Fiona Bradley

A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS

Quality of life is an increasingly important outcome measure in medicine and health care. Many measures of quality of life present patients with predetermined lists of questions that may or may not be relevant to the individual patient. This paper describes a brief measure, the SEIQoL-DW, which is derived from the schedule for evaluation of individual quality of life (SEIQoL). The measure allows respondents to nominate the areas of life which are most important, rate their level of functioning or satisfaction with each, and indicate the relative importance of each to their overall quality of life. Given its practicality and brevity, the measure should prove particularly useful in clinical situations where patient generated data on quality of life is important. This article describes the first clinical application of the measure, assessing the quality of life of a cohort of patients with HIV/AIDS managed in general practice.

Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey.

Abstract Objectives: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in the prison population of the Republic of Ireland and to examine risk factors for infection. Design: Cross sectional, anonymous, unlinked survey, with self completed risk factor questionnaire and provision of oral fluid specimen for antibody testing. Setting: Nine of the 15 prisons in the Republic of Ireland. Participants: 1366 prisoners, of whom 1205 (57 women) participated. In the smaller prisons all prisoners were surveyed, while in the three largest prisons one half of the population was randomly sampled. Three small prisons believed not to have a problem with injecting drug use were excluded. Main outcome measures: Prevalence of antibodies to hepatitis B core antigen, antibodies to hepatitis C virus, and antibodies to HIV. Self reported risk factor status. Results: Prevalence of antibodies to hepatitis B core antigen was 104/1193 (8.7%; 95% confidence interval 7.2% to 10.5%), to hepatitis C virus, 442/1193 (37%; 34.3% to 39.9%), and to HIV, 24/1193 (2%; 1.3% to 3%). The most important predictor of being positive for hepatitis B and hepatitis C was a history of injecting drug use. Thirty four women (60%) and 474 men (42%) reported ever injecting drugs. A fifth (104) of 501 injecting drug users reported first injecting in prison, and 347 (71%) users reported sharing needles in prison. Conclusions: Infection with hepatitis C secondary to use of injected drugs is endemic in Irish prisons. Better access to harm reduction strategies is needed in this environment.

Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina. Final results of the Southampton heart integrated care project (SHIP)

Abstract Objective: To assess the effectiveness of a programme to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina. Design: Randomised controlled trial; stratified random allocation of practices to intervention and control groups. Setting: All 67 practices in Southampton and south west Hampshire, England. Subjects: 597 adult patients (422 with myocardial infarction and 175 with a new diagnosis of angina) who were recruited during hospital admission or attendance at a chest pain clinic between April 1995 and September 1996. Intervention: Programme to coordinate preventive care led by specialist liaison nurses which sought to improve communication between hospital and general practice and to encourage general practice nurses to provide structured follow up. Main outcome measures: Serum total cholesterol concentration, blood pressure, distance walked in 6 minutes, confirmed smoking cessation, and body mass index measured at 1 year follow up. Results: Of 559 surviving patients at 1 year, 502 (90%) were followed up. There was no significant difference between the intervention and control groups in smoking (cotinine validated quit rate 19% v 20%), lipid concentrations (serum total cholesterol 5.80 v 5.93 mmol/l), blood pressure (diastolic pressure 84 v 85 mm Hg), or fitness (distance walked in 6 minutes 443 v 433 m). Body mass index was slightly lower in the intervention group (27.4 v 28.2; P=0.08). Conclusions: Although the programme was effective in promoting follow up in general practice, it did not improve health outcome. Simply coordinating and supporting existing NHS care is insufficient. Ischaemic heart disease is a chronic condition which requires the same systematic approach to secondary prevention applied in other chronic conditions such as diabetes mellitus.

Development and evaluation of complex interventions in health services research: case study of the Southampton heart integrated care project (SHIP)

Interventions are often defined pragmatically and lack any clear theoretical basis, which limits generalisability. Implementation is rarely described, which limits understanding of why an intervention is or is not locally successful. Integration of qualitative methods within pilot trials can help interpret the quantitative result by clarifying process and testing theory. This approach defines three levels of understanding: the evidence and theory which inform the intervention, the tasks and processes involved in applying the theoretical principles, and people with whom, and context within which, the intervention is operationalised. A case study shows how this novel method of programme development and evaluation can be applied.

Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey

Abstract Objectives: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection. Design: Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing. Setting: Five of seven committal prisons in the Republic of Ireland. Participants: 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999. Main outcome measures: Prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in prison entrants, and self reported risk factor status. Results: Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%), to hepatitis C virus was 130/596 (22%; 19% to 25%), and to HIV was 12/596 (2%; 1% to 4%). A third of the respondents had never previously been in prison; these had the lowest prevalence of antibodies to hepatitis B core antigen (4/197, 2%), to hepatitis C (6/197, 3%), and to HIV (0/197). In total 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and hepatitis C virus. Conclusions: Use of injected drugs and infection with hepatitis C virus are endemic in Irish prisons. A third of prison entrants were committed to prison for the first time. Only a small number of first time entrants were infected with one or more of the viruses. These findings confirm the need for increased infection control and harm reduction measures in Irish prisons. What is already known on this topic High rates of using injected drugs, initiation of use of injected drugs, and sharing of injecting equipment occur in Irish prisons Injecting drug users have high rates of infection with hepatitis B and C viruses, and hepatitis C is endemic in injecting drug users and in Irish prisoners What this study adds The prevalence of antibodies to hepatitis B core antigen, to hepatitis C, and to HIV in prison entrants who had previously been imprisoned was similar to that found in the recent national survey of Irish prisoners, but the prevalence of these antibodies was much lower in the third of prison entrants who had never previously been in prison Tattooing in prison is an independent risk factor for hepatitis C infection in prisoners who have never used injected drugs

Reducing the risk of recurrent coronary heart disease. We know a bit more about what doesn't work.

General practice p 1522 We know that coronary heart disease is the commonest cause of avoidable mortality in Britain and Ireland, that Britains position in the league table of developed nations is poor, and that we should do better in trying to prevent it.1 How to achieve this goal remains an unresolved issue. In the early 1990s the NHS introduced routine health checks for the over 75s and health promotion clinics for primary prevention in general practice. However, the evidence base for this approach was disappointing. 2 3 More recently priority has been given to reducing risk in patients with established coronary heart disease: as the absolute risk for this group is greater, so is the potential for effective intervention. Much evidence exists that a variety of behavioural changes and drug treatments can reduce morbidity and mortality for those with existing coronary heart disease.4 Stopping smoking; eating a “Mediterranean diet”; participating in exercise; and taking appropriate drug treatment with aspirin, β blockers, angiotensin converting enzyme inhibitors, and …

Attitudes towards and experience of general practice among HIV-positive patients in the Republic of Ireland.

In order to study their attitudes to and experience of general practitioner care, 150 attenders at the only HIV specialist clinic in the Republic of Ireland were asked to complete an anonymous, self administered questionnaire. (81%) of respondents reported having a regular GP and 94% of those indicated that the GP was aware of their HIV diagnosis. The majority (64%) of patients with a regular GP reported seeing their doctor on more than 5 occasions during the previous year. Most patients were satisfied with the support which they received from their GPs. Even so, the majority of patients (72%) would go directly to the hospital clinic for any problem which they perceive to be HIV related.

No (safer) sex please, we’re Irish: Sexual functioning and use of safer sexual practices in an Irish HIV positive cohort

This study examined the implications for sexual functioning of having a HIV positive diagnosis. Also examined was whether safer sex was being routinely practiced. Findings are reported from first contact interviews in a prospective study of 52 people with HIV who were ambulatory and living in the community. A majority were infected through injecting drug use. Results indicated a disruption in sexual functioning that was particularly evidenced by a decrease in sexual activities and decreased interest in and satisfaction derived from sex. This disruption was reported in particular by female respondents. Almost half of the overall study group reported never or not always practicing safer sex. Women were found to be the least likely to adopt safer sexual practices. These findings have implications for HIV prevention programmes directed at drug-using populations and, more specifically, those directed at drug-using women.