Self-reported access to health care, communicable diseases, violence and perception of legal status among online transgender identifying sex workers in the UK.

OBJECTIVES: Transgender-identifying sex workers (TGISWs) are among the most vulnerable groups but are rarely the focus of health research. Here we evaluated perceived barriers to healthcare access, risky sexual behaviours and exposure to violence in the United Kingdom (UK), based on a survey of all workers on BirchPlace, the main transgender sex commerce website in the UK. STUDY DESIGN: The study design used in the study is an opt-in text-message 12-item questionnaire. METHODS: Telephone contacts were harvested from BirchPlace's website (n = 592 unique and active numbers). The questionnaire was distributed with Qualtrics software, resulting in 53 responses. RESULTS: Our survey revealed significant reported barriers to healthcare access, exposure to risky sexual behaviours and to physical violence. Many transgender sex workers reportedly did not receive a sexual screening, and 28% engaged in condomless penetrative sex within the preceding six months, and 68% engaged in condomless oral sex. 17% responded that they felt unable to access health care they believed medically necessary. Half of the participants suggested their quality of life would be improved by law reform. CONCLUSIONS: TGISWs report experiencing a high level of risky sexual behaviour, physical violence and inadequate healthcare access. Despite a National Health System, additional outreach may be needed to ensure access to services by this population.

Missed opportunities for earlier diagnosis of rifampicin-resistant tuberculosis despite access to Xpert® MTB/RIF.

OBJECTIVE: To assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa. DESIGN: We conducted a retrospective analysis among RR-TB patients diagnosed from 2012 to 2014. Patients were considered to have missed opportunities for earlier diagnosis if 1) they were incorrectly screened according to the Western Cape diagnostic algorithm; 2) the first specimen was not tested using Xpert® MTB/RIF; 3) no specimen was ever tested; or 4) the initial Xpert test showed a negative result, but no subsequent specimen was sent for follow-up testing in human immunodeficiency virus-positive patients. RESULTS: Among 543 patients, 386 (71%) were diagnosed with Xpert and 112 (21%) had had at least one presentation at a health care facility within the 6 months before the presentation at which RR-TB was diagnosed. Overall, 95/543 (18%) patients were screened incorrectly at some point: 48 at diagnostic presentation only, 38 at previous presentation only, and 9 at both previous and diagnostic presentations. CONCLUSIONS: These data show that a significant proportion of RR-TB patients might have been diagnosed earlier, and suggest that case detection could be improved if diagnostic algorithms were followed more closely. Further training and monitoring is required to ensure the greatest benefit from universal Xpert implementation.

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries.

OBJECTIVES: Persons engaged in the sex industry are at greater risk of HIV and other sexually transmitted infections than the general population. One major factor is exposure to higher levels of risky sexual activity. Expanding condom use is a critical prevention strategy, but this requires negotiation with those buying sex, which takes place in the context of cultural and economic constraints. Impoverished individuals who fear violence are more likely to forego condoms. METHODS: Here we tested the hypotheses that poverty and fear of violence are two structural drivers of HIV infection risk in the sex industry. Using data from the European Centre for Disease Prevention and Control and the World Bank for 30 countries, we evaluated poverty, measured using the average income per day per person in the bottom 40% of the income distribution, and gender violence, measured using homicide rates in women and the proportion of women exposed to violence in the last 12 months and/or since age 16 years. RESULTS: We found that HIV prevalence among those in the sex industry was higher in countries where there were greater female homicide rates (ß = 0.86; P = 0.018) and there was some evidence that self-reported exposure to violence was also associated with higher HIV prevalence (ß = 1.37; P = 0.043). Conversely, HIV prevalence was lower in countries where average incomes among the poorest were greater (ß = -1.05; P = 0.046). CONCLUSIONS: Our results are consistent with the theory that reducing poverty and exposure to violence may help reduce HIV infection risk among persons engaged in the sex industry.

A nationwide assessment comparing nonelective open with minimally invasive complex colorectal procedures.

AIM: The use of minimally invasive colorectal surgery has increased greatly for both benign and malignant disease. Studies evaluating complex procedures have been largely limited to elective indications. We aimed to compare the outcome of a laparoscopic with an open transverse (TC) and total abdominal colectomy (TAC) in the nonelective setting. METHOD: Comparative analysis was made using the Nationwide Inpatient Sample (2008-11) of patients undergoing a nonelective TC or TAC identified by ICD-9-CM procedure codes. The risk-adjusted 30-day outcome was assessed using regression modelling accounting for patient characteristics, comorbidity and surgical procedure. RESULTS: We identified 7261 admissions including 818 laparoscopic and 6443 open procedures. The mean age of the population was 65 ± 17 years and patients in the laparoscopic group were younger (56 ± 20 vs. 66 ± 17 years; P < 0.05). The rate of a single complication was lower in the laparoscopic group (26% vs. 38%; P < 0.01), but this did not remain significant following a logistic regression analysis. Mortality was significantly lower in the laparoscopic group (3.1% vs. 17%; P < 0.01) and this remained true after adjusting for covariates (OR = 0.62; P < 0.05). Laparoscopic cases were associated with a shorter median length of stay (10 vs. 13 days; P < 0.01) and hospital charge ($75,758 vs. $98,833; P < 0.01). CONCLUSION: A nonelective laparoscopic TC or TAC is associated with an equivalent complication rate and lower mortality compared with an open operation. The results should encourage surgeons with the appropriate skills to consider a laparoscopic approach for nonelective pathology requiring a complex colectomy.

Nurse and parent collaborative case management in a rural setting.

A collaborative parent and nurse case management model can facilitate meeting the variety of needs of children who have special health care problems. When families live in depressed social and economic conditions in rural areas, services can be difficult to obtain. Families can be assisted to be advocates for their children by a close interaction with a nurse case manager.

Nurse case management in a rural parent-infant enrichment program.

Nurse case managers assist families with children with special health-care problems to receive services. This article describes the families and services provided in a parent-infant enrichment program in a rural setting. The interdisciplinary program encourages a parent-provider supportive case management model based on a realistic assessment of the family's ability to actively participate in the case management process. The program empowers families to become advocates for their children.

Case management for young children with special health care needs.

Case management for young children and their families with special health care needs is an organized system of health care. Fifty-eight families were surveyed to assess their experience with case management or determine their need for case management. Suggestions are provided for nurses to participate actively in this role.

HIV and preconceptional counselling.

PIP: This article provides a general discussion of a variety of different features of HIV infection and the not widely accepted concept of preconception counseling. The focus is on testing, counseling and counselors, infertility clinics, promotion of awareness, attitudes to HIV testing, education, parameters for counseling, the risk of coitus and the value of contraceptive usage in the presence of HIV, accurate and understandable information, attitudes of children, legal significance, and the effect of disaster on the family and relationships. The author is concerned with the need to provide testing facilities, and prepregnancy testing. The risk of HIV infection adds to the importance of planned pregnancy and counseling in family planning and selecting appropriate methods. Informed and responsible decisions require adequate consideration of all the issues and information currently available. Preconceptual counseling clinics tend to be small in number, but the health care professionals serving the population in need must be well educated in the knowledge of obstetrics and the behavior of HIV infection/AIDS. Infertility clinics are one potential source of contact with those at high risk of HIV. A national campaign to emphasize the need to seek advice on family planning for those at risk of HIV is necessary in countries where HIV is widespread. Preconception counseling is possible only after there is awareness of risk of HIV infection and the risks of pregnancy. Confounding policies for testing and counseling are attitudes of politicians and officials which may reflect the general welfare rather than individual welfare or public opinion and attitudes of pressure groups which may not reflect the general welfare. 2 issues are of concern: that risk by accurately assessed, and terms like safe sex avoided. The following understandable information needs to be provided; a woman's risk with an HIV positive husband, a woman's pregnancy risk, a father's risk with an HIV infected partner, the fetal risk (estimated at 30%), prognosis for an infected child, the effect on family of having an infected child, possible cures/effective treatment in the future, the effect of relationships and parents work/life, the possibility of an orphaned child or loss of a parent, adverse effects of factors on pregnancy, the relevance of any treatment, and children's welfare with harmful parent lifestyles. Counselors must be aware of the influence of race, religion, class, and the pressures in prostitution for unprotected sex. Legal issues may arise between parent and child, or in counselor negligence. Caring for a handicapped child and the nature of discrimination against those with AIDs must be approached openmindedly. An informed decision must be an available option.^ieng

Quantitative and qualitative home assessment of primary caretaker-child interactions in lower socioeconomic families.

Assessment is an important component of nursing management of at-risk children. Low socioeconomic status and intrauterine growth retardation are often considered to be risk factors for developmental disabilities. Home visitation is often suggested as a way to assess adult-child interactions. In this article, the author provides information about assessments conducted in lower socioeconomic homes and difficulties encountered in conducting them. She raises several questions for consideration as a result of her efforts to assess home environments and primary caregiver-child interactions of children with intrauterine growth retardation.

The role of the clinical nurse specialist in the assessment and development of social-sexual skills of adults who are developmentally disabled.

Clinical nurse specialists (CNSs) functioning in ambulatory settings such as sheltered workshops or other community placements where developmentally disabled persons receive services have an excellent opportunity to use their teaching, counseling and guidance and interaction skills to assist them in gaining competencies that they need to be successful in social/sexual interactions. In this article, preassessment of these skills was performed and an outline of an educational program provided so that CNSs can assume this important teaching and counseling role.

Field assessment of dihaploid Solatium tuberosum and S. brevidens somatic hybrids.

Following both chemical and electrical fusion of protoplasts of a dihaploid line of potato (Solanum tuberosum), (PDH40), with those of the wild species, Solanum brevidens, 11 and 40 somatic hybrid plants, respectively were obtained. Fifteen of these somatic hybrid genotypes and the two parents were studied further in a small field trial to assess field performance and phenotypic variability. In the UK, somatic hybrid plants are classified as genetically engineered organisms, and the UK Advisory Committee on Genetic Manipulation have imposed various restrictions on field experiments. Examination of the somatic hybrids in the field showed extensive phenotypic variability, and no two genotypes were identical. Some of the variation reflected changes in chromosome numbers, but other factors were also involved. Half the somatic hybrid genotypes produced tubers in the field, although the tubers were smaller and differed morphologically from those of PDH40. The results of the study suggest that the extent of somaclonal variation manifested in somatic hybrids is greater than that found in protoplast-derived plants of potato. The implications of this observation and the current regulations concerning field experiments of somatic hybrid plants in the UK are discussed.

Quantitative assessment of cervical neoplasia by hydrolysed DNA assay.

A hydrolysed component of DNA was measured in cervical smears from 187 women. The results clearly distinguished patients with cervical intraepithelial neoplasia and invasive carcinoma from a control group. This method could be automated.