Sexual behaviours determined incidence and reinfection, regardless of healthcare setting. Our results suggest annual screening of women aged 16-24 years who are chlamydia negative, or sooner if partner change occurs. Rescreening chlamydia-positive women within 6 months of baseline infection may be sensible, especially if partner change occurs or all partners are not treated.

Objectives: To determine the prevalence and treatment outcomes among young women screened opportunistically for genital Chlamydia trachomatis and to evaluate the impact of screening in those participating. Design: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples, tested by ligase chain reaction (LCR). In-depth interviews were used for programme evaluation. Setting: Screening was offered in two health authorities at general practice, family planning, genitourinary medicine (GUM), adolescent sexual health, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics). Main participants: Sexually active women (16-24 years) attending for any reason. Main outcome measures: Screening data: prevalence of infection by age and healthcare setting; proportion of positive patients attending for treatment. Evaluation data: participants' attitudes and views towards screening and follow up. Results: In total, 16 930 women (16-24 years) were screened. Prevalence was higher in younger women (16-20) than those aged 21-24 years and was highly variable at different healthcare settings (range 3.4%-17.6%). Prevalence was approximately 9% in general practice. The role of the project health advisers in managing results and coordinating treatment of positive individuals was essential; the vast majority of all positives were known to be treated. Women felt that screening was beneficial. Improving awareness and education about sexually transmitted infections is required to alleviate negative reactions associated with testing positive for infection. Conclusions: Prevalence of infection outside GUM clinics is substantial and opportunistic screening using urine samples is an acceptable method of reaching individuals with infection who do not normally present at specialist clinics.T his paper presents data from a large scale pilot of opportunistic screening for genital Chlamydia trachomatis infection at a range of healthcare settings including primary care. Offering opportunistic screening at healthcare settings outside genitourinary medicine (GUM) clinics is likely to detect many infected individuals who may not consider themselves at risk of infection, or who are asymptomatic and so would not normally be diagnosed. The main aim of the pilot, which was undertaken in response to the recommendations of the chief medical officer's expert advisory group on Chlamydia trachomatis, 1 was to assess the feasibility and acceptability of screening in healthcare settings outside GUM clinics. In addition, the study has generated accurate estimates of prevalence in healthcare settings outside GUM clinics, which can be used to inform decision making on the cost effectiveness of screening and which settings should be utilised in a national screening programme. In this paper, we present results on the prevalence of infection, treatment outcomes, and the impact of screening on young people taking part in the programme. METHODSA full description of th...

High parental expressed emotion (EE), reflected by criticism or emotional over-involvement, has been related to poorer outcome in family-based treatment (FBT) for adolescent anorexia nervosa. This study assessed EE in 89 mothers and 64 fathers at baseline and end of treatment in a randomised trial comparing conjoint FBT to parent-focused FBT (PFT). Compared with conjoint FBT, PFT was associated with a decrease in maternal criticism, regardless of adolescent remission. Furthermore, an increase in maternal criticism was more likely to be observed in conjoint FBT (80%) than PFT (20%, p = 0.001). Adolescents of mothers who demonstrated an increase in EE, or remained high in EE, were less likely to remit compared with adolescents for whom EE decreased or remained low (33% and 0% vs. 43% and 50%, p = 0.03). There were no significant effects for paternal EE. The results highlight the importance of considering EE when implementing FBT for adolescents with anorexia nervosa. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Family-based treatment (FBT; Lock & Le Grange, 2013) is currently the most efficacious outpatient treatment for medically stable adolescents with anorexia nervosa (AN) (Lock, 2015) and is considered first-line outpatient treatment (Ciao, Accurso, Fitzsimmons-Craft, Lock, & Le Grange, 2015; Couturier, Kiymber, & Szatmari, 2013). Despite this, FBT is not effective for all patients, thus prompting exploration of factors that might enhance, or hinder, patient recovery. One such factor is expressed emotion (EE).Expressed emotion characterises the quality of interpersonal interactions and the relationship between a caregiver and an unwell relative (Brown & Rutter, 1966;Hodes, Dare, Dodge, & Eisler, 1999;Vaughn & Leff, 1976). Family members characterised as having high EE are generally critical or hostile towards the unwell family member and/or emotionally overinvolved (Rienecke, Accurso, Lock, & Le Grange, 2016). In assessing EE within families, the attitudes, emotions and feelings expressed by family members towards an unwell relative is evaluated (Rein et al., 2006). The most common face-to-face methods used to assess EE are the Camberwell Family Interview (Vaughn & Leff, 1976), Standardised Clinical Family Interview (SCFI;Kinston & Loader, 1984) and the Five Minute Speech Sample (FMSS; Magana, Goldstein, Karno, & Miklowitz, 1986).Early studies have suggested that parental EE predicts treatment response in family therapy for adolescents with AN. Specifically, high parental EE has been associated with treatment dropout (Szmukler, Eisler, Russell, & Dare, 1985) and poor treatment outcomes (Le Grange, Eisler, Dare, & Russell, 1992;van Furth et al., 1996). For instance, in a small (n = 18) randomised clinical trial (RCT) of conjoint family therapy (CFT) versus separated family therapy (SFT), parents of adolescents who had a poor response to treatment made significantly more critical comments during the SCFI (i.e., high EE) at baseline compared with those who had a good or inte...

The American Academy of Paediatrics recommend that parent and children (aged 2–18 years) jointly engage in media yet the impact on interactions is unknown. This systematic review identified joint media engagement (JME) rates, the supports offered by parents and children to each other and the impact of JME on parent–child interactions. A search within six article databases (ProQuest, PsycInfo, Web of Science, Scopus, Pub Med, and CINAHL) from January 2007 to June 2019 found 7,130 results. Included papers involved parent–child dyads engaging in JME with a smartphone or tablet. In the 27 identified papers, most parents engaged in JME sometimes (41–72%) compared to JME use that was frequent (13–38%) and JME refusal (4–8%). Parents and children supported each other with cognitive, physical, technical, and affective techniques. Children were more engaged during JME activities and key elements of language quality was reduced compared to nonmobile device activities (such as toy play). The impact of JME on language quantity, warmth, scaffolding and the overall parent–child relationship was inconsistent, however, several factors that potentially influenced this impact were identified. Research investigating these factors and how apps may foster interactions is needed.

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Although research on children of parents with mental illness is growing, few researchers have examined the long-term impact of parental mental illness on adult children. This study explored the potential impact of growing up with a parent with a mental illness on the parenting role assumed by adult children. The qualitative study included ten participants, who were individually interviewed using a semi-structured interview schedule. Interpretative phenomenological analysis (IPA) along with member checks were utilised to derive themes from participants’ narratives. Three main themes were identified, including: ‘this is me’, ‘a whole new world’, and ‘because of you’. ‘This is me’ consisted of narratives highlighting how adult children intentionally went about parenting in ways different from their parents, and ‘a whole new world’ captured the salient identity that parenthood served for adult children. The third theme, ‘because of you’ highlighted the challenges adult children faced in their parenting roles as a result of their childhood experience living with a parent with mental illness. Participants highlighted the main challenges to be an absence of a reference point and lack of informal social supports. Recommendations for mental health practitioners and future research are presented in order to develop better ways to support adult children and their families.

Teladorsagia circumcincta is an important pathogenic nematode of sheep. It has been demonstrated previously that stimulation of murine T lymphocytes with excretory-secretory (ES) products derived from fourth stage larvae of T. circumcincta (Tci-L4-ES) results in de novo expression of Foxp3, a transcription factor intimately involved in regulatory T cell function. In the current study, Foxp3+ T cell responses in the abomasum and the effects of Tci-L4-ES on ovine peripheral blood mononuclear cells (PBMC) following T. circumcincta infection were investigated. T. circumcincta infection resulted in a significant increase in numbers of abomasal Foxp3+ T cells, but not an increase in the proportion of T cells expressing Foxp3. Unlike in mice, Tci-L4-ES was incapable of inducing T cell Foxp3 expression but instead suppressed mitogen-induced and antigen-specific activation and proliferation of ovine PBMC in vitro. This effect was heat labile, suggesting that it is mediated by protein(s). Suppression was associated with up-regulation of interleukin-10 (IL-10) mRNA, and specific monoclonal antibody neutralisation of IL-10 resulted in a 50% reduction in suppression, indicating involvement of the IL-10 signaling pathway. Suppression was significantly reduced in PBMC isolated from T. circumcincta infected vs. helminth-naïve lambs, and this reduction in suppression was associated with an increase in Tci-L4-ES antigen-specific T cells within the PBMC. In conclusion, we have identified a mechanism by which T. circumcincta may modulate the host adaptive immune response, potentially assisting survival of the parasite within the host. However, the impact of Tci-L4-ES-mediated lymphocyte suppression during T. circumcincta infection remains to be determined.

Background The use of fitness trackers as tools of self-management to promote physical activity is increasing. However, the content of fitness trackers remains unexplored. Objective The aim of this study was to use the Behavior Change Technique Taxonomy v1 (BCTTv1) to examine if swim-proof fitness trackers below Aus $150 (US$ 105) incorporate behavior change techniques (BCTs) that relate to self-management strategies to increase physical activity and reduce sedentary behavior and to determine if content of the fitness trackers correspond to physical activity guidelines. Methods A total of two raters used the BCTTv1 to code 6 fitness trackers that met the inclusion criteria. The inclusion criteria were the ability to track activity, be swim proof, be compatible with Android and Apple operating systems, and cost below Aus $150. Results All fitness trackers contained BCTs known to promote physical activity, with the most frequently used BCTs overlapping with self-management strategies, including goal setting, self-monitoring, and feedback on behavior. Fitbit Flex 2 (Fitbit Inc) contained the most BCTs at 20. Huawei Band 2 Pro (Huawei Technologies) and Misfit Shine 2 (Fossil Group) contained the least BCTs at 11. Conclusions Fitness trackers contain evidence-based BCTs that overlap with self-management strategies, which have been shown to increase physical activity and reduce sedentary behavior. Fitness trackers offer the prospect for physical activity interventions that are cost-effective and easily accessed by a wide population.