participants in Britain's third National Survey of Sexual Attitudes and Lifestyles (conducted 2010-2012), we explored socio-demographic and behavioural factors associated with prevalent chlamydia infection (detected in urine; n=1832), self-reported testing and self-reported diagnosis in the last year (both n=3115). RESULTS: Chlamydia prevalence was 3.1% (95% CI 2.2% to 4.3%) in women and 2.3% (1.5% to 3.4%) in men. A total of 12.3% of women and 5.3% men had a previous chlamydia diagnosis. Factors associated with prevalent infection were also associated with testing and diagnosis (eg, increasing numbers of sexual partners), with some exceptions. For example, chlamydia prevalence was higher in women living in more deprived areas, whereas testing was not. In men, prevalence was higher in 20-24 than 16-19 year olds but testing was lower. Thirty per cent of women and 53.7% of men with ≥2 new sexual partners in the last year had not recently tested. CONCLUSIONS: In 2010-2012 in Britain, the proportion of young adults reporting chlamydia testing was generally higher in those reporting factors associated with chlamydia. However, many of those with risk factors had not been recently tested, leaving potential for undiagnosed infections. Greater screening and prevention efforts among individuals in deprived areas and those reporting risk factors for chlamydia may reduce undiagnosed prevalence and transmission.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Adolescente , Factores de Edad , Actitud , Bacteriuria/microbiología , Infecciones por Chlamydia/diagnóstico , Análisis por Conglomerados , Femenino , Humanos , Entrevistas como Asunto , Estilo de Vida , Modelos Logísticos , Masculino , Prevalencia , Factores de Riesgo , Conducta Sexual , Factores Sociológicos , Reino Unido/epidemiología , Adulto Joven
10.
Eur J Public Health ; 26(3): 382-8, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26498953

RESUMEN

BACKGROUND: In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS: Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS: In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION: Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Encuestas de Atención de la Salud/estadística & datos numéricos , Prevención Primaria/métodos , Europa (Continente) , Encuestas de Atención de la Salud/métodos , Humanos , Prevención Primaria/estadística & datos numéricos , Encuestas y Cuestionarios
11.
Sex Transm Infect ; 91(5): 314-23, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25759476

RESUMEN

BACKGROUND: Active recall can improve reattendance rates and could increase retesting rates and detection of HIV and sexually transmitted infections (STIs), but the best strategy remains uncertain. METHODS: We conducted a systematic review and meta-analysis of active recall for HIV and/or STI testing. We searched six electronic databases using terms for HIV, STIs, tests and active recall (defined as a reminder to retest for HIV/STIs) for randomised, non-randomised and observational English-language studies published between 1983 and 2013. Outcomes included reattendance/retesting rate and STI diagnosis at follow-up. RESULTS: Of 5634 papers identified, 17 met the inclusion criteria. Of the 14 comparative studies, all but one demonstrated higher reattendance/retesting rates in the intervention group, but the range was wide (17.5-89%). Meta-analysis of nine RCTs found reattendance/retesting rates were significantly higher in the intervention versus control groups (pooled OR 2.42 (95% CI 1.84 to 3.19)). In a subgroup analysis, home sampling increased retesting compared with clinic testing (pooled OR 2.20 (95% CI 1.65 to 2.94)). In observational studies SMS reminders increased retesting compared with standard clinic care (pooled OR 2.19 (95% CI 1.46 to 3.29)), but study estimates were highly heterogeneous (I(2)=94%, p<0.001). CONCLUSIONS: Active recall interventions are associated with higher reattendance/retesting rates for HIV/STI. Although home sampling and SMS reminders were associated with higher reattendance/retesting rates in most studies, evidence is limited by the heterogeneity of interventions and control groups and the quality of studies. Further work is needed to explore which active recall modality is clinically cost-effective and acceptable for HIV/STI screening.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Gonorrea/prevención & control , Infecciones por VIH/prevención & control , Tamizaje Masivo , Sífilis/prevención & control , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Citas y Horarios , Infecciones por Chlamydia/diagnóstico , Estudios Transversales , Gonorrea/diagnóstico , Infecciones por VIH/diagnóstico , Investigación sobre Servicios de Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sistemas Recordatorios , Sífilis/diagnóstico , Envío de Mensajes de Texto
12.
Sex Transm Infect ; 91(6): 412-4, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26294693

RESUMEN

OBJECTIVES: Chlamydia prevalence in the general population is a potential outcome measure for the evaluation of chlamydia control programmes. We carried out a pilot study to determine the feasibility of using a postal survey for population-based chlamydia prevalence monitoring. METHODS: Postal invitations were sent to a random sample of 2000 17-year-old to 18-year-old women registered with a general practitioner in two pilot areas in England. Recipients were randomised to receive either a self-sampling kit (n=1000), a self-sampling kit and offer of £5 voucher on return of sample (n=500) or a self-sampling kit on request (n=500). Participants returned a questionnaire and self-taken vulvovaginal swab sample for unlinked anonymous Chlamydia trachomatis testing. Non-responders were sent a reminder letter 3 weeks after initial invitation. We calculated the participation rate (number of samples returned/number of invitations sent) and cost per sample returned (including cost of consumables and postage) in each group. RESULTS: A total of 155/2000 (7.8%) samples were returned with consent for testing. Participation rates varied by invitation group: 7.8% in the group who were provided with a self-sampling kit, 14% in the group who were also offered a voucher and 1.0% in the group who were not sent a kit. The cost per sample received was lowest (£36) in the group who were offered both a kit and a voucher. CONCLUSIONS: The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England. STUDY REGISTRATION NUMBER: (UKCRN ID 10913).


Asunto(s)
Pruebas Anónimas/métodos , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Adolescente , Estudios Transversales , Inglaterra/epidemiología , Estudios de Factibilidad , Femenino , Humanos , Tamizaje Masivo , Proyectos Piloto , Vigilancia de la Población , Servicios Postales , Prevalencia , Manejo de Especímenes , Encuestas y Cuestionarios
13.
J Med Internet Res ; 16(4): e108, 2014 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-24727742

RESUMEN

BACKGROUND: Health promotion interventions on social networking sites can communicate individually tailored content to a large audience. User-generated content helps to maximize engagement, but health promotion websites have had variable success in supporting user engagement. OBJECTIVE: The aim of our study was to examine which elements of moderator and participant behavior stimulated and maintained interaction with a sexual health promotion site on Facebook. METHODS: We examined the pattern and content of posts on a Facebook page. Google analytics was used to describe the number of people using the page and viewing patterns. A qualitative, thematic approach was used to analyze content. RESULTS: During the study period (January 18, 2010, to June 27, 2010), 576 users interacted 888 times with the site through 508 posts and 380 comments with 93% of content generated by users. The user-generated conversation continued while new participants were driven to the site by advertising, but interaction with the site ceased rapidly after the advertising stopped. Conversations covered key issues on chlamydia and chlamydia testing. Users endorsed testing, celebrated their negative results, and modified and questioned key messages. There was variation in user approach to the site from sharing of personal experience and requesting help to joking about sexually transmitted infection. The moderator voice was reactive, unengaged, tolerant, simplistic, and was professional in tone. There was no change in the moderator approach throughout the period studied. CONCLUSIONS: Our findings suggest this health promotion site provided a space for single user posts but not a self-sustaining conversation. Possible explanations for this include little new content from the moderator, a definition of content too narrow to hold the interest of participants, and limited responsiveness to user needs. Implications for health promotion practice include the need to consider a life cycle approach to online community development for health promotion and the need for a developing moderator strategy to reflect this. This strategy should reflect two facets of moderation for online health promotion interventions: (1) unengaged and professional oversight to provide a safe space for discussion and to maintain information quality, and (2) a more engaged and interactive presence designed to maintain interest that generates new material for discussion and is responsive to user requests.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Promoción de la Salud/métodos , Salud Reproductiva , Medios de Comunicación Sociales , Adolescente , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Conducta Sexual , Red Social , Reino Unido , Adulto Joven
14.
Sex Transm Infect ; 89(1): 28-31, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22454551

RESUMEN

OBJECTIVES: To investigate the impact of repeat chlamydia testing on annual population coverage estimates and to examine repeat testing patterns in a New Zealand district with high chlamydia testing rates. METHODS: Chlamydia testing data for 15-44-year-old men and women in a single New Zealand district during February 2008 to January 2011 were analysed. Annual coverage of testing was estimated in two ways, using the number of tests and the number of individuals as the numerator. Rates of repeat testing were calculated using survival analysis. RESULTS: There were 73 879 tests (12 251 men, 61 628 women) from 41 342 individuals (8437 men, 32 905 women) during 3 years. Coverage estimates in 2010 using the number of individuals as the numerator were 17% lower for men and 26% lower for women than when the number of tests was used (5.9% vs 4.9% for men and 28.7% vs 21.2% for women). The rate of repeat testing was 16.9 per 100 person-years among men (95% CI 16.2 to 17.7) and 31.6 among women (95% CI 31.1 to 32.2). Rates of repeat testing were higher among women, in younger age groups and following a positive rather than a negative baseline test (p<0.001). CONCLUSION: Relatively high rates of repeat testing were observed among young women in Waikato district during 2008 to 2010. Estimates of population coverage by test for this group therefore considerably overestimate individual coverage. The findings will inform discussions about improving surveillance to capture more accurate chlamydia testing coverage rates in New Zealand.


Asunto(s)
Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/estadística & datos numéricos , Linfogranuloma Venéreo/diagnóstico , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Nueva Zelanda , Adulto Joven
15.
Sex Transm Infect ; 89(1): 51-6, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22941864

RESUMEN

OBJECTIVES: To explore patterns of repeat chlamydia testing among young people in England and factors associated with testing positive at repeat test. METHODS: We analysed chlamydia testing among 15 to 24-year-olds in England in a single calendar year (2010) using data from the genitourinary medicine clinic activity dataset (GUMCAD) and tests reported through the National Chlamydia Screening Programme (NCSP). Case records were linked using patient clinic numbers (GUMCAD), or by matching date of birth, gender and postcode (NCSP). Individuals could not be linked between datasets. The incidence of repeat testing was estimated using survival analysis. Risk factors for testing positive at repeat test were explored using multivariable logistic regression. RESULTS: 1 235 058 tests in the NCSP dataset and 502 095 in GUMCAD were included. The incidence of repeat testing was 18.4 and 26.1 per 100 person years in the NCSP dataset and GUMCAD respectively. Among NCSP repeat tests, the proportion testing positive was higher in those reporting recent change of sexual partner (adjusted OR males 1.44; females 1.52), and among those with a positive compared to a negative baseline test (adjusted OR males 2.57; females 1.95). CONCLUSIONS: We observed moderate levels of repeat testing within a year. Considering the frequency of partner change among young people, more could be done to encourage re-testing upon change of sexual partner. Increasing re-testing following a positive test could probably identify unresolved or repeat infections that may otherwise go untreated. Work to establish the optimum approach to repeat testing in England is now warranted.


Asunto(s)
Técnicas Bacteriológicas/estadística & datos numéricos , Chlamydia trachomatis/aislamiento & purificación , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Masculino , Recurrencia , Factores de Riesgo , Adulto Joven
16.
Eur J Contracept Reprod Health Care ; 18(5): 364-71, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23768267

RESUMEN

OBJECTIVES: Genital human papillomavirus (HPV) infections and associated precancerous lesions adversely affect health-related quality of life (HRQoL). HPV vaccines provide effective protection against these conditions. We therefore investigated the impact of HPV vaccination on HRQoL in young women five years after participation in a phase III HPV vaccination trial. METHODS: A total of 4808 originally 16- to 17-year-old Finnish girls had participated in the PATRICIA trial and received either bivalent HPV 16/18 vaccine or hepatitis A-virus (HAV) vaccine in 2004 to 2005. Unvaccinated girls (n = 9602), from adjacent birth cohorts, had participated in the control cohort in 2005. From 2009 to 2011, at 22 to 23 years of age, all participants received a questionnaire consisting of two generic HRQoL instruments (RAND36 and EQ VAS) and a disease-specific questionnaire (CECA10). RESULTS: We analysed responses of 1143 HPV 16/18-vaccinated, 980 HAV-vaccinated, and 3753 unvaccinated young women. The unadjusted mean outcome measures of the different HRQoL estimates were similar in the three different responder cohorts. CONCLUSIONS: Five years after vaccination the health-related quality of life of HPV 16/ 18- vaccinated young women did not differ from those of HAV-vaccinated or unvaccinated controls representing the general population.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Calidad de Vida/psicología , Vacunación/psicología , Adolescente , Adulto , Condiloma Acuminado/prevención & control , Femenino , Finlandia , Estudios de Seguimiento , Hepatitis A/prevención & control , Vacunas contra la Hepatitis A , Humanos , Proyectos Piloto , Conducta Sexual , Encuestas y Cuestionarios , Displasia del Cuello del Útero/prevención & control , Adulto Joven
17.
BMC Public Health ; 12: 1095, 2012 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-23253518

RESUMEN

BACKGROUND: In recent years there has been interest in websites as a means of increasing access to free chlamydia tests through the National Chlamydia Screening Programme (NCSP) in England. We aimed to describe and evaluate online access to chlamydia testing within the NCSP. METHODS: We analysed NCSP chlamydia testing data (2006-2010) for 15-24 year olds from the 71/95 programme areas in England where site codes were available to identify tests ordered through the internet. The characteristics of people using online testing services in 2010 were compared with those testing in general practice (GP) or community sexual and reproductive health (SRH) services. We evaluated 58 websites offering free chlamydia tests through the NCSP, and 32 offering kits on a commercial basis for signposting to clinical service and health promotion advice offered. RESULTS: Between 2006 and 2010, 5% of all tests in the included programme areas were accessed through the internet. The number of internet tests increased from 18 (<1% of all tests) in 2006 to 59,750 in 2010 (6% of all NCSP tests). In 2010 the proportion of NCSP tests accessed online by programme area ranged from <1% to 38%. The proportion of tests with a positive result on the internet was higher than tests from general practice and comparable to those from community SRH services (internet 7.6%; GP 5.6%; Community SRH 8.2%). A higher proportion of people accessing online testing were male, aged 20-24 and reported >1 sexual partner in the past year. Provision of sexual health information and appropriate signposting for those in need of clinical services varied between websites. Service provision within the NCSP was fragmented with multiple providers serving specific geographical catchment areas. CONCLUSION: Internet testing reaches a population with a relatively high risk of chlamydia infection and appears acceptable to young men, a group that has been difficult to engage with chlamydia testing. In order to maximise the potential benefit of these services, websites should be consistent with national guidelines and adhere to minimum standards for signposting to clinical care and health promotion information. The current system with multiple providers servicing geographically specific catchment areas is contrary to the geographically unrestricted nature of the internet and potentially confusing for clients.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Accesibilidad a los Servicios de Salud/tendencias , Internet/estadística & datos numéricos , Tamizaje Masivo/métodos , Adolescente , Chlamydia trachomatis/aislamiento & purificación , Servicios de Salud Comunitaria/estadística & datos numéricos , Inglaterra , Femenino , Medicina General/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Reproductiva/estadística & datos numéricos , Adulto Joven
19.
Sex Transm Infect ; 87(6): 464-8, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21813567

RESUMEN

OBJECTIVES: To estimate the total number of cases of, and cost of care for, genital warts (GWs) in England, to inform economic evaluations of human papillomavirus vaccination. METHODS: The number of GW cases seen in general practices (GPs) and in genitourinary medicine (GUM) clinics was estimated using the General Practice Research Database and the GUM Clinic Activity Dataset. The overlap in care of cases in the two settings was estimated. The calculated costs of care in GP and hospitals were added to the costs of care in GUM clinics (estimated elsewhere) to estimate the cost of care for GWs in England. RESULTS: In England, in 2008, GP and GUM saw 80,531 new (157/100,000 population) and 68,259 recurrent (133/100,000 population) episodes, giving a total of 148,790 episodes of care of GWs (289/100,000 population). Seventy-three per cent of cases were seen only in GUM clinics, 22% were seen by a GP before being referred to GUM, and 5% by GPs only. Hospital care was given in 1.3% of cases and contributed 8% of the costs. The average cost of care per episode was £113, and the estimated annual cost of care in England was £16.8 million. CONCLUSIONS: This study provides a fairly comprehensive measure of GW frequency and care in England. GWs exert a considerable impact on health services, a large proportion of which could be prevented through immunisation using the quadrivalent human papillomavirus vaccine.


Asunto(s)
Condiloma Acuminado/economía , Costos de la Atención en Salud/estadística & datos numéricos , Vacunas contra Papillomavirus/economía , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Condiloma Acuminado/epidemiología , Condiloma Acuminado/prevención & control , Costo de Enfermedad , Inglaterra/epidemiología , Medicina Familiar y Comunitaria/economía , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia , Venereología/estadística & datos numéricos , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-21158521

RESUMEN

OBJECTIVES: Human papillomavirus (HPV) vaccines protect against infections/conditions which potentially adversely affect quality of life (QoL). We investigated the impact of HPV infection on QoL five years post vaccination in 22-23 year-old women and a group of controls. METHODS: Participants were 22-23 year-old women who had either previously been enrolled in the FUTURE II trial of the quadrivalent HPV vaccine in Finland at age 16-17 (n = 1749), or were unvaccinated females in the birth cohort above those eligible for participation in FUTURE II in Finland (n = 6534). Participants were sent a questionnaire consisting of two generic QoL instruments (RAND36 and EQ VAS). RESULTS: We received and analysed 4438 valid responses. Unadjusted mean outcomes of the different QoL measures (RAND36 domains and EQ VAS) were similar. Multiple regression analysis showed that reporting current or previous genital warts, or cytological abnormalities, was significantly associated with reduced QoL. There were no significant differences between the HPV-vaccinated group and the placebo or unvaccinated groups. CONCLUSIONS: Diagnoses of genital warts or of cervical anomalies have a significant impact on QoL. The QoL of women who received the placebo or no vaccine was no lower, five years later, than that of those who received the active HPV vaccine.


Asunto(s)
Indicadores de Salud , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Calidad de Vida , Adolescente , Condiloma Acuminado/epidemiología , Femenino , Finlandia , Estudios de Seguimiento , Humanos , Modelos Lineales , Aceptación de la Atención de Salud , Psicometría/instrumentación , Análisis de Regresión , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/epidemiología , Adulto Joven
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