We conducted a matched case-control study to investigate social factors associated with gonorrhoea acquisition among genitourinary (GU) medicine clinic attendees, designed to inform appropriate prevention strategies. Detailed social and behavioural data were elicited using a self-completed questionnaire. The effect sizes of these characteristics were quantified using univariate and multivariable conditional logistic regression in 53 cases and 106 matched controls. Homo-bisexual orientation was the strongest independent predictor of gonorrhoea acquisition (Adjusted odds ratio 31.1 (95% confidence intervals, 3.09-312.92). Other independent predictors were not currently being in a relationship and concordant residential characteristics. Three principal implications for sexual health policy were identified; social marketing approaches to gonorrhoea prevention should focus on gay men and individuals not in established relationships; gonorrhoea prevention should be more closely integrated with wider social inclusion policies; finally, more proactive, systematic and theory-based approaches should capitalize on opportunities for sexual health promotion in GU medicine clinic settings.

Concern about the increasing number of drug related deaths inBrighton & Hove prompted a Confidential Inquiry into 69 deaths. This led to recommendations concerning better data collection, identifying vulnerable populations, improving responses to overdose, and modifying service organization. Heroin-related deaths were halved between 2000 and 2003, but the rate for total drug deaths remained the highest at 25.3 per 100,000 (2003) in participating coroners' jurisdictions. In a subsequent Capture Recapture study, the prevalence of intravenous drug use in Brighton & Hove was estimated at 2 per cent of people aged 15-44, higher than Liverpool or London. The proportion of opiate drug users dying from opiate overdose was also highest in Brighton & Hove, at 2.1 per cent. A network of interlocking services was established within strong multi-agency partnerships, supplemented by: increasing the numbers in treatment; fast tracking hospital discharges and prison releases into treatment; new specialist posts in the local prison, the accident and emergency department and police custody suite; and participation by pharmacists and primary care services. This was underpinned by good liaison with the coroner. 266 53(3)

We applied the principles of Hazard Analysis and Critical Control Points (HACCP) to systematically analyse the care pathway of patients diagnosed with gonorrhoea to identify potential intervention opportunities for preventive action. Data were collected on individuals with culture-positive gonococcal infection during 27 February 2003 to 08 January 2004. Qualitative data were gathered within individual semi-structured interviews. Two hundred and twenty-three gonorrhoea patient episodes were evaluated. The median interval between presentation and treatment was significantly longer in females and men having sex with men (MSM), compared with heterosexual men (P = 0.002). Females were significantly more likely to be in regular relationships at the timepoint of perceived infection acquisition than heterosexuals or MSM (P < 0.0001). Four major themes emerged from the interviews: life-stage and infection risk, determinants of risk perception around sexual encounters, attitudes to preventing re-infection and condom use. These informed three potential 'critical control points': health-related attitudes/behaviours preceding infection; access to appropriate care and optimizing health promotion to prevent further infection.

VSP uses browser-based virtual environments to simulate life-like and challenging clinical scenarios. They are an innovative and creative way to develop proficiency capabilities of healthcare professionals as an adjunct to their studies and practice placement. Evidence suggests that a simulated environment can better equip nursing and allied health professional students for practice [1–3]. The concept of VSP may have been brought forward by the COVID-19 pandemic but was inevitable with the increasing access to technology-enhanced learning and the emerging evidence of its benefit. This VSP was a collaboration between UK simulationists and Indonesian academics with a two-month deadline. Work was completed online using videoconferencing and translation services, the evaluation (with ethical approval) was completed using a JISC online survey in March 2022. The Indonesia VSP consists of four patient scenarios, one scenario from each of the fields of children and young people, adult, mental health and learning disability nursing and is set within the emergency department and is aimed at learners in their final year of a nursing programme in Indonesia. The Indonesia VSP scenarios were designed in line with the UK Nursing and Midwifery Council (NMC) proficiencies and the Indonesian equivalents and were designed based on clinical scenarios that are not commonly seen in clinical practice or may be particularly challenging to enhance learners’ skills and build their confidence with managing such situations. The VSP was designed for 10 hours of learning and was made available to adult nursing students from 37 Poltekkes across the Indonesian continent. The VSP project was delivered on time with the evaluation from the pilot group being overwhelmingly positive with 82% of respondents being satisfied with the quality of VSP (response rate of 30% n=51/171) The key themes identified were: ‘real-life patient scenarios based on holistic and patient-centered care’ and the VSP enabling learners to use ‘critical thinking skills and relate the content to previous knowledge’ gained on their course so far. VSP is a meaningful way of enhancing exposure to experiences that are not guaranteed for all learners leading to greater equity of experience. The reflective and blended nature of the VSP leads to a better understanding of difficult topics. The VSP platform enables knowledge transfer that allows our team to take our in-house digital innovations to a global platform to support the training of the future nursing workforce of Indonesia. 1. Akselbo I, Olufsen V, Ingebrigtsen O, Aune I. Simulation as a learning method in public health nurse education. Public Health Nurs. 2019;36(2):226–232. 2. Bogossian FE, Cant RP, Ballard EL, Cooper SJ, Levett‐Jones TL, McKenna LG, Ng LC, Seaton PC. Locating ‘gold standard’ evidence for simulation as a substitute for clinical practice in prelicensure health professional education: a systematic review. J Clin Nurs. 2019;28(21–22):3759–3775. 3. Mills BW, Carter OB, Rudd CJ, Ross NP, Claxton LA. 2015. Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simul Healthc. 2015;10(5):263–269.

A letter about the article on genital piercing by Anderson et al. that appeared in the previous issue of Trends in Urology & Men's Health (July/August 2011;2(4):31–6). Copyright © 2011 Wiley Interface Ltd