Attendees of Manchester's Lung Health Check pilot express a preference for community-based lung cancer screening.

Manchester's 'Lung Health Check' pilot utilised mobile CT scanners in convenient retail locations to deliver lung cancer screening to socioeconomically disadvantaged communities. We assessed whether screening location was an important factor for those attending the service. Location was important for 74.7% (n=701/938) and 23% (n=216/938) reported being less likely to attend an equivalent hospital-based programme. This preference was most common in current smokers (27% current smokers vs 19% former smokers; AdjOR 1.46, 95% CI 1.03 to 2.08, p=0.036) and those in the lowest deprivation quartile (25% lowest quartile vs 17.6% highest quartile; AdjOR 2.0, 95% CI 1.24 to 3.24, p=0.005). Practical issues related to travel were most important in those less willing to attend a hospital-based service, with 83.3% citing at least one travel related barrier to non-attendance. A convenient community-based screening programme may reduce inequalities in screening adherence especially in those at high risk of lung cancer in deprived areas.

Randomized controlled trial of a lay-facilitated angina management programme.

AIMS: This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). BACKGROUND: Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. DESIGN: A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. METHODS: Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. RESULTS: There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: anxiety; depression; and angina misconceptions. The intervention was considered cost-effective. CONCLUSION: The angina management programme produced some superior benefits when compared to advice from a specialist nurse.

The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake.

School nurses in the United Kingdom are largely responsible for delivering the human papillomavirus (HPV) vaccine to 12-13 year old girls. In order to assess the impact of HPV vaccination on school nurses' roles, we gave a questionnaire to all 33 school nurses who offered Cervarix ™ in two Primary Care Trusts one year ahead of the national vaccine programme. Key organisational issues raised by the school nurses were the size of the team and its skill mix. A few found their schools uncooperative and were dissatisfied with mechanisms for problem resolution. On average, nurses spent an additional 69 h (0.80 h per child) on vaccine-related activities. In semi-qualitative interviews (n=17), school nurses complained of work overload and described the difficulties of establishing good relationships with some of their schools. Nurses expected schools to take some responsibility for ensuring good uptake and were frustrated when help was not forthcoming. We conclude that variation in uptake between schools in part reflects a difficult relationship with the school nurse which may be attributed to characteristics of the school, schools' attitudes towards health interventions, organisational problems, multiple school nurse roles and/or personal ability. Some of these issues will need to be addressed to ensure continued high vaccine coverage as HPV vaccination becomes a less prioritised, routine activity.

Who and how many people are taking herbal supplements? A survey of 21,923 adults.

BACKGROUND: There is little information on the number and characteristics of adults taking herbal supplements and the relationship of this with other health and lifestyle factors. These were examined in the current study. METHODS: Information on herbal supplement use and health and lifestyle characteristics was obtained by postal questionnaire, sent to a sample of the adult population in Northwest England. RESULTS: In summer 2001, 70.5% (15,465/21,923) of questionnaires were returned. The mean age of responders was 49.8 years (SD 17.57) and 45.2% (6,986/15,465) were men. The percentage taking at least one herbal supplement was 12.8% (1,987/15,465). Users of herbal supplements were more likely to be younger, female, white, and to own their home. Herbal supplement use was not strongly associated with any health and lifestyle variables examined. Weak associations were found with physical activity, psychiatric caseness, and use of prescribed medications. The most common herbal supplement was evening primrose oil, taken by 7.7% (1,186/15,465) of respondents (12.7% of women and 1.1% of men). CONCLUSIONS: More than one in ten adults were taking herbal supplements, with evening primrose oil, the most common supplement, used mainly by women. Individual characteristics such as age, sex, ethnicity, and social class influenced the use of herbal supplements, but there was no evidence that this substituted for conventional medical care. The evidence base to support some popular herbal supplements is weak. Large well-designed trials are needed to quantify the value of herbal supplements to health and well-being.