ABSTRACT
BACKGROUND: Opportunistic human papillomavirus (HPV) vaccination for men who have sex with men (MSM) was piloted in sexual health clinics (SHC) in England between 2016 and 2018. AIM: to evaluate the pilot's first year (April 2016-March 2017) in terms of feasibility, acceptability, uptake, impact and equity and interpret the outcome in the context of wide HPV vaccination policy. METHODS: Attendance and uptake data from routine SHC surveillance datasets and a cross-sectional survey administered to individuals receiving the vaccine were analysed. RESULTS: Among 18,875 eligible MSM, 8,580 (45.5%) were recorded as having received one HPV vaccine dose, decreasing slightly with increasing age, and uptake was higher in rural than urban areas. Survey results suggested that of those receiving the first dose of HPV vaccine, 8% were new attendees and that among those, less than 11% attended just to receive the vaccine. Of those having their first HPV vaccination, 95% indicated they would like to receive the next vaccine doses at the same clinic and 85% of patients reported accessing other services when visiting SHC for the first dose of vaccine. CONCLUSION: An opportunistic HPV vaccination programme for MSM can be delivered in an acceptable and, as far as can be evaluated, equitable manner, without major disruption to SHC and HIV clinics.
Subject(s)
Ambulatory Care Facilities/statistics & numerical data , Health Knowledge, Attitudes, Practice , Homosexuality, Male/statistics & numerical data , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Patient Acceptance of Health Care/statistics & numerical data , Vaccination/statistics & numerical data , Adolescent , Adult , Age Distribution , Cross-Sectional Studies , Feasibility Studies , Humans , Immunization , Male , Papillomaviridae , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Program Evaluation , Rural Population , Urban PopulationABSTRACT
OBJECTIVE: To establish the effects of group exercise on mobility and strength. DESIGN: Randomized controlled trial. SETTING: Two public hospital outpatient rehabilitation services. PARTICIPANTS: One hundred and seventy-three people (mean age 74.9 years, SD 10.8) with impaired mobility were randomized and 159 people (92%) completed the trial. INTERVENTIONS: Five-week, twice-weekly ;circuit-style' group exercise programme run by a physiotherapist (n = 85) and a no-intervention waiting list control group (n = 88). MAIN OUTCOME MEASURES: Three aspects of mobility: balance while standing and stepping (Step Test, semi-tandem and tandem stance times); sit-to-stand ability (rate and minimum height) and gait (6-metre and 6-minute walk tests). Lower limb muscle strength (knee flexion and extension). RESULTS: At retest, exercise participants had improved significantly more than their control counterparts on measures of balance while stepping, sit to stand and gait. Exercise participants averaged 1.6 more steps on the 15-second Step Test (95% confidence interval (CI) 0.5 to 2.8, P=0.005), walked an average of 0.12 m/s faster (95% CI 0.05 to 0.2, P=0.002) and took 2.5 fewer steps in 6 metres (95% CI -4.2 to -0.8, P=0.004). Exercise participants also averaged 0.04 more sit-to-stands/second, (95% CI 0.003 to 0.08, P=0.037) and walked an average of 30.9 metres further in 6 minutes (95% CI 9.4 to 52.4, P=0.005). There were no clinically important or statistically significant between-group differences at retest for the measures of strength (knee extension and flexion), balance while standing or minimal sit-to-stand height. CONCLUSION: This short-duration circuit class programme improved mobility, but not strength.