Abstract Worldwide, cancer screening faced significant disruption in 2020 due to the COVID-19 pandemic. If this has led to changes in public attitudes towards screening and reduced intention to participate, there is a risk of long-term adverse impact on cancer outcomes. In this study, we examined previous participation and future intentions to take part in cervical and colorectal cancer (CRC) screening following the first national lockdown in the UK. Overall, 7543 adults were recruited to a cross-sectional online survey in August-September 2020. Logistic regression analyses were used to identify correlates of strong screening intentions among 2,319 participants eligible for cervical screening and 2,502 eligible for home-based CRC screening. Qualitative interviews were conducted with a sub-sample of 30 participants. Verbatim transcripts were analysed thematically. Of those eligible, 74% of survey participants intended to attend cervical screening and 84% intended to complete home-based CRC screening when next invited. Thirty percent and 19% of the cervical and CRC samples respectively said they were less likely to attend a cancer screening appointment now than before the pandemic. Previous non-participation was the strongest predictor of low intentions for cervical (aOR 26.31, 95% CI: 17.61-39.30) and CRC (aOR 67.68, 95% CI: 33.91-135.06) screening. Interview participants expressed concerns about visiting healthcare settings but were keen to participate when screening programmes resumed. Intentions to participate in future screening were high and strongly associated with previous engagement in both programmes. As screening services recover, it will be important to monitor participation and to ensure people feel safe to attend.
Background: Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors who have limited experience of these conditions. In contrast to paediatric practice, data from industrialized countries with regard to current hospital management practice are lacking. Aim: To examine whether current practice meets recommended standards in hospital management of community-acquired bacterial meningitis and meningococcal septicaemia among adults. Design: National audit of medical records. Methods: We conducted a survey of all patients with acute bacterial meningitis and meningococcal septicaemia admitted to 18 randomly selected acute hospitals in England and Wales between 1 January 2000 and 31 December 2001. All stages of care, including pre-hospital management, initial hospital assessment, record keeping, and ongoing hospital and public health management, were assessed. Results: We identified 212 cases of bacterial meningitis and meningococcal septicaemia; 190 cases remained in the final analysis. Clinical record keeping did not meet acceptable standards in 33% of cases. Parenteral antibiotics were given within 1 h of hospital arrival in 56% of cases, increasing to 79% among those with an initial differential diagnosis that included bacterial meningitis or meningococcal septicaemia. A full severity of illness assessment was made in 27%. The quality of clinical practice varied widely between hospitals. This was most pronounced in the timeliness of consultant review ( p < 0.0005). Discussion: The quality of adult clinical practice for bacterial meningitis and meningococcal septicaemia needs improvement. This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries.
Background: Bacterial meningitis and meningococcal septicaemia are important causes of morbidity and mortality in the UK and elsewhere. There have been achievements in paediatric care, including vaccination; however mortality amongst otherwise healthy young adults remains high. Objective: I undertook this study to examine the way by which the public health burden of meningitis in adults can be reduced. Methods: I used routine surveillance data (laboratory reports, clinical notifications, hospital activity, mortality data) to examine the epidemiology and determine the changing trends. I undertook a capture-recapture study to quantify the underreporting through the routine surveillance. I conducted a retrospective review of clinical management of adult patients with meningitis in England and Wales using medical records of patients diagnosed with meningitis or meningococcal septicaemia. I examined the association of clinical management with the outcome of the disease (CABM and MS). Findings: The epidemiology of adult meningitis in England and Wales is changing. Overall forms of CABM show no significant changing trend, whilst meningococcal septicaemia shows an increasing trend. Tubercular meningitis is increasing significantly, whilst pneumococcal, HiB and Listeria meningitis are falling. Mortality generally remains in a steady trend. There are differences by age-group and causative organisms. There is considerable (-50%) underreporting of both, incidence and mortality from all major routine surveillance systems. Hospital management of meningitis is largely sub-optimal. Main areas of deficiency in clinical care are: timely diagnosis and consequently administration of antibiotics, assessment of severity, and record keeping; and these appeared to vary between the hospitals. It is difficult to examine the association between clinical with the outcome of meningitis primarily due to confounding by severity of illness which in my study was further jeopardised by the lack of recorded data and study power. Conclusion: This study has identified areas within public health interventions, such as vaccination policies, and clinical care, such as improved diagnosis and severity assessment, where there is potential for improvement towards a reduced public health burden of adult meningitis in England and Wales.
Over the last decade, new protein-conjugate vaccines against Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroup C (MenC) have had a dramatic effect on the epidemiology of childhood meningitis in the United Kingdom. Amongst adults, bacterial meningitis remains an important cause of preventable morbidity and mortality. Clinicians need to remain vigilant for the possibility of this infection. The identification of the one patient with meningitis out of many with trivial viral infections remains a difficult task. Even once the diagnosis is made clinically, the subsequent investigation and management of the patient remains controversial, with strong opinions often influenced by one or two adverse experiences. Potential improvements in the way we identify and manage meningitis patients have been identified in recent years. This review will focus on those areas relevant to the emergency care specialist. Meningitis in the immunocompromised patient often has a different clinical and epidemiological pattern and is beyond the scope of this review.
Background Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people’s perceptions of remote consultations and identify potential resulting inequalities. Aim To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. Design and setting A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. Method In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. Results A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications ( B = −0.82, 95% confidence interval [CI] = −1.41 to −0.23) or those with low or no qualifications ( B = −1.65, 95% CI = −2.29 to −1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland ( B = −1.94, 95% CI = −3.11 to −0.78), although caution is warranted due to small group numbers. Conclusion These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.
To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March-August 2020) of the UK COVID-19 pandemic.
To improve estimates of disease incidence and deaths from pneumococcal meningitis among adults in England, we performed a capture-recapture analysis for 1996 through 1999. We compared data from Hospital Episode Statistics (HES) and the Public Health Laboratory Services (PHLS) for incidence estimates and from HES and the Office for National Statistics (ONS) for estimates of deaths. Estimated sensitivities for the examined systems were 46% (95% confidence interval [CI] 42% to 50%) for HES and 40% [95% CI 37% to 44%] for PHLS. Sensitivities for mortality rates were found to be similar, 48% [95% CI 41% to 55%] for HES and 49% [95% CI 42% to 56%] for ONS. Stratification analysis showed that the sensitivity in those >85 years of age was significantly lower than the sensitivity for other ages. The estimated case-fatality rate was 24% [95% CI 21% to 26%]. These estimates indicate that a cost-benefit analysis of adult pneumococcal vaccination programs is required.
We examined the epidemiology of community-acquired bacterial meningitis among adults in England and Wales between 1991 and 2002. Among 3169 cases, meningococcal infection was predominant among young adults and pneumococcal meningitis among older adults. Whilst infection due to most causes decreased, the incidence of tuberculous (TB) meningitis doubled over the 12 years. The mortality rate among meningococcal and pneumococcal infections fell from 0·45/10 5 to 0·31/10 5 ( P =0·0001). This study demonstrates important changes in the epidemiology of bacterial meningitis among UK adults. Improvements in clinical management, childhood vaccination programmes and the re-emergence of tuberculosis are likely to be drivers of these changes.
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