ObjectiveTo assess the association between features of acute sore throat and the growth of streptococci from culturing a throat swab.DesignDiagnostic cohort.SettingUK general practices.ParticipantsPatients aged 5 or over presenting with an acute sore throat. Patients were recruited for a second cohort (cohort 2, n=517) consecutively after the first (cohort 1, n=606) from similar practices.Main outcomePredictors of the presence of Lancefield A/C/G streptococci.ResultsThe clinical score developed from cohort 1 had poor discrimination in cohort 2 (bootstrapped estimate of area under the receiver operator characteristic (ROC) curve (0.65), due to the poor validity of the individual items in the second data set. Variables significant in multivariate analysis in both cohorts were rapid attendance (prior duration 3 days or less; multivariate adjusted OR 1.92 cohort, 1.67 cohort 2); fever in the last 24 h (1.69, 2.40); and doctor assessment of severity (severely inflamed pharynx/tonsils (2.28, 2.29)). The absence of coryza or cough and purulent tonsils were significant in univariate analysis in both cohorts and in multivariate analysis in one cohort. A five-item score based on Fever, Purulence, Attend rapidly (3 days or less), severely Inflamed tonsils and No cough or coryza (FeverPAIN) had moderate predictive value (bootstrapped area under the ROC curve 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection (38% in cohort 1, 36% in cohort 2 scored ≤1, associated with a streptococcal percentage of 13% and 18%, respectively). A Centor score of ≤1 identified 23% and 26% of participants with streptococcal percentages of 10% and 28%, respectively.ConclusionsItems widely used to help identify streptococcal sore throat may not be the most consistent. A modified clinical scoring system (FeverPAIN) which requires further validation may be clinically helpful in identifying individuals who are unlikely to have major pathogenic streptococci.

BackgroundGeographically weighted Poisson regression (GWPR) was applied to the relation between cervical cancer disease incidence rates in England and socio-economic deprivation, social status and family structure covariates. Local parameters were estimated which describe the spatial variation in the relations between incidence and socio-economic covariates.ResultsA global (stationary) regression model revealed a significant correlation between cervical cancer incidence rates and social status. However, a local (non-stationary) GWPR model provided a better fit with less spatial correlation (positive autocorrelation) in the residuals. Moreover, the GWPR model was able to represent local variation in the relations between cervical cancer incidence and socio-economic covariates across space, whereas the global model represented only the overall (or average) relation for the whole of England. The global model could lead to misinterpretation of the relations between cervical cancer incidence and socio-economic covariates locally.ConclusionsCervical cancer incidence was shown to have a non-stationary relationship with spatially varying covariates that are available through national datasets. As a result, it was shown that if low social status sectors of the population are to be targeted preferentially, this targeting should be done on a region-by-region basis such as to optimize health outcomes. While such a strategy may be difficult to implement in practice, the research does highlight the inequalities inherent in a uniform intervention approach.

The next generation of public health professionals requires rigorous training in behavioral health, in order to design effective behavioral interventions to respond effectively to the epidemiological transition in China. This study aimed to investigate issues in training in social and behavioral sciences in public health in China. A cross-sectional survey was conducted among 1285 and 835 last-year undergraduate and graduate public health students in 2013. The results showed that (1) majority of undergraduate students but a minority of graduate students had enrolled in psychology, social medicine, and health promotion courses; (2) very few had enrolled in other social and behavioral sciences courses; (3) high percentages of students perceived significance, needs, and interests related to social sciences courses; (4) very few were familiar with commonly used behavioral health theories and constructs, or had applied such theories/constructs to their thesis. The situation deviates from international accreditation requirement. A timely review and benchmarking are warranted.