Minimizing sample bias due to stigmatized behaviours: the representativeness of participants in a cohort study of alcohol in pregnancy.

Background: Stigmatized behaviours are often underreported, especially in pregnancy, making them challenging to address. The Alcohol and Child Development Study (ACDS) seeks to inform prevention of foetal alcohol harm, linking self-report as well as a maternal blood alcohol biomarker with child developmental outcomes. Samples were requested using passive, generic consent.

Systematic review of the effects of antimicrobial cycling on bacterial resistance rates within hospital settings.

Aims: Antimicrobial resistance is an evolving phenomenon with alarming public health consequences. Antibiotic cycling is a widely known antimicrobial stewardship initiative that encompasses periodical shifts in empirical treatment protocols with the aim of limiting selective pressures on bacterial populations. We present a review of the evidence regarding the actual impact of antimicrobial cycling on bacterial resistance control within hospitals.

Review of antimicrobial resistance control strategies: low impact of prospective audit with feedback on bacterial antibiotic resistance within hospital settings.

Background: Antimicrobial stewardship constitutes an essential element of any concerted effort to tackle bacterial resistance, a rising public health threat both in community as well as hospital settings. The term comprises variable strategies which aim to optimise prescribing practices through either antibiotic restrictions or prospective audits of prescriptions with subsequent feedback to clinicians. Although highly debated, the actual effects of the latter on the antimicrobial susceptibility patterns of hospital flora are uncertain.

Not Up for Discussion: Applying Lukes' Power Model to the Study of Health System Corruption Comment on "We Need to Talk About Corruption in Health Systems".

This companion paper suggests the potential benefits of applying Steven Lukes' dimensions of power model to the study of corruption in health systems. Lukes' model sets out three "faces of power" classified by their influence on political discourse, resulting in overt, covert and latent discussion of issues depending on the degree of their alignment with the agenda of dominant power interests. His concept that differential access to public discourse varies according to this alignment implies the potential for identifying more serious forms of corruption by the mismatch between their practical importance and the amount of open debate addressing them.

Awareness, attitudes and perceptions regarding HIV and PMTCT amongst pregnant women in Guinea-Bissau- a qualitative study.

Background: The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers' experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010-11).

Validation of US cerebral palsy growth charts using a UK cohort.

Aim: Growth charts for cerebral palsy (CP) have been constructed using data for 24 920 Californian patients, covering ages 2 to 20 years, with separate charts for the five severity levels of the Gross Motor Function Classification System (GMFCS). Our aim was to test how the data for British children with CP fit these charts, compared with conventional local charts.

Method: US CP growth reference was reanalysed using the lambda-mu-sigma (LMS) method to allow calculation of standard deviation z-scores.

Assessing the impact of multidrug-resistant tuberculosis in children: an exploratory qualitative study.

Background: While the prevalence of multidrug-resistant (MDR) tuberculosis (TB) is high among children in the Western Cape of South Africa, the psychosocial implications of treatment for children with MDR-TB remain poorly understood. We sought to explore how MDR-TB and its treatment impact children on an individual, familial, and social level.

Methods: Semi-structured interviews were conducted with 20 children and caregivers purposively sampled from a prospective clinical cohort of children.

Bickerstaff's encephalitis.

Bickerstaff's brainstem encephalitis is a rare syndrome defined by the triad of ophthalmoplegia, ataxia and decreased consciousness. It is considered to be a variant of Miller Fisher syndrome and Guillain-Barré syndrome but is differentiated from the two by the presence of central nervous system involvement, commonly in the form of impaired consciousness. We present an unusual case of Bickerstaff's encephalitis, where the patient presented with pseudobulbar affect.

"Home is where the patient is": a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis.

Background: Ambulatory, community-based care for multi-drug resistant tuberculosis (MDR-TB) has been found to be effective in multiple settings with high cure rates. However, little is known about patient preferences around models of MDR-TB care. Médecins Sans Frontières (MSF) has delivered home-based MDR-TB treatment in the rural Kitgum and Lamwo districts of northern Uganda since 2009 in collaboration with the Ministry of Health and the National TB and Leprosy Programme.

Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis.

Objectives: We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs.

Design: A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005.

Ditching the single-payer system in the national health service: how the English Department of Health is learning the wrong lessons from the United States.

Reforms to the British National Health Service introduce major changes to how health care will be delivered. The core elements include the creation of new purchaser organizations, Clinical Commissioning Groups, which unlike their predecessors will be able to recruit and reject general practices and their patients without geographical restriction. The Clinical Commissioning Groups are to transition from statutory bodies to freestanding organizations, with most of their functions privatized and an increasingly privatized system of provision, In this paper, we explore the likely consequences of these proposals, drawing in particular on the experience of managed care organizations in the United States, whose approach has influenced the English proposals extensively.

Competition-based reform of the National Health Service in England: a one-way street?

The Conservative-led government in the United Kingdom is embarking on massive changes to the National Health Service in England. These changes will create a competitive market in both purchasing and provision. Although the opposition Labour Party has stated its intention to repeal the legislation when it regains power, this may be difficult because of provisions of competition law derived from international treaties.

Opening the oyster: the 2010-11 NHS reforms in England.

This opinion paper briefly considers the credibility of the announced rationale behind the current extensive reform of the NHS in light of recent research evidence about performance of the system. The paper outlines the authors' views of the history of the reform, which originates in a set of documents, produced in the late 1980s by the Centre for Policy Studies, which aimed to introduce private sector involvement throughout the NHS, and a brief report by a consultant for a health maintenance organisation in the USA. Tracking of the pro-private sector changes in the NHS demonstrates that the bill is a major step in the implementation of NHS privatisation and also delineates a roadmap for coming developments, which have been explained to corporate providers and investors seeking new profit opportunities but have not yet been debated openly with the electorate in the UK.

'No decision about me, without me': a place for social marketing within the new public health architecture?

July 2011 marked the 40th anniversary of social marketing. However, while the previous Labour administration dedicated sustained resources and support to developing the field of social marketing, this was followed by a time of uncertainty during the Coalition Government's ascent to power. This paper explores the potential future position of social marketing within David Cameron's evolving public health landscape, outlining areas of synergy between social marketing's key features, and the coalition's emergent public health architecture.

Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system.

Treatment by injection or infusion is widespread in China. Using the common cold as a tracer condition, we explored the reasons for over-prescription of injections and infusions in Guizhou, China. Interviews with prescribers, patients and key informants were supplemented by focus groups.

HIV as a chronic disease considerations for service planning in resource-poor settings.

This paper reviews the healthcare issues facing nations which have a substantial caseload of chronic HIV cases. It considers the challenges of extending antiretroviral coverage to an expanding caseload as supplier price rises and international trade agreements come into force to reduce the availability of affordable antiretrovirals just as the economic downturn restricts donor funding. It goes on to review the importance in this context of supporting adherence to drug regimens in order to preserve access to affordable antiretrovirals for those already on treatment, and of removing key barriers such as patient fees and supply interruptions.

Capillary TSH screening programme for Down's syndrome in Scotland, 1997-2009.

Objectives: To assess uptake of community-based capillary thyroid stimulating hormone (TSH) screening in Scotland and determine the optimal frequency of screening, the justification for preschool screening and strategies for treatment.

Methods: Subjects with Down's syndrome aged 1-19 years underwent capillary TSH measurement. Clinical and biochemical data were collected using proformas.