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Objectives To identify if HIV-infected individuals attending genitourinary clinics in the UK are not disclosing their HIV status, and to examine the potential utility of drug detection as a method to indicate non-disclosure. Methods HIV-positive samples from the unlinked anonymous seroprevalence survey from one London centre in 2009 had viral load (VL) assays performed to identify samples with VL below the level of detection (50 copies/ml, VLBLD) or <1000 copies/ml. After data matching, known HIV positives were excluded and the remaining samples analysed for the presence of a panel of antiretroviral drugs. Results Of 130 HIV-positive samples with sufficient clinical information and not undergoing an HIV test, 18 were classified as remaining undiagnosed after the clinic visit. Thirteen (72%, 95% CI: 47% to 90%) had a VLBLD (n=11) or VL <1000 copies/ml (n=2). Eight had sufficient volume to undergo ARV testing, and all were positive for the presence of drug; all with therapeutic levels of clinically appropriate combinations. Conclusions Non-disclosure of HIV status occurs among individuals attending sexual health services in the UK. This study demonstrates the feasibility and utility of using both VL and ARV assays in serum samples. Furthermore, the close correlation of detection of ARV with VLBLD suggests drug detection would be a useful tool to monitor non-disclosure prospectively, thus enabling the use of stored serum samples in future studies. The extent to which these findings can be extrapolated to other settings, and the potential impact of non-disclosure on undiagnosed estimates warrants urgent prospective study.

Better understanding of the variation in macronutrient content of human donor milk (HDM) potentiates targeted nutrition for preterm babies. The present study describes the relationship of maternal age, parity, monthly lactation stage estimate (LSEm), daily volume of milk expressed (Vd), sex, gestation and birth weight z scores with macronutrient content of HDM. Multilevel mother–infant pair ID random intercept models were performed using the predictor variables above on the outcome HDM macronutrient content determined using mid-IR spectroscopy. Mean macronutrient content was also compared by gestational age and small for gestational age (SGA) ( z score < –1·28) or appropriate for gestational age (AGA) ( z score ≥ –1·28) categories. A total of 2966 samples of donations from 1175 mother–infant pairs to the UK Northwest Human Milk Bank between 2011 and 2017 were analysed. Mean protein, fat, carbohydrate and calculated energy were 0·89 ( SD 0·24) g/dl, 2·99 ( SD 0·96) g/dl, 7·09 ( SD 0·44) g/dl, and 60·37 ( SD 8·41) kcal/dl (252·59 ( SD 35·19) kJ/dl), respectively. Preterm SGA HDM was significantly higher in protein, fat and energy content than term AGA HDM and significantly lower in carbohydrate content than term AGA HDM after controlling for LSEm, Vd and between-subject effects. Degree of prematurity did not influence macronutrient content. Between-subject effects accounted for more of the variance in macronutrient content than the fixed effects in the model. Despite this, SGA status, as well as prematurity, may be an important determinant of macronutrient content in human milk. As bioavailability of macronutrients from HDM is uncertain, studies evaluating growth and body composition in preterm and SGA babies fed HDM are warranted.

ObjectivesThe End Child Poverty Coalition reported 35% of children and young people (CYP) in the North East, and 31% in Yorkshire and Humber living in poverty in 21/22.1 The CYP Diabetes Networks in these areas set out to action wider understanding of the impact of poverty on CYP living with diabetes, how poverty affects equity in accessing services and diabetes therapeutic technology. During 2022 three Trusts embarked on a first of its kind programme of Poverty Proofing© within a health setting delivered by Children North East Charity (CNE) with the ethos of‘No activity or planned activity should identify, exclude, treat differently or make assumptions about those babies, children, young people and families whose household income is lower than others’The findings and impact from these three Trust deep-dives were deemed so significant that North East Yorkshire (NEY) CYP Diabetes Leadership Group used regional funds for the purpose of levelling up access to diabetes treatment technology to deliver widescale multidisciplinary team (MDT) training to 38 Paediatric and transition diabetes teams and 3 complications of excessive weight childhood obesity clinics with a remit for prevention of type 2 diabetes.MethodsKey learning derived from the Poverty Proofing© programmes informed the design of a shorter bespoke half day training, covering the fundamentals of poverty proofing services, and a forum for teams to question their bias and tackle barriers without prejudice.Seven, free training events across the geography of NEY and avoiding popular clinical sessions were scheduled. Teams were encouraged to attend the sessions as complete MDTs and invite influential service managers or other stakeholders.Results210 professionals attended representing every NEY paediatric diabetes team. Supporting them were Trust, ICB and community stakeholders.100% of participants felt their understanding of poverty and its impacts had increased as a result of training. 98.5% recommending the training to colleagues.2 Five key themes emerged – Travel, navigating appointments systems, accessing support and education, financial awareness and understanding, diabetes technology. CNE published an impact report for wider dissemination to all diabetes workforce.3 4 ConclusionMDT training at low cost and scale has improved awareness of poverty, healthcare professional and system bias, and resulted in action.Immediate interventions include hypo treatment on prescription, Trust level review of travel reimbursement, Carb Counting and Healthy Eating on a budget training, provision of refurbished mobile phones to enable diabetes technology, introduction of remote clinics, universal provision of information on financial benefits.ReferencesStone, J. Local indicators of child poverty after housing costs, 2021/22. [online] 2023. Available at: https://endchildpoverty.org.uk/wp-content/uploads/2023/06/Local-indicators-of-child-poverty-after-housing-costs_Final-Report-3.pdf.Leggott, E. Poverty Proofing Diabetes Network End of Project Report. Children North East 2023b.Leggott, E. Common Themes Poverty Proofing Diabetes Healthcare. [online] Children North East 2023. Available at: https://children-ne.org.uk/wp-content/uploads/2023/10/2.-REPORT-Poverty-Proofing%C2%A9-Health-Care-Common-Themes-Paediatric-Diabetes.pdf [Accessed 30 Oct. 2023].Leggott E. Poverty proofing diabetes workforce guide. Children North East 2023c.

The highest attack rate was in those born between 1983 and 1986, who were too old to be offered MMR vaccination routinely when it was introduced in 1988, although some may have received one dose of MMR as part of a catch-up programme offered at school entry. 3 These individuals would have missed the opportunity for mumps exposure during childhood because high coverage in younger children had reduced circulation of mumps in the UK. What is already known about this topic The incidence of mumps fell after the MMR was introduced in 1988 The number of confirmed mumps cases in 2004 has risen across England and Wales, with a number of reported outbreaks in universities What this study adds The current mumps outbreak has been predominantly in older teenagers and young adults, who would not have been offered two doses of MMR This confirms the effectiveness of the current vaccination policy The mumps component of the MMR vaccine used in the UK is believed to offer around 90% protection for one dose, although recent reports indicate that this could be as low as 64%.

Purpose – The purpose of this paper is to compare the program design of a sustainability leadership certificate to participants’ perceptions of their in-program learnings and competencies development. The authors present the results from the analysis of one program evaluation component, a survey, which was delivered before the program start and at the program end. Design/methodology/approach – The authors describe key design elements of a sustainability leadership certificate, which was framed around five key sustainability competencies. Using a pre/post self-assessment, participants (n = 32) selected their level of confidence and competence in each of the key sustainability competencies and completed open-ended questionnaires. Quantitative data were analyzed using a Mann–Whitney U test, and qualitative data were transcribed and coded using a grounded theory approach in NVivo 10. Findings – Based on the survey feedback, the program participants were generally excited by the program’s experiential format and supportive community. They felt that they had improved their confidence and competence in the key sustainability competencies. Three themed clusters, community, future and personal development, emerged from the participants’ open-ended responses. This supports the program design and can inform further program development. Practical implications – The third theme, personal development, is notable, as it is not a typical focus of sustainability in higher education, but held high importance to participants. This strong resonance with participants suggests that sustainability programs should consider the role of the self to foster the development of key sustainability competencies. Originality/value – The program’s focus on “personal” was intentional in the program design. Based on participants’ feedback, the inclusion of personal development exercises was a critical element for successful sustainability leadership development.

Current behavioural treatment of obsessive‐compulsive disorder (OCD) is informed by fear conditioning and involves iteratively re‐evaluating previously threatening stimuli as safe. However, there is limited research investigating the neurobiological response to conditioning and reversal of threatening stimuli in individuals with OCD. A clinical sample of individuals with OCD (N = 45) and matched healthy controls (N = 45) underwent functional magnetic resonance imaging. While in the scanner, participants completed a well‐validated fear reversal task and a resting‐state scan. We found no evidence for group differences in task‐evoked brain activation or functional connectivity in OCD. Multivariate analyses encompassing all participants in the clinical and control groups suggested that subjective appraisal of threatening and safe stimuli were associated with a larger difference in brain activity than the contribution of OCD symptoms. In particular, we observed a brain‐behaviour continuum whereby heightened affective appraisal was related to increased bilateral insula activation during the task (r = 0.39, pFWE = .001). These findings suggest that changes in conditioned threat‐related processes may not be a core neurobiological feature of OCD and encourage further research on the role of subjective experience in fear conditioning. Studying brain imaging of patients with obsessive‐compulsive disorder (OCD) during a fear reversal task showed no significant brain activation differences with healthy controls. Multivariate analysis revealed that subjective appraisal had a greater impact on brain activity than OCD symptoms.

Objectives: To assess the knowledge and current tetanus prevention practices of various staff members in accident and emergency (A&E) departments. Design, setting and participants: A structured questionnaire containing 16 questions on tetanus guidance, anti-tetanus practice, vaccination preparations and information on the population served by the department was sent to medical and nursing staff in A&E departments across England. Results: 366 completed questionnaires from 67 hospitals were returned. 48.9% of the questionnaires were completed by the medical staff and 39.9% by the nursing staff at various grades. 75% of respondents said that their department had a local tetanus guideline, but only 29% stated that the tetanus guidelines were always followed. 31.4% of respondents said that injecting drug users were managed as a high-risk group in their department. Many respondents did not follow the national policy; they tended to err on the side of caution when it came to defining and treating tetanus-prone wounds, with 22.1% stating that they would consider any wound tetanus prone. Contrary to current Department of Health guidelines, 46.2% of respondents said that they would give a booster dose if the fifth dose had been given >10 years ago. Conclusions: There are clear differences between the recommended guidelines for tetanus prevention and current practice in A&E departments. The changes announced in 2002 do not seem to have been widely implemented. As a result, the apparent success of the national tetanus vaccination programme may be the result of more cautious clinical practice than would be expected from the UK policy. If national recommendations for tetanus are implemented in clinical practice, then the impact on control of the disease should be monitored closely.

New interventions are needed for obsessive-compulsive disorder. Here we present a randomized single-blinded, two-arm, parallel-group, sham-controlled clinical trial assessing the efficacy of prefrontal cortex stimulation in reducing obsessive-compulsive disorder symptoms and frontostriatal connectivity (ACTRN12616001687482). Conducted at a single academic center, the trial enrolled participants diagnosed with obsessive-compulsive disorder who underwent baseline clinical assessments and neuroimaging. The intervention comprised 20 weekday sessions of neuronavigated continuous theta burst stimulation of the frontal pole or sham. Participants and all staff assessing intervention outcomes were blind to the conditions. We enrolled a sample of 50 individuals (26 active continuous theta burst stimulation) who completed the neuroimaging and clinical assessments at the primary 4 week endpoint. Clinical data at the secondary 6 month endpoint were obtained from 46 participants (23 active). Symptoms of obsessive-compulsive disorder (primary outcome) decreased in both groups (active −4.35, P < 0.001; sham −5.92, P < 0.001), but there was no significant difference between groups (P = 0.33, ηp2 = 0.02). Likewise, there was no significant difference between groups in changes of frontal pole connectivity with the striatum (P = 0.09, ηp2 = 0.06). Changes in secondary outcomes (symptoms of anxiety and depression and localized frontal pole activity) did not differ between groups. Dropout rates did not vary between groups and the most common treatment-related adverse event in both groups was headache. Our findings suggest that frontal pole continuous theta burst stimulation is no different to sham in reducing obsessive-compulsive disorder symptoms. The absence of changes in brain activity prompts further evaluation of alternative stimulation protocols.Cocchi and coauthors report that continuous theta burst stimulation of the frontal pole shows no difference from sham in reducing symptoms of obsessive-compulsive disorder or frontostriatal connectivity.

ObjectiveTo perform a European sentinel surveillance study for antimicrobial resistance (AMR) in Neisseria gonorrhoeae as part of the European Surveillance of Sexually Transmitted Infections Programme.MethodsFrom 2006 to 2008 17 countries participated in the AMR surveillance programme. The susceptibility of a total of 3528 consecutive isolates was tested using the agar dilution breakpoint technique or Etests for ciprofloxacin, penicillin, tetracycline, azithromycin, spectinomycin and ceftriaxone. Nitrocefin was used to detect β-lactamase activity.ResultsRates of resistance to ciprofloxacin, the previously recommended treatment, were high across Europe (42–52%), indicating that usage is no longer appropriate. Although resistance to the currently recommended treatment, ceftriaxone, was not demonstrated, a concerning upward drift in the minimal inhibitory concentration (MIC) distribution was identified since an earlier European study in 2004. No resistance to spectinomycin was seen, whereas azithromycin resistance varied from 2% to 7% and isolates from Scotland (n=4) and Ireland (n=1) showed high-level resistance (MIC >256 mg/l). High-level resistance to tetracycline and penicillin remained relatively constant at 16% and 12%, respectively.ConclusionsAMR is an ongoing problem in Europe, with high rates of resistance to many previously recommended therapeutic agents observed in many European countries. Continual European and global surveillance of AMR in N gonorrhoeae is essential to monitor for increasing, emerging and high-level resistance to therapeutically relevant agents and to inform treatment guidelines so optimum treatments are administered.

Gut inflammation is thought to modify brain activity and behaviour via modulation of the gut-brain axis. However, how relapsing and remitting exposure to peripheral inflammation over the natural history of inflammatory bowel disease (IBD) contributes to altered brain dynamics is poorly understood. Here, we used electroencephalography (EEG) to characterise changes in spontaneous spatiotemporal brain states in Crohns Disease (CD) (n = 40) and Ulcerative Colitis (UC) (n = 30), compared to healthy individuals (n = 28). We first provide evidence of a significantly perturbed and heterogeneous microbial profile in CD, consistent with previous work showing enduring and long-standing dysbiosis in clinical remission. Results from our brain state assessment show that CD and UC exhibit alterations in the temporal properties of states implicating default-mode network, parietal, and visual regions, reflecting a shift in the predominance from externally to internally-oriented attentional modes. We investigated these dynamics at a finer sub-network resolution, showing a CD-specific and highly selective enhancement of connectivity between the insula and mPFC, regions implicated in cognitive-interoceptive appraisal mechanisms. Alongside overall higher anxiety scores in CD, we also provide preliminary support to suggest that the strength of chronic interoceptive hyper-signalling in the brain co-occurs with disease duration. Together, our results demonstrate that a long-standing diagnosis of CD is, in itself, a key factor in determining the risk of developing altered brain network signatures. Competing Interest Statement The authors have declared no competing interest.