Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa.

Objective: To assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa.

Design And Methods: Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individuals representative of the general population of countries or regions of sub-Saharan Africa.

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa.

Objectives: To investigate whether the prevalence of HIV infection among young people, and sexual behaviours associated with increased HIV risk, are differentially distributed between students and those not attending school or college.

Design: A random population sample of unmarried young people (916 males, 1003 females) aged 14-25 years from rural South Africa in 2001.

Methods: Data on school attendance and HIV risk characteristics came from structured face-to-face interviews.

Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001-2004.

Objectives: To estimate HIV incidence and explore evidence for changing sexual behaviour over time among men and women belonging to different socioeconomic groups in rural South Africa.

Design And Methods: A cohort study conducted between 2001 and 2004; 3881 individuals aged 14-35 years enumerated in eight villages were eligible. At least three household visits were made to contact each eligible respondent at both timepoints.

Improving school ethos may reduce substance misuse and teenage pregnancy.

Current strategies to improve teenage health are not having the desired effect. , and examine the evidence for a wider focus

Does the UK government's teenage pregnancy strategy deal with the correct risk factors? Findings from a secondary analysis of data from a randomised trial of sex education and their implications for policy.

Background: Much of the UK government's 1999 report on teenage pregnancy was by necessity based on rather old or non-longitudinal research.

Aim: To examine the associations between risk factors identified in the report and pregnancy at or before age 16 years among young women and partners of young men using the more recent data.

Results: Socioeconomic disadvantage, being born to a teenage mother, expectation of being a teenage parent, low educational expectations and various other behaviours are potential risk factors for teenage pregnancy, as suggested by unadjusted analyses.

Assessment of generalisability in trials of health interventions: suggested framework and systematic review.

Most evaluations of new treatments use highly selected populations, making it difficult to decide whether they would work elsewhere. Systematic evaluation and reporting of applicability is required

Influence of family type and parenting behaviours on teenage sexual behaviour and conceptions.

Background: Longitudinal data were used to explore relations between teenage pregnancy, sexual behaviour, and family type. The study examined whether students from lone parent and/or teenage mother initiated families more commonly report sex, lack of contraception at first sex, and/or conceptions by age 15/16, and whether such associations can be explained by low parental strictness, difficult parent-child communication, and/or low parental input into sex education. Up to date longitudinal UK research on family influences on conceptions is lacking, as is longitudinal research on family influences on sexual behaviour.

Should structural interventions be evaluated using RCTs? The case of HIV prevention.

Structural interventions addressing macro-social determinants of risk have been suggested as potentially important adjuncts to biomedical and behavioural interventions for the prevention of HIV and other diseases. A few interventions of this type have been evaluated using randomised controlled trials (RCTs), the most rigorous design to evaluate the effects of biomedical and behavioural interventions. The appropriateness of applying RCTs to structural interventions is however debated.

Process evaluation in randomised controlled trials of complex interventions.

Most randomised controlled trials focus on outcomes, not on the processes involved in implementing an intervention. Using an example from school based health promotion, this paper argues that including a process evaluation would improve the science of many randomised controlled trials

HIV prevention outreach in commercial gay venues in large cities: evaluation findings from London.

Human immunodeficiency virus (HIV) prevention delivered in gay venues in US cities has been found to be effective in reducing HIV transmission in the 1990s but effects might not be generalizable to different times and settings. Doubts have been raised about: outreach's ability to address skills and explore personal behaviour; big-city commercial gay venues being appropriate sites for outreach because of gossip and social surveillance; and acceptability of outreach by professionals rather than 'popular opinion formers'. We evaluated coverage, feasibility, acceptability and perceived impact of venue-based HIV prevention outreach by professionals in London, employing observation, surveys and interviews with venue-users, and focus groups/semi-structured interviews with workers.

[Factors that affect the Hoffmann reflex as a tool used in neurophysiological examination].

Introduction: The Hoffmann reflex, or H-reflex, which is the electrical equivalent of the myotatic reflex, is a very valuable tool for evaluating the reflex pathway and for investigating the mechanisms that regulate the intensity of its response. Yet, the complex interaction of the H-reflex circuit with other neural components requires a tight-fit recording protocol.

Development: In this paper we present a review of the main technical, physiological and methodological factors that affect the recording of the H-reflex when used as an instrument for neurophysiological exploration.

The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education.

Study Objective: To examine whether attitude to school is associated with subsequent risk of teenage pregnancy. To test two hypotheses that attitude to school is linked to pregnancy via pathways involving young people having "alternative" expectations or deficits in sexual health knowledge and confidence.

Design: Analysis of longitudinal data arising from a trial of sex education.

Why is teenage pregnancy conceptualized as a social problem? A review of quantitative research from the USA and UK.

To explore why teenage pregnancy is regarded by researchers from the USA and UK as a major social problem, a systematic review was conducted of published research on the social influences on teenage pregnancy. Papers published in the USA and UK between 1981 and 2000 were examined with respect to samples, social influences and outcomes. UK studies often justified investigating teenage pregnancy in terms of health.

Effect of social exclusion on the risk of teenage pregnancy: development of hypotheses using baseline data from a randomised trial of sex education.

Study Objective: The UK government argues that "social exclusion" increases risk of teenage pregnancy and that educational factors may be dimensions of such exclusion. The evidence cited by the government is limited to reporting that socioeconomic disadvantage and educational attainment influence risk. Evidence regarding young people's attitude to school is not cited, and there is a lack of research concerning the UK.

Behavioural interventions to prevent HIV infection: rapid evolution, increasing rigour, moderate success.

Behavioural interventions aim to alter behaviours that make individuals more vulnerable to becoming infected or infecting others with HIV. Research in this field has developed rapidly in recent years. Increased rigour in the design and conduct of evaluations and moderate successes in bringing about behaviour change in target populations are the key achievements so far.

Sexually transmitted infection as a risk factor for homosexual HIV transmission: a systematic review of epidemiological studies.

Existing reviews suggest some sexually transmitted infections (STIs) are risk factors in heterosexual HIV transmission. This may not be so in homosexual HIV transmission, about which reviews make no specific conclusions. This paper reviews published studies which report on the relative risk of STIs in HIV seroconversion in homosexually-active men in order to examine this matter.

Evidence-based nursing: a stereotyped view of quantitative and experimental research could work against professional autonomy and authority.

In recent years, there have been calls within the United Kingdom's National Health Service (NHS) for evidence-based health care. These resonate with long-standing calls for nursing to become a research-based profession. Evidence-based practice could enable nurses to demonstrate their unique contribution to health care outcomes, and support their seeking greater professionalization, in terms of enhanced authority and autonomy.

Crossover trial of partial shift working and a one in six rota system for house surgeons in two teaching hospitals.

The objective of this study was to compare an on call rota and partial shift working pattern for house surgeons in two hospitals. The study was conducted using a crossover trial of working both systems for 6 weeks each in two groups of newly appointed house surgeons. Assessment was by questionnaire to house surgeons, consultants, registrars, nursing staff and patients.

Adult asthma assessment in an accident & emergency department.

Poor initial assessment contributes to morbidity and mortality in acute severe asthma. We have audited this aspect of management in an A & E department over a single 6-month senior house officer employment cycle. The use of a cheap and simple stamp highlighting important clinical features of asthma was associated with a significant improvement in early assessment.

Commissioning diabetic eye screening by optometrists: a local initiative at the primary-secondary care interface.

The rationale behind the decision of a London family health services authority (Lambeth, Southwark, and Lewisham) to embark on a programme for diabetic eye screening by optometrists is outlined, discussing the way in which the scheme was set up and its possible future development. This family health services authority brought together a range of professionals across primary and secondary care to reach agreement on development of the service, and a consensus on clinical guidelines for operation of the scheme. This was particularly difficult in an area served by four hospitals which provide care to diabetics.