1,721,250 research outputs found
Identifying individuals engaging in risky sexual behaviour for chlamydia infection in the UK: a latent class approach
No full textChlamydia trachomitis is the most common sexually transmitted infection in the UK and the number of cases diagnosed each year continues to rise. Although much is known about the risk factors for chlamydia from previous observational studies, less is known about how individuals put themselves at risk. Do they engage in just one risky type of behaviour or are certain individuals ‘risky’, engaging in multiple risky behaviours? This paper uses latent class analysis, applied to the National Survey of Sexual Attitudes and Lifestyles II (2000–2001), to determine whether a subgroup of high-risk individuals can be identified and explores which features of their behaviour distinguish them from other groups of lower risk individuals. A 3-class solution was obtained, splitting the sample on the basis of the number of sexual partners in the past year. Those with no sexual partners in the past year (8%) and one sexual partner in the past year (71%) were much less likely to have engaged in any of the other behaviours known to increase chlamydia risk. However, the group who had two or more sexual partners in the past year (21%) were much more likely to have also engaged in other risky behaviours. The number of partners in the past year is therefore a useful marker for identifying those at increased risk of chlamydia infection. Individuals under 25 years old, males and those who were single or previously married were more likely to be allocated to the risky group. However, in spite of observed higher incidence of chlamydia infection, individuals in the black ethnic minority groups did not show an increased prevalence of risky behaviour, after controlling for age, sex and marital statu
Three essays on sexual behaviour and sexually transmitted disease in the UK
No full textThis thesis aims to explore the measurement of and the correlation between risky sexual behaviour and chlamydia and gonorrhoea infection in the UK in three chapters. The first of these explores methods of calculating rates of Chlamydia and gonorrhoea infection at UK genitourinary medicine (GUM) clinics. Data from KC60 returns from clinics in the Northwest, Southwest and East Midlands of England are used to provide a numerator for the rates and three methods are tested to derive the denominator: Thiessen polygons, 15 mile boundaries, and 30 minute drive times. The study finds that the rates calculated are relatively insensitive to the method chosen and thus the simplest approach, the Thiessen polygons, is recommended. The analysis also highlights substantial regional differences in GUM service accessibility.The second chapter uses latent class analysis to derive a measure of risky sexual behaviour with respect to chlamydia and gonorrhoea infection. Data from the National Survey of Sexual Attitudes and Lifestyles II, a nationally representative survey of sexual behaviour in Britain, has been analysed in order to identify patterns of behaviours associated with increased disease risk A 3-class solution is obtained, with individuals classified on the basis of the number of partners they have had in the last 12 months.The third chapter examines the relationship between the rates of chlamydia andgonorrhoea infection and the measure of risky sexual behaviour. Small areaestimates of risky behaviour are obtained for all wards in England using syntheticregression methods. These are then aggregated in line with the Thiessenpolygons in order to explore the correlation with the rates of chlamydia andgonorrhoea infection. There is a positive correlation for both infections, but farstronger for gonorrhoea than chlamydia (r=0.70 and r=0.41 respectively),suggesting that although risky behaviour may explain some of the observedvariation, further research is need to explore other possible explanations
Clustering of continuous and binary outcomes at the general practice level in individually randomised studies in primary care - a review of 10 years of primary care trials
No full textBackground: in randomised controlled trials, the assumption of independence of individual observations is fundamental to the design, analysis and interpretation of studies. However, in individually randomised trials in primary care, this assumption may be violated because patients are naturally clustered within primary care practices. Ignoring clustering may lead to a loss of power or, in some cases, type I error. Methods: Clustering can be quantified by intra-cluster correlation (ICC), a measure of the similarity between individuals within a cluster with respect to a particular outcome. We reviewed 17 trials undertaken by the Department of Primary Care at the University of Southampton over the last ten years. We calculated the ICC for the primary and secondary outcomes in each trial at the practice level and determined whether ignoring practice-level clustering still gave valid inferences. Where multiple studies collected the same outcome measure, the median ICC was calculated for that outcome. Results: The median intra-cluster correlation (ICC) for all outcomes was 0.016, with interquartile range 0.00-0.03. The median ICC for symptom severity was 0.02 (interquartile range (IQR) 0.01 to 0.07) and for reconsultation with new or worsening symptoms was 0.01 (IQR 0.00, 0.07). For HADS anxiety the ICC was 0.04 (IQR 0.02, 0.05) and for HADS depression was 0.02 (IQR 0.00, 0.05). The median ICC for EQ5D-3L was 0.01 (IQR 0.01, 0.04) Conclusions: There is evidence of clustering in individually randomised trials primary care. The non-zero ICC suggests that, depending on study design, clustering may not be ignorable. It is important that this is fully considered at the study design phase.<br/
Investigating the feasibility of a mobile mindfulness-based digital intervention for patients with asthma
No full textA non-linear optimisation method to extract summary statistics from Kaplan-Meier survival plots using the published P value
No full textThe RUTI trial: a feasibility study exploring Chinese herbal medicine for the treatment of Recurrent Urinary Tract Infections
No full textEthnopharmacological relevanceChinese herbal medicine (CHM) is a widely used traditional intervention that may have a role to play in addressing the global problem of antimicrobial resistance in conditions such as recurrent urinary tract infections (RUTIs). Aim of the studyTo evaluate the feasibility of administering standardised and individualised formulations of CHM for RUTIs as a Clinical Trial of an Investigational Medicinal Product (CTIMP) within primary care of the UKs National Health Service (NHS).Materials and methodsRegulatory approval was applied for a placebo controlled, double blinded randomised controlled feasibility trial comparing a) standardised CHM vs placebo administered via General practitioners, and b) individualised CHM vs placebo administered by an experienced CHM practitioner. Primary feasibility outcomes included: gaining regulatory approval, recruitment, randomisation, retention, safety and the relevance of outcomes measures. ResultsRegulatory approval for testing CHM as a CTIMP was successfully obtained. Recruitment to the trial was slow and non-NHS self-help networks were required to find participants for the individualised arm (n=31). Retention and data collection in the standardised arm (n= 30) were problematic, but these were acceptable in the individualised arm. The use of a daily symptom diary was not a suitable outcome measure for women with continuous infection. Other measures showed promising preliminary data for the individualised arm on improvement in symptoms, and reduction in antibiotic use during and after the trial.ConclusionCHM can fulfil the demanding requirements of a CTIMP study but it may not be feasible at this point in time to recruit and treat via NHS primary care. However acceptable rates of recruitment and retention via self-help groups and promising preliminary results in the individualised arm suggest it would be worth testing this approach in a full trial.<br/
Understanding general practitioners’ views and experiences of using clinical prediction rules in the management of respiratory infections: a qualitative study
No full text'Watchful waiting' or 'active monitoring' in depression management in primary care: exploring the recalled content of general practitioner consultations
Full text linkBackground: Despite the great burden of depression on sufferers and society, there is a lack of reliable information regarding the full range of psychosocial difficulties associated with depression and their related variables. This systematic review aimed to demonstrate the utility of the International Classification of Functioning, Disability and Health (ICF) in describing the psychosocial difficulties that shape the lived experience of persons with depression.Methods: An electronic search that included publications from 2005 to 2010 in the MEDLINE and PsycHINFO databases was conducted to collect psychosocial outcomes. Quality of studies was also considered.Results: 103 studies were included. 477 outcomes referring psychosocial difficulties were extracted and grouped into 32 ICF related categories. Emotional functions (19% of studies), followed by energy and drive (17% of studies), were the most frequent psychosocial outcomes. The onset, course, determinants, and related variables of the most important psychosocial difficulties, reported in at least 10% of studies, were described. Medication played a dual role as determinant of onset and change in some psychosocial areas, e.g. in pain, sleep, and energy and drive.Limitations: The search was limited by year of publication and focused only on minor and major depression diagnoses: other depressive disorders were not included. Some underresearched, but relevant psychosocial areas could have not been analyzed.Conclusions: The present systematic review provides information on the psychosocial difficulties that depressive patients face in their daily lives. Future studies on depression should include outcome instruments that cover these relevant areas in order to comprehensively describe psychosocial functioning
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