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Background: The phased implementation of the National Chlamydia Screening Programme (NCSP) began in September 2002. The NCSP offers opportunistic screening for chlamydia to women and men under 25 years of age attending clinical and non-clinical screening venues using non-invasive urine or vulvo-vaginal swab samples tested via nucleic acid amplification. This review describes the implementation of the NCSP, reports positivity rates for the first year, and explores risk factors for genital chlamydial infection. Methods: Cross sectional study of the first year's screening data from the NCSP. A standardised core dataset for each screening test was collected from 302 screening venues, excluding genitourinary medicine (GUM) clinics, across 10 phase 1 programme areas. We estimated chlamydia positivity by demographic and behavioural characteristics, and investigated factors associated with infection through univariate and multivariate analyses. Results: Chlamydia positivity among people under 25 years of age screened in non-GUM settings was 10.1% (1538/15 241) in women and 13.3% (156/1172) in men. Risk factors varied by sex: for womenage 16-19, non-white ethnicity, and sexual behaviours were associated with infection; for men-only age 20-24 and non-white ethnicity were associated with infection. Discussion: In the first phase of the NCSP, 16 413 opportunistic screens among young adults under 25 years of age were performed at non-GUM settings and testing volume increased over time. Rates of disease were similar to those found during the English screening pilot and were comparable to the first year of widespread screening in Sweden and the United States. The screening programme in England will continue to expand as further phases are included, with national coverage anticipated by 2008.

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A balance of cognitive rest and timely return to school need to be considered for returning any student to school after a concussion. Implementation of these new recommendations may be an important tool in prevention of prolonged absence from school and academic failure while supporting brain recovery.

Measurements of simultaneously extracted metals (SEM), acid volatile sulfide (AVS), and invertebrate toxicity were combined with X-ray absorption spectroscopy (XAS) to evaluate metal speciation and ecological hazard of contaminated sediments from the Seaplane Lagoon, Naval Air Station Alameda (CA). This site is characterized by moderate to low toxicity in surface sediments and by metal concentrations in sediments and porewaters that increase with depth. Standard 1-h ΣSEM/AVS measurements for surface sediments were compared with time-series (0.25−24 h) measurements of metal and sulfide release from sediments at 30 cm. Results show that AVS is rapidly and completely evolved after 1 h, but metal extraction continues with time and is not complete after 24 h. Sediment−water interface tests of invertebrate toxicity using sand dollar embryos (D. excentricus) and adult amphipods (E. estuarius) exposed to intact cores showed no to low toxicity in surface sediments. In sediments from 30- and 60-cm depth, high toxicity in several replicates was attributed to factors other than metal concentrations, such as high dissolved ammonia or low dissolved oxygen concentrations. Metal speciation and bonding determined from XAS show that cadmium (100%), zinc (≈80%), and manganese (≈50−70%) are associated with monosulfide phases in the sediments. The remaining fraction of zinc and manganese and all of the chromium and lead are ligated by oxygen atoms, indicating association with oxide, carbonate, or silicate minerals. Iron is present in the sediments in two fractions, as Fe(II) in the sulfide phase pyrite and as oxygen-ligated octahedral iron, probably associated with clay minerals. Bulk chemical measurements of porewaters and sediments, and speciation information from XAS, suggest that AVS could be accounted for by volatilization of porewater sulfide. Our results indicate that metals are removed from porewaters by formation of monosulfide phases only for cadmium and partially for zinc and manganese but not for lead or chromium, even though these are reduced, anoxic sediments typical of a restricted marine estuary environment. Comparison of geochemical, spectroscopic, and biological data provides new insight for the interpretation of ΣSEM/AVS measurements and points out the need for synergistic biological/geochemical tests for determining potential ecological hazard.

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...