Impacts of stigma and discrimination in the workplace on people living with psychosis.

BACKGROUND: Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would a qualitative sample including multiple stakeholder groups reveal similar results and if so, what would be the main impacts of such stigma and discrimination? METHOD: This analysis used data from a qualitative study that had employed focus groups and interviews to investigate the employment barriers and support needs of people living with psychosis, including views of the multiple stakeholders (those living with mental health conditions, health professionals, care-givers, employments consultants and community members and employers). RESULTS: The impacts of workplace stigma and discrimination on people living with psychosis included work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment. CONCLUSIONS: Significant impacts from such stigma and discrimination were found in this study. The findings indicate a need to provide support mechanisms and to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.

A survey of ewe mortality on the Central Tablelands of New South Wales in 2010, a year of above-average rainfall.

BACKGROUND: Sheep producers reported elevated ewe mortality following a wetter-than-average season on the tablelands of New South Wales in 2010. We conducted a survey of local producers to determine the extent and cause of ewe losses, as well as associated risk factors. METHODS: A questionnaire was designed and posted to sheep producers running at least 1000 sheep. Data from questionnaires were analysed using linear mixed models to identify risk factors associated with ewe mortality. Data on the likely causes of deaths, particularly those associated with foot abscess, were analysed by ordinal generalised linear mixed models to determine the most prevalent causes of ewe death. RESULTS: The mean annual ewe mortality was 5.4% (range 0.1%-28.6%). Higher mortality was associated with older ewes and lambing in paddocks with longer pastures. The two most important causes of ewe death reported by farmers were 'died during lambing' and 'foot abscess'. Mortality due to foot abscess was more commonly reported in adult ewes than maiden ewes (odds ratio and 95% confidence interval: 5.61; 3.52, 8.94), when lambing on pasture longer than 5 cm than ≤5 cm (2.96; 1.54, 5.70) and when lambing in spring than in autumn (4.87; 1.36, 17.41). CONCLUSIONS: The level of ewe mortality observed was at the upper end of that reported previously in Australia. Risk factor analysis suggested that, in wet years, losses due to foot abscess could be reduced by lambing older heavier ewes in autumn on pasture swards less than 5 cm high.

Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin.

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Post-weaning growth of beef heifers drenched with long- or short-acting anthelmintics.

OBJECTIVE: To determine whether (i) the drenching practices of beef producers in the Central Tablelands of NSW utilising short-acting anthelmintics limit the post-weaning growth of heifers and (ii) a single weaning treatment of a long-acting anthelmintic improves post-weaning growth. METHODS: Commencing at weaning, 20/100 heifers in each of five herds were injected four times at 90-day intervals with long-acting moxidectin to suppress gastrointestinal nematodes. In year 1 the balance was drenched using the owner's usual commercial practice with short-acting anthelmintics (5 herds) or left undrenched (1 herd). In year 2 the balance was drenched with long-acting moxidectin within 3 months of weaning (4 herds) or with short-acting drenches only (2 herds). At each visit live weight (LW) was recorded and a subsample tested for worm egg count (WEC) and plasma pepsinogen. RESULTS: In year 1 by 3 and 6 months' post weaning, suppressed heifers were significantly heavier than the undrenched and short-acting groups, and by 12 months were 40 and 28 kg heavier, respectively. In year 2, the LW of the suppressed and long-acting heifers was not different, but by 3 and 6 months both groups were significantly heavier than the short-acting group and by 12 months were 22 kg heavier. CONCLUSION: The post-weaning growth of beef heifers treated with short-acting drenches as adopted by Tablelands beef producers was slower than heifers drenched suppressively or with a single long-acting drench at weaning.

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm.

UNLABELLED: Essentials Ignorance of direct oral anticoagulants' effects on coagulation tests may be a safety issue. An electronic questionnaire was sent to prescribers in NHS Grampian with 143 respondents. We found widespread evidence of inappropriate interpretation of the clinical scenarios given. The study suggests potential for patient harm due to lack of knowledge and education is required. SUMMARY: Background Lack of awareness of the nature of the direct oral anticoagulants (DOACs) combined with the poor correlation between routine coagulation test prolongation and the activity of these drugs represents a potential for patient harm. Objectives To establish the level of awareness of the different DOACs, and to assess whether prescribers were able to recognize the state of anticoagulation in a hypothetical patient. Methods and results An electronic questionnaire was sent by email to prescribers in our health board. Among 143 respondents, we found significant differences in awareness of the currently licensed drugs. Of the respondents, 88%, 80% and 50%, respectively, recognized rivaroxaban, dabigatran, and apixaban. When provided with a routine clinical situation, only 13.5%, 17.5% and 16.8%, respectively, recognized that the hypothetical patient was anticoagulated, and only 55-58% recognized that it was unsafe to proceed with an invasive procedure. Conclusion These results indicate a significant risk for patient harm related to lack of knowledge about this new group of frequently used drugs, and indicate that additional education and training on this subject are required.

Commercially available versus home produced egg media for isolation of mycobacteria.

AIMS: To compare the growth of clinical isolates of mycobacteria on in-house and commercial egg media. METHODS: Fresh test media were inoculated with dilutions of the test organisms and growth, colonial morphology and microscopic appearance were compared blindly by two observers. The process was repeated after the test media had been stored for three months. The user friendliness of each of the test media was also assessed. RESULTS: There was no difference in the microscopic appearance of any given mycobacterial species between different media. All of the test media grew the test species, although Mycobacterium bovis required four weeks on BioMerieux media, compared with two weeks on the other media. There was little obvious effect of storage on any of the media, except with M kansasii. Individual species gave characteristic colonial appearances on inhouse media; all of the commercial media gave non-specific colonial appearances that made presumptive identification very difficult. There were clear differences in the user friendliness of different media. CONCLUSIONS: Although commercially available egg media in general gave good growth of mycobacteria, only in-house media combined good growth with useful colonial features.

Effect of the growth of anaerobic bacteria on the surface pH of solid media.

Changes in surface pH occurring after varying periods of anaerobic incubation were measured for a total of 23 test solid media. There was little change in the surface pH of uninoculated plates, but plates inoculated with Bacteriodes fragilis showed a striking fall in pH, to pH 5 in the case of some of the test media. The problems of controlling the surface pH of solid media are discussed and possible methods of control are considered.

Comparison of three isolation systems for the culture of mycobacteria from respiratory and non-respiratory samples.

AIMS: To compare the recovery of mycobacteria from clinical samples using the MB/BacT rapid culture system with that obtained using egg medium or the Bactec radiometric method. METHODS: The three methods were compared using 681 clinical samples (462 respiratory and 219 non-respiratory samples) and eight external quality control strains. Culture media were incubated at 35-37 degrees C for six weeks in the MB/BacT system and for 12 weeks in the Bactec system and on egg medium. Solid media were examined macroscopically once a week and the Bactec vials were read six times in the first two weeks, and then weekly for the next 10 weeks (a growth index > 50 indicated a positive vial). The MB/BacT system positive vials were unloaded from the machine as soon as possible after detection. Confirmation of growth for all systems was by Ziehl-Neelson stained smears. Isolates were identified by a combination of phenotypic and molecular methods. RESULTS: Of the 681 clinical samples, 59 (8.7%) were positive on culture, including 23 strains of Mycobacterium tuberculosis. None of the three systems recovered all of the isolates, but each recovered mycobacteria not detected by either of the other two systems. After six weeks incubation, isolation rates were 87%, 78%, and 90%, and mean times to detection were 13, 19, and nine days for the MB/BacT, egg medium, and Bactec systems, respectively. Although the MB/BacT system was slightly slower than the Bactec system, the biomass was greater, allowing earlier use of molecular probes and earlier inoculation of susceptibility tests. CONCLUSIONS: The MB/BacT system provides comparable performance to the Bactec radiometric system, without the problems of disposal of radioactive waste. Optimal recovery is obtained when culture on egg medium is used in conjunction with a rapid culture system.

Tests of performance of anaerobic jars.

This paper briefly reviews methods of assessing the in-use performance of anaerobic jars and outlines a simple system combining a rapid test of catalytic activity with a biological indicator that can detect defects in the jars after incubation.

The efficacy of the heat killing of Mycobacterium tuberculosis.

There is concern that current procedures for the heat inactivation of Mycobacterium tuberculosis may not be adequate. This raises serious safety issues for laboratory staff performing molecular investigations such as IS6110 restriction fragment length polymorphism typing. This paper confirms that the protocol of van Embden et al, as performed routinely in this laboratory, is safe and effective for the heat inactivation of M tuberculosis. This procedure involves complete immersion of a tube containing a suspension of one loopfull of growth in a water bath at 80 degrees C for 20 minutes. Seventy four isolates were included in this investigation. Despite prolonged incubation for 20 weeks, none of the heat killed M tuberculosis suspensions produced visible colonies or gave a positive growth signal from liquid culture. This method did not affect the integrity of the DNA for subsequent molecular investigations.

Can direct gas-liquid chromatography of clinical samples detect specific organisms?

A total of 1929 samples was analyzed by direct gas-liquid chromatography and the volatile fatty acid (VFA) patterns of the positive samples were compared with the results of culture. There was no correlation between any bacterial genus or species and the detailed VFA patterns although the presence of butyric or valeric acids, or both, was generally associated with the presence of anaerobes and that of acetic acid was generally associated with aerobic bacteria; however, the technique could not predict the nature of the subsequent bacterial isolate. There was also poor correlation between the VFA pattern in a given sample and the VFA pattern(s) of anaerobic bacteria subsequently isolated from that sample.

Gas-liquid chromatography in the diagnosis of anaerobic infections: a three year experience.

Nearly two thousand clinical samples were examined by direct gas-liquid chromatography over a three year period. Absence of volatile fatty acids (VFAs) in the samples correlated well with negative culture results for anaerobic bacteria. In general the presence of acetic acid alone correlated well with the presence of aerobic organisms, whereas the presence of a mixture of VFAs correlated well with the presence of anaerobic organisms, either alone or in combination with aerobes. However a proportion of such VFA-positive samples gave no growth on culture. Swabs gave comparable results to samples of pus or exudates except that a higher proportion of the former were VFA-negative but culture positive.

Comparison of techniques for antimicrobial susceptibility testing of mycobacteria.

AIMS: To evaluate adenosine triphosphate (ATP) bioluminescence as a rapid technique for antimicrobial susceptibility testing of Mycobacterium spp by comparing it with conventional and radiometric methods, and to assess its potential for use in clinical microbiology laboratories. METHODS: 115 clinical isolates from a wide range of mycobacterial species and four control organisms of known susceptibility were tested against six antimicrobial agents. Minimum inhibitory concentrations (MICs) were determined after 4-6 weeks' incubation on Middlebrook 7H10 agar. Susceptibility was also determined radiometrically using a Bactec 460, and by bioluminescent assay of ATP using a 1250 luminometer (LKB-Wallac). RESULTS: Susceptibility results after 7 days showed excellent correlation with conventionally determined MICs. 714 susceptibility tests were performed by both techniques, with seven major discrepancies between the two systems. For pyrazinamide, agreement was 100%, but five strains of M tuberculosis, including one control, and 11 mycobacteria other than M tuberculosis (MOTT) failed to grow on Middlebrook agar at pH 5.5. 606 tests were performed by radiometry, with four major discrepancies between this technique and ATP bioluminescence. No particular species of Mycobacterium gave aberrant results. Contamination was a problem; 12 of the 119 strains tested were contaminated at day 1 and had to be repeated before results were obtained. Contamination of individual tests increased significantly after 7 days of incubation. CONCLUSIONS: ATP bioluminescence can be used to monitor mycobacterial growth in fluid culture media; the technique has considerable potential for rapid susceptibility testing. Advantages include lower initial cost of analytical equipment, lower reagent cost per test, and the use of non-radioactive substrates.

A national audit of the laboratory diagnosis of tuberculosis and other mycobacterial diseases within the United Kingdom.

In order to audit United Kingdom laboratory diagnostic and reference services including novel molecular methods for tuberculosis, a questionnaire was sent to laboratories submitting specimens to the PHLS Mycobacterium Reference Unit (MRU) and regional centres and to the Scottish Mycobacteria Reference Laboratory (SMRL) in 1996-7. Nationally, 67.2% of laboratories responded. Most UK laboratories were fully or conditionally CPA accredited and take part in the NEQAS proficiency scheme. On average only 3.3% of primary samples submitted for mycobacterial diagnosis in 1995 produced a mycobacterial culture from approximately half as many patients (that is, a mean of 1488 specimens producing 49 isolates from 23 patients). Potentially over 380,000 specimens are processed for mycobacteria in the UK each year. The majority of laboratories use 4% NaOH +/- NALC for specimen decontamination. Culture on solid media was used by most laboratories and 62.9% also use liquid media. Most laboratories incubated cultures for eight weeks. Few laboratories use molecular diagnostic methods. Laboratories were most likely to use molecular methods for diagnosing tuberculous meningitis and for specimens from immunocompromised patients, although usage was strongly influenced by cost. Within England and Wales 43.9% (47/107) and 56% (61/109) of laboratories wanted a rapid service for rifampicin resistance detection in M tuberculosis from immunocompetent and immunocompromised patients, respectively. In regard to a tuberculous meningitis service, 80.5% (43/112) and 84.3% (102/121) of laboratories wanted this service for immunocompetent and immunocompromised patients, respectively. The quality of reference services was rated as "very good"/"good" by 85.6% of respondents nationally. Rapid molecular amplification diagnostic services were established at the PHLS MRU for rifampicin drug resistance detection nationally and for tuberculous meningitis at the MRU.

Disseminated disease due to Mycobacterium avium complex in AIDS.

We retrospectively analysed 46 cases of disseminated infection with Mycobacterium avium complex (MAC) within a cohort of 702 HIV-infected patients in Edinburgh. Clinical features were compared with case-matched controls (AIDS cases without disseminated MAC), and survival and progression times were controlled for confounding variables that influence survival. Disseminated MAC was diagnosed antemortem in 18% of AIDS patients, and was the AIDS-defining diagnosis in 6% of all AIDS cases. Concomitant colonization of respiratory and gastrointestinal tracts was common (61% and 48%, respectively). In 58% of cases, CD4+ counts were < 10 cells/mm3 (median 6 cells/mm3). Weight loss, anaemia, leucopenia, and elevated liver transaminases and alkaline phosphatase were significantly more common among cases than controls. Therapy was given in 74%, and not tolerated in 32%. Following AIDS diagnosis, disseminated MAC incidence was 14% at one year, 25% at 2 years and 36% at 3 years. Median survival after disseminated MAC diagnosis was 6 months, with shorter survival in untreated cases. However, overall survival from AIDS diagnosis was not significantly different between patients who did or did not develop disseminated MAC. Disseminated MAC contributes significantly to AIDS morbidity, and its incidence increases with prolonged AIDS survival. Although survival following diagnosis is short, the development of disseminated MAC in AIDS probably does not affect overall survival. In cohorts with a low incidence, an alternative to prophylaxis might be surveillance and early diagnosis.

Isolation of zidovudine resistant Escherichia coli from AIDS patients.

Zidovudine-resistant Escherichia coli were isolated from faecal samples from 6 out of 11 AIDS patients receiving zidovudine. Resistance appeared to be due to the loss of thymidine kinase activity which is required for the phosphorylation of zidovudine to its active form. No zidovudine resistant enterobacteria were isolated from 30 control faecal samples. Hence, clinically, there appeared to be a high correlation between the development of zidovudine-resistance in E. coli and exposure to zidovudine (chi 2: 11.77, P less than 0.001). However the development of zidovudine resistance does not appear to be associated with cross-resistance to other antimicrobial agents as the zidovudine-resistant E. coli did not display a high degree of resistance to other antibacterials.

A defined medium for the growth of Clostridium tetani and other anaerobes of clinical interest.

The growth of six strains of Clostridium tetani was assessed in a chemically supplemented commercially available defined medium. All strains grew reliably even after 12 serial passages, and two strains produced demonstrable toxic activity after passage. Consistent growth of the test strains could also be obtained on a solid version of this medium ("CA109-S" medium), and the strains could be serially passaged on this medium. Preliminary evidence is presented that the medium supports the surface growth of some other test anaerobes. Such a defined solid medium might prove of value in further studies on the surface growth of C. tetani and of other anaerobes of clinical interest.

What are anaerobic cocci?

Criteria are suggested for the definition of "anaerobic cocci" as a general term to include all obligately anaerobic cocci. Such a definition draws a clear distinction between obligately anaerobic and micro-aerophilic strains and might form a basis both for characterisation of these organisms in the diagnostic laboratory and for further studies on their taxonomy and pathogenicity.

Analysis of multidrug-resistant Mycobacterium bovis from three clinical samples from Scotland.

OBJECTIVE: To determine whether multidrug-resistant (MDR) strains of Mycobacterium bovis isolated from patients in Scotland were genotypically related. DESIGN: Genotypes of MDR strains were determined using three molecular fingerprinting techniques: pulsed-field gel electrophoresis (PFGE), spoligotyping and restriction fragment length polymorphism (RFLP). PFGE profiles were also obtained for all medical and veterinary isolates occurring in Scotland in 1997-1998. RESULTS: MDR strains showed individual Dra I PFGE profiles. Case III/98 had a profile represented in both veterinary and medical populations, Case I/94 had a profile observed in medical but not veterinary isolates, and Case II/98 had a profile unique to this study. Afl II PFGE discriminated the resistant strains. Spoligotyping grouped Cases I/94 and II/98 (ST-134). Case III/98 had a spoligotype ST-140, which is commonly observed in veterinary isolates. Similarly, DRr-RFLP analysis grouped cases I/94 and II/98, whereas Case III/98 had a common veterinary profile. DRX(PGRS) RFLP gave three unique profiles. CONCLUSION: Three resistant strains were discriminated by PFGE and DRX(PGRS) RFLP, indicating that the three strains are not related in an epidemiologically relevant time scale. However, Cases I/94 and II/98 were more closely linked by spoligotyping and DRr-RFLP data. PFGE and DRr-RFLP linked Case III/98 profiles to the most common veterinary isolate.

Non-tuberculous mycobacteria: patterns of isolation. A multi-country retrospective survey.

OBJECTIVE: To collect data on non-tuberculous mycobacteria (NTM) isolated from clinical laboratories in different countries to establish: 1) whether the isolation of NTM was increasing, 2) which species were increasing, and 3) whether there was any pattern of geographical distribution. DESIGN: In 1996, the Working Group of the Bacteriology and Immunology Section of the International Union Against Tuberculosis and Lung Disease contacted 50 laboratories in different countries for the necessary information. RESULTS: The number of patients reported with NTM was 36099 from 14 countries. Mycobacterium avium complex, M. gordonae, M. xenopi, M. kansasii and M. fortuitum were the five species most frequently isolated. There was a significant upward trend for M. avium complex and M. xenopi. Pigmented mycobacteria predominated in Belgium, the Czech Republic and the Mediterranean coast of Spain. Non-chromogenic mycobacteria were found to be predominant in the area of the Atlantic coast of Brazil and in Turkey, the United Kingdom, Finland and Denmark. CONCLUSIONS: There was an increase in the number of NTM isolated from clinical samples of patients. Isolation of the most frequent species is constantly changing in most of the geographical areas, and newer species are emerging due to better diagnostic techniques to detect and identify NTM.