Places in protecting housing per 100 000 inhabitants from 1990 to 2012, Western Europe

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How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Forensic beds per 100 000 inhabitants from 1990 to 2012, Western Europe

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How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Psychiatric hospital beds per 100 000 inhabitants from 1990 to 2012, Western Europe

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How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Western EU prison population per 100 000 inhabitants from 1990 to 2012

More and via:  http://goo.gl/WxTHOz

How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Utilisation Patterns & Cost of Hospital Care for People Living with HIV in Ireland in 2012: A Single-Centre Study

Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. 

The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. 

Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. 

This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.

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By:  Brennan A1, Horgan M2, Jackson A3, Browne JP4, Bergin CJ5.

• 1Department of Epidemiology and Public Health, University College Cork, Cork, Ireland aline.brennan@ucc.ie.
• 2School of Medicine, University College Cork, Cork, Ireland Cork University Hospital, Cork, Ireland.
• 3Cork University Hospital, Cork, Ireland.
• 4Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
• 5St James's Hospital, Dublin, Ireland School of Medicine, Trinity College, Dublin, Ireland 
• Int J STD AIDS. 2016 Mar 21. pii: 0956462416640167

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Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes

BACKGROUND:

At global, national, and local level, the need for ongoing, timely and cost efficient, comprehensive drug treatment monitoring, and evaluation systems have clearly been well recognized.

OBJECTIVES:

To test the feasibility of linking laboratory data and client intake data and its usefulness for modeling retrospectively, for the first time, 5-year longitudinal drug treatment outcomes in an Irish opiate treatment setting.

METHODS:

A multisite, retrospective, longitudinal cohort study was implemented to evaluate outcomes for opiate users based on 1.7 million routine urinalysis results collected from 4,518 individuals presenting for opioid substitution treatment in Ireland from January 2006 to December 2010.

RESULTS:

Analysis of opiates, cocaine, benzodiazepine, and cannabis use at treatment intake, 6 months and at 1-5 year follow-ups revealed differences in urinalysis protocols; significant differences in age of first drug use between those using and not using opiates at 5 years; significant decreases in opiate use; increases in benzodiazepine use and significant increasing effects of concurrent cocaine and benzodiazepine use on the odds of using opiates. Time series analysis of weekly proportions opiate positive predicted 16% (95% confidence interval: 7%-25%) of clients would be opiate positive 5 years postinitial intake. 

CONCLUSIONS: 

Underutilized urinalysis data can be used to address the need for cost effective, efficient evidence of drug-treatment outcomes across time, place, and systems. Linking and matching the cross-sectional data across sites and times also revealed where improvements in electronic records could be made.

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By:  Comiskey CM1, Snel A1.

• 1 School of Nursing and Midwifery, Trinity College, University of Dublin , Dublin , Ireland.
• Subst Use Misuse. 2016 Mar 20;51(4):498-507. doi: 10.3109/10826084.2015.1126738. Epub 2016 Mar 4. 

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Regular STI Testing amongst Men Who Have Sex with Men & Use Social Media Is Suboptimal - A Cross-Sectional Study

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. 

Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. 

Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more 'out' (adjusted odds ratio = 1.79; confidence interval = 1.20-2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03-28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47-3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27-83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00-0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19--0.69) were less likely to test regularly for STIs. 

As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men's STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

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By:  Frankis J1, Goodall L2, Clutterbuck D3, Abubakari R4, Flowers P5.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow j.frankis@gcu.ac.uk.
• 2Cobridge Sexual Health Centre, Church Terrace, Cobridge, Stoke on Trent.
• 3Chalmers Sexual Health Centre, NHS Lothian, Edinburgh.
• 4School of Health and Life Sciences, GCU London, Glasgow Caledonian University, Glasgow.
• 5School of Health and Life Sciences, Glasgow Caledonian University, Glasgow. 
• Int J STD AIDS. 2016 Mar 4. pii: 0956462416636780.

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Economic & Health Implications from Earlier Detection of HIV Infection in the United Kingdom

Purpose: 

To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.

Patients and methods: 

A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).

Results: 

In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).

Conclusion: 

The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

Purchase full article at:   https://goo.gl/6wGaAh

By:  Vladimir Zah,^1,2 Mondher Toumi¹

¹Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France; ²ZRx Outcomes Research Inc., Mississauga, Canada

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Towards Preparedness for PrEP: PrEP Awareness & Acceptability among MSM at High Risk of HIV Transmission Who Use Sociosexual Media in Four Celtic Nations: Scotland, Wales, Northern Ireland & the Republic of Ireland: An Online Survey

OBJECTIVE:

To assess the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and use sociosexual media at high risk of HIV infection in four Celtic nations.

DESIGN:

Cross-sectional study.

METHODS:

Online self-complete survey of 386 HIV-negative/status unknown MSM who reported condomless anal intercourse (CAI) with ≥2 men in the last year, recruited from gay sociosexual media.

RESULTS:

One-third (34.5%, 132/386) of the participants were aware of PrEP but over half (58.5%, 226/356) reported that they would be willing to use PrEP if it were available to them. Only men who regularly tested for HIV every 6 months were more likely to be aware of PrEP. PrEP acceptability was only associated with reporting ≥5 CAI partners in the last year.

CONCLUSIONS:

Low levels of PrEP awareness were reported across these Celtic nations. Only one-third of high-risk MSM had heard of PrEP but over one-half would be willing to take a daily pill to prevent HIV infection. Sociodemographic factors, commercial gay scene proximity and social network use were unrelated to considering PrEP use. However, those reporting most CAI partners were more likely to consider PrEP use.

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By:  Frankis JS1, Young I2, Lorimer K1, Davis M3, Flowers P1.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
• 2MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
• 3School of Social Sciences, Monash University, Melbourne, Victoria, Australia. 
• Sex Transm Infect. 2016 Jan 22. pii: sextrans-2015-052101. doi: 10.1136/sextrans-2015-052101.

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United Kingdom PornHub 2015 Use Review

Via:  http://www.pornhub.com/insights/pornhub-2015-year-in-review  MT https://twitter.com/pornhub

Inter-Group Conflict & Cooperation: Field Experiments Before, During & After Sectarian Riots in Northern Ireland

The idea that cooperative groups out-compete less cooperative groups has been proposed as a theoretical possibility for the evolution of cooperation through cultural group selection. Previous studies have found an association between increased cooperation and exposure to inter-group violence, but most have not been able to identify the specific target of cooperation and are based on correlational data making it difficult to establish causality. 

In this study we test the hypothesis that inter-group conflict promotes parochial altruism (i.e., in-group altruism and out-group hostility) by using longitudinal data of a real-world measure of cooperation-charity and school donations-sampled before, during and after violent sectarian riots between Catholics and Protestants in Belfast, Northern Ireland. 

We find that conflict is associated with reductions in all types of cooperation, with reduced donations to a neutral charity, and both in-group and out-group primary schools. After the conflict, both in-group and out-group donations increased again. In this context we find no evidence that inter-group conflict promotes parochial altruism.

Below:  Map of Belfast with the neighborhoods Ballymacarrett 1 and Bellevue 2 in green and the 4 primary schools used in the donations experiments before, during and after the sectarian riots. Catholic primary schools (green markers) and Protestant primary schools (red markers).

Below:  Predicted donations by type over time. Predicted value (£) of an individual donating to the neutral charity Save the Children, an in-group primary school, an out-group primary school and all combined donations over time (before, during, and after the riots). These predicted values are controlled for individual household income, educational level, age, gender and religion. Error bars represent the standard errors.

Full article at:   http://goo.gl/mfidL5

By:   Silva AS1, Mace R1.

• 1Department of Anthropology, University College London London, UK. 

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Chronic Pain in Irish Prison Officers: Profile and Predictors of Pain-Related Disability and Depression

OBJECTIVE:

International research has consistently found increased risk for physical health and psychological difficulties among prison officers including elevated risk of assault resulting in acute pain. This study represented an exploratory examination of the experience of chronic pain conditions among Irish prison officers with particular reference to the psychosocial predictors of pain severity, pain interference, and depression.

DESIGN:

A questionnaire battery was completed by 152 Irish prison officers. The questionnaires measured pain severity and interference, anxiety, depression, social support, coping strategies, and resilience.

RESULTS:

Results showed that 48% of participants reported chronic pain based on the International Association for the Study of Pain definition. Psychological distress was high among respondents reporting chronic pain, with 38% of participants meeting the criteria for "probable depression" while 51% met the criteria for "probable anxiety disorder." In regression analyses, depression emerged as a significant predictor of both pain severity and pain interference while anxiety and pain interference emerged as significant predictors of depression.

CONCLUSION:

Chronic pain appears to be prevalent in prison officers and is associated with both physical and psychological impairment. Health care staff in correctional facilities should be aware that these health difficulties are prevalent in the prison work environment.

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By:  Costello E1, Bogue JE1, Sarma K1, McGuire BE1,2.

• 1Clinical Psychology Programme, School of Psychology, National University of Ireland, Galway, Ireland.
• 2Centre for Pain Research, National University of Ireland, Galway, Ireland. 

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Injection of New Psychoactive Substance Snow Blow Associated with Recently Acquired HIV Infections among Homeless People Who Inject Drugs in Dublin, Ireland, 2015

In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p = 0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.

In February 2015, the Department of Public Health (DPH), Health Service Executive (HSE) in Dublin, Ireland, identified an unexpected increase in cases of acute HIV infection among people who inject drugs (PWID); three cases were diagnosed p24 antigen-positive in January and February 2015, compared with two cases diagnosed during the whole year in 2014 [1]. Drug treatment clinicians had also identified increased use of a new psychoactive substance (NPS) alpha-pyrrolidinovalerophenone (α-PVP), known as snow blow, which was being used by ‘chaotic’ PWID, and which they suspected might be linked to the increase [2]. Clinicians defined the chaotic group as homeless PWID who, if on opioid substitution treatment (OST), required daily attendance at their treatment programme, due to continued use of a variety of other illicit substances in an intensive or chaotic way. We undertook an epidemiological investigation to identify the likely source of this increase...

Below:  Number of recent HIV infections or diagnoses with epidemiological link to recent infections in PWID in Dublin, by month of first diagnosis, January 2014 to September 2015a (n = 38)

Full article at: http://goo.gl/s5QWLl

By: C Giese ^1 2 , D Igoe ² , Z Gibbons ³ , C Hurley ⁴ , S Stokes ³ , S McNamara ³ , O Ennis ⁴ , K O’Donnell ² , E Keenan ³ , C De Gascun ^5 6 , F Lyons ⁷ , M Ward ⁴ , K Danis ^1 8 , R Glynn ⁴ , A Waters ⁵ , M Fitzgerald ⁴ , on behalf of the outbreak control team ⁹

1. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden

2. HSE Health Protection Surveillance Centre, Dublin, Ireland

3. HSE National Drug Treatment Centre, Dublin, Ireland

4. Department of Public Health, Dublin, Ireland

5. National Virus Reference Laboratory, University College Dublin, Dublin, Ireland

6. School of Medicine, University College Dublin, Dublin, Ireland

7. St. James’s Hospital, Dublin, Ireland

8. French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Paris, France

9. The members of the team are listed at the end of the article

  

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Clustering of Sex and Substance Use Behaviors in Adolescence

Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence.

To investigate clustering of sexual activity and substance use among youth in Northern Ireland.

Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored.

Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth.

While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender.

Via:  http://goo.gl/GKMY2m

By: McAloney K1.

• 1a Psychology and Allied Health Sciences, Glasgow Caledonian University , Glasgow , United Kingdom. 

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Does Antiretroviral Therapy Reduce HIV-Associated Tuberculosis Incidence to Background Rates? A National Observational Cohort Study From England, Wales & Northern Ireland

Whether the incidence of tuberculosis in HIV-positive people receiving long-term antiretroviral therapy (ART) remains above background population rates is unclear. We compared tuberculosis incidence in people receiving ART with background rates in England, Wales, and Northern Ireland.

We analysed a national cohort of HIV-positive individuals linked to the national tuberculosis register. Tuberculosis incidence in the HIV-positive cohort (2007-11) was stratified by ethnic origin and time on ART and compared with background rates (2009). Ethnic groups were defined as follows: the black African group included all individuals of black African origin, including those born in the UK and overseas; the white ethnic group included all white individuals born in the UK and overseas; the south Asian group included those of Indian, Pakistani, and Bangladeshi origin, born in the UK and overseas; and the other ethnic group included all other ethnic origins, including black Afro-Caribbeans.

The HIV-positive cohort comprised 79 919 individuals, in whom there were 1550 incident cases in 231 664 person-years of observation (incidence 6·7 cases per 1000 person-years). Incidence of tuberculosis in the HIV-positive cohort was 13·6 per 1000 person-years in black Africans and 1·7 per 1000 person-years in white individuals. Incidence of tuberculosis during long-term ART (≥5 years) in black Africans with HIV was 2·4 per 1000 person-years, similar to background rates of 1·9 per 1000 person-years in this group (rate ratio 1·2, 95% CI 0·96-1·6; p=0·083); but in white individuals with HIV on long-term ART the incidence of 0·5 per 1000 person-years was higher than the background rate of 0·04 per 1000 person-years (rate ratio 14·5, 9·4-21·3; p<0·0001). The increased incidence relative to background in white HIV-positive individuals persisted when analysis was restricted to person-time accrued on ART with CD4 counts of at least 500 cells per μL and when white HIV-positive individuals born abroad were excluded.

Tuberculosis incidence is unacceptably high irrespective of HIV status in black Africans. In white individuals with HIV, tuberculosis incidence is significantly higher than background rates in white people despite long-term ART. Expanded testing and treatment for latent tuberculosis infection to all HIV-infected adults, irrespective of ART status and CD4 cell count, might be warranted.

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By: Gupta RK1, Rice B2, Brown AE2, Thomas HL3, Zenner D4, Anderson L3, Pedrazzoli D5, Pozniak A6, Abubakar I7, Delpech V2, Lipman M8.

• 1Division of Medicine, University College London, London, UK; HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
• 2HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
• 3TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
• 4TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Infectious Disease Epidemiology, University College London, London, UK.
• 5TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
• 6Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK.
• 7TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; MRC Clinical Trials Unit and Centre for Infectious Disease Epidemiology, University College London, London, UK.
• 8Division of Medicine, University College London, London, UK. 

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Awareness of Sexually Transmitted Infection & Protection Methods among University Students in Ireland

Sexually transmitted infections (STIs) are a major public health challenge. In 2012, young people (20-29 years) represented 59.1 % of STI notifications in Ireland. In studying awareness and knowledge of STIs, methods of protection, and sexual practices of young people, many researchers have accessed university students.

Survey of 419 university students, investigating awareness and knowledge of sexual health and STIs, and risky sexual behaviour as a surrogate indicator of sexual activity in that age group.

• 419 students responded: 56.1 % female and 78.1 % undergraduate students. 
• 74.2 % remembered receiving sexual education in secondary school and 
• 84 % of those found it useful, 
• but only 51.8 % remembered education regarding STIs. 
• 44.4 % believed that STIs do not pose a long-term health risk. 
• 90.7 % of respondents were sexually active, and 
• 10.3 % had contracted STIs. 
• 94.7 % of sexually active students used contraception, with condoms most frequently used. 
• 69.1 % of those active had experienced penetrative vaginal sex, 
• 86.4 % oral sex and 
• 19.2 % anal sex without a condom in the prior 2 years. 
• Condom usage initiated by women was primarily for STI prevention.

Young people do not always have the information needed for them to take responsibility for their sexual health. In this study, university-provided medical and information resources were available, but large numbers of students were unaware or uncomfortable accessing them. Future work is needed to determine factors contributing to effective communication of sexual health information to young people.

Via: http://goo.gl/HIEzhU  Purchase full article at: http://goo.gl/AXnJDj

By: Lally K1, Nathan-V Y, Dunne S, McGrath D, Cullen W, Meagher D, Coffey JC, Dunne C.

• 1Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 

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