Papers by Gillian Holdsworth
Journal of the Royal Society of Medicine, 1996
BMC Health Services Research, 2015
Online sexual health services are an emerging area of service delivery. Theory of change critical... more Online sexual health services are an emerging area of service delivery. Theory of change critically analyses programmes by specifying planned inputs and articulating the causal pathways that link these to anticipated outcomes. It acknowledges the changing and contested nature of these relationships. We developed two versions of a theory of change for an online sexual health service. The first articulated the theory presented in the original programme proposal and the second documented its development in the early stages of implementation through interviews with key programme stakeholders. The programme proposal described an autonomous and empowered user completing a sexual health check using a more convenient, accessible and discreet online service and a shift from clinic based to online care. The stakeholder interviews confirmed this and described new and more complex patterns of service use as the online service creates opportunities for providers to contact users outside of the traditional clinic visit and users move between online and clinic based care. They described new types of user/provider relationships which we categorised as: those influenced by an online retail culture; those influenced by health promotion outreach and surveillance and those acknowledging the need for supported access. This analysis of stakeholder views on the likely the impacts of online sexual health services suggests three areas for further thinking and research. 1. Co-development of clinic and online services to support complex patterns of service use. 2. Developing access to online services for those who could use them with support. 3. Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others. This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services.
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2014
Tuberculosis (TB) treatment centres in Eastern Nepal. To determine smoking cessation rates among ... more Tuberculosis (TB) treatment centres in Eastern Nepal. To determine smoking cessation rates among TB patients advised to quit. One intervention and one control centre were studied. At the intervention centre, brief advice about smoking and cessation was given at the start of anti-tuberculosis treatment, and repeated 2 and 5 months later. After 6 months of standard treatment, patients were asked about quitting. Expired air carbon monoxide (CO) was measured in those claiming 6 months of abstinence. None of the 51 controls achieved 6 months of abstinence, whereas 77 (39%) of the 195 in the intervention group claimed at least 6 months of abstinence. All claims were verified by CO measurement in expired air (95%CI 31.4-47.6, P < 0.0001 for the difference in smoking cessation). Brief advice on smoking cessation to patients starting anti-tuberculosis treatment in the National Tuberculosis Programme (NTP) setting in Eastern Nepal led to 39% quitting for least 6 months. Our results should ...
British journal of cancer, Jan 9, 2014
Public Health, 2012
This article presents an overview of a partnership between public health teams in two primary car... more This article presents an overview of a partnership between public health teams in two primary care trusts in South East London, their local acute hospital trusts, and crime and disorder reduction partnerships to support the reduction of harm from violence. It discusses recent developments in violence prevention in emergency departments in the UK, and developments around outreach and case management, more common in the USA. It then outlines the elements of the violence prevention project being conducted in South East London.
Journal of Public Health, 1999
This paper describes the management of public relations following an outbreak of multidrug resist... more This paper describes the management of public relations following an outbreak of multidrug resistant TB at a London hospital. Eight patients were involved, all of the secondary cases occurred in HIV seropositive patients, and three cases died. The paper describes how the the Incident Committee undertook to recall contacts of the cases for screening, inform the general practitioners of all of the contacts about their patients' exposure, warn other organizations and professionals interested or involved in the management of HIV in the London area as to the nature of the incident, and establish a helpline, before informing a wider audience through the EPINET, Communicable Disease Report and national press.
Journal of Hospital Infection, 1998
Journal of Family Planning and Reproductive Health Care, 2008
The English National Health Service Cervical Screening Programme (NHSCSP) recommendation not to o... more The English National Health Service Cervical Screening Programme (NHSCSP) recommendation not to offer cervical screening to women aged 20-24 years is considered in the context of national rates of cervical intraepithelial neoplasia grade 3 (CIN3) and invasive cervical carcinoma, falling screening coverage in young women, detection of screen-detected invasive cancers and risks of excisional treatment of CIN. Registrations of invasive and in situ cervical carcinoma were obtained from the Office for National Statistics, data on screening coverage and cytology results from the NHSCSP website and data on screen-detected cancers from an audit at Guy&amp;amp;amp;amp;amp;amp;#39;s &amp;amp;amp;amp;amp;amp;amp; St Thomas&amp;amp;amp;amp;amp;amp;#39; NHS Foundation Trust (GSTFT). Before and after the introduction of organised screening in England, CIN3 was primarily detected in women aged 20-39 years. Increasing rates of CIN3 were recorded in women aged 20-24 years during the last decade (3000-4000 cases per year) despite falling screening coverage. The peak incidence of invasive cancer in screening age groups is now 35-39 years. At GSTFT in 1999-2006, 24 of 32 cancers (75%) in women aged 20-34 years were screen-detected and that percentage declined in subsequent 15-year age bands (p &amp;amp;amp;amp;amp;amp;lt; or =0.0001). Delaying the age for screening eligibility carries a risk of CIN becoming more extensive, and therefore more difficult to excise, as well as a risk of progression. The NHSCSP should reconsider its decision and encourage young women to be screened, not excluding those aged 20-24 years. Facilities for taking the tests should be made more convenient. Women should be informed that low-grade CIN is potentially reversible and may safely be monitored. Cervical screening also provides an opportunity for education on healthy lifestyles and safer sex while treatment should be reserved for high-grade CIN.
International Journal of Health Planning and Management, 1993
Overuse' of hospital outpatient departments in urban areas of developing countries is perceived a... more Overuse' of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or 'reference centres', as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital-based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self-referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over-prescribe, particularly antibiotics and sedatives.
International Journal of Cancer, 2009
We write in response to Sasieni et al. 1 who refer to our article on the benefit of screening you... more We write in response to Sasieni et al. 1 who refer to our article on the benefit of screening young women. 2 We accept that their calculations (based on modeling) may be more or less correct in saying that ''only'' 3% of CIN3 would become invasive by age 25 years. During 2003, before implementing the policy of not inviting women aged 20-24 years for screening, 4,000 cases of CIN3 were registered in England in that age band. Those 120 women [3%] might disagree that screening was unnecessary. Furthermore, not all women are screened as soon as they reach age 25 years. Treating highgrade CIN is essentially a treatment of risk and reduces the likelihood of invasive cancer developing in subsequent years of life-after an unknown interval for any individual woman. We quoted the evidence of Peto et al. that at least 50% of CIN3 would eventually become invasive later in life. 3 Highgrade CIN has always been detected and in most cases treated primarily in women aged 20-39 years. We accept that some may regress and that regression is probably more likely in younger women. But we see no clear evidence that management of CIN3 in women aged 20-24 should be any different from in those aged 25-34 years.
British Journal of Ophthalmology, 2004
Aims: To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam... more Aims: To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam and Tanzania, and the gender distribution of surgical cases, to determine if women are using surgical services proportional to their needs. Methods: Population based data from surveys done in Tanzania and Vietnam as part of the national trachoma control programmes were used to determine the rate of trichiasis by gender in the population. Surgical records provided data on the gender ratio of surgical cases. Results: The rates of trichiasis in both countries are from 1.4-fold to sixfold higher in females compared to males. In both countries, the female to male rate of surgery was the same or even higher than the female to male rate of trichiasis in the population. Conclusions: These data provide assurance of gender equity in the provision and use of trichiasis surgery services in the national programmes of these two countries. Such simple analyses should be used by other programmes to assure gender equity in provision and use of trichiasis surgery services.
BMC Research Notes, 2013
Background: Child Death Overview Panels (CDOP) provide a multidisciplinary and confidential forum... more Background: Child Death Overview Panels (CDOP) provide a multidisciplinary and confidential forum to learn from and reduce deaths in those under 18 years. How well they perform and how to improve their effectiveness is a question posed at both local and national levels in England. With this in mind, this study looked at the child death review process in two London boroughs with a joint CDOP. Findings: Data on cases reviewed from April 2008 to January 2011 were analysed focusing on cause of death and modifiable factors. Key stakeholders involved in the child death review process were interviewed regarding the effectiveness of the local death review process with responses analysed thematically. 105 (50.5%) of all notified deaths were reviewed to completion by CDOP of which 26.7% had modifiable factors. Neonates were the largest group of deaths (42.8%). Stakeholders found reviews time consuming, required significant administration and better integration with related processes e.g. hospital mortality meetings. Too much time was spent analysing cases of limited modifiability such as neonates. Implementation of recommendations needed strengthening and inclusion into the wider health and social care economy including joint strategic needs assessments and commissioning processes. Delayed reporting of information on cases contributed to a backlog. Conclusions: The current process is bureaucratic, should better address neonatal deaths and needs more focus on implementing recommendations. Solutions include simpler forms, neonates-only subgroups, and linking recommendations to strategic initiatives such as Health and Wellbeing Boards.
BJOG: An International Journal of Obstetrics & Gynaecology, 2010
Objectives To investigate why invasive cervical cancers developed in a high-risk urban population... more Objectives To investigate why invasive cervical cancers developed in a high-risk urban population with an established screening programme and to place cancers in the context of high-grade cervical intraepithelial neoplasia (CIN) and cervical glandular intraepithelial neoplasia (CGIN) diagnosed during the same period of time. Study design Observational study of CIN2+ (CGIN, CIN3 and CIN2) and invasive cervical cancer diagnosed at Guy's and St Thomas' NHS Foundation Trust in 1999-01, 2002-04 and 2005-07 and audit of screening histories of women with invasive cancer analysed according to route to diagnosis, histological type and International Federation of Obstetrics and Gynecology (FIGO) stage.
Journal of Public Mental Health, 2013
ABSTRACT Purpose ‐ Youth violence victimisation impacts on health, mental health and future risk ... more ABSTRACT Purpose ‐ Youth violence victimisation impacts on health, mental health and future risk trajectories. A London hospital emergency department (ED) outreach youth service provides a unique intervention opportunity to support adolescents involved in violence. The purpose of this paper is to describe the set-up of the service. Design/methodology/approach ‐ Young people (YP) targeted were aged 12-18, from two London boroughs and attended ED with injuries from a violent incident. They were referred to Oasis youth workers for a mentoring/youth work intervention. Lifestyle and symptom scales were used to assess risk profile. Hospital staff questionnaires determined service awareness in the first six months, and interviews/focus group identified potential barriers to service uptake. Findings ‐ By 12 months, the service was operating smoothly. Of the first 505 YP attending ED, a third were referred, a third ineligible and a third non-contactable/refused. Detailed analysis of the first 30 attending found most were male (87 per cent), equal White or Black ethnicity (40 per cent) with 20 per cent &quot;Other&quot; ethnicities, with only a third living with both biological parents. This was similar to the full population attending. Nearly half (49 per cent) had been assaulted, 30 per cent had injuries self-generated through poor anger management, the remainder injured in fighting. Over half (57 per cent) had disorder, mostly behavioural, correlated with lifestyle risk scores. Barriers to service use/implementation included YP mistrust and fear of reprisals, problems with service visibility in the busy hospital environment and ineffective staff communication with YP, all countered during the running of the service. Gauging outcome at follow-up is the second evaluation stage. Originality/value ‐ The youth violence project is an important initiative for intervention in youth violence.
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Papers by Gillian Holdsworth