Objective: There is limited evidence regarding effective smoking cessation interventions in deprived communities. This study explored what factors are considered most important in smoking cessation, from the perspective of a group of NHS Stop Smoking Service users from a deprived community. Design: A qualitative study. Setting: A deprived community in Brighton and Hove City, Southeast England. Methods: Fifteen adults who had used the local NHS Stop Smoking Service were recruited to the focus groups. Thematic analysis was used to identify key themes regarding factors that were considered most helpful during the smoking cessation attempt. Results: Factors deemed most important for a successful smoking cessation attempt were counsellors' attitude and knowledge, flexibility of appointments, personalized one-to-one support including additional support between sessions, all provided in an accessible local community setting. Individuals were most likely to decide to quit smoking for health reasons, and support from family and friends was important during the quit attempt. Conclusion: This study shows that smokers from deprived communities require more intensive, flexible and personalized support from a stop smoking service which should ideally be located in their community setting. A more innovative, tailored and less prescriptive approach to providing stop smoking services may help to improve cessation rates among smokers in deprived communities.

Background Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features. Methods Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak. Results There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility. Conclusions This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.

Introduction The UK National Health Service Cervical Screening Programme (NHSCSP) advice on cervical cytology screening states that women who have never had sex with men are at very low risk of developing cervical cancer, and advice regarding need for screening in lesbians is inconsistent.Methods Literature review searching PubMed, Web of Science and the Internet for articles on lesbians, cervical cancer and cervical cancer risk factors focusing on human papillomavirus (HPV) and screening behaviours. ResultsCase reports and prevalence studies show that HPV can be transmitted sexually between women. It is not known whether prevalence of HPV or cervical cancer differs between lesbians and heterosexual women. The evidence consistently shows that prevalence of non- 49 IntroductionConcerns have been raised that despite being at risk of cervical cancer, lesbians are under-utilising cervical screening services. [1][2][3][4][5] Lesbians are less preventionoriented in their health care behaviour, tend to avoid routine health care and are more likely to avoid screening tests such as Papanicolaou (Pap) smears. 1,3,6,7 Health inequalities may exist for lesbians due to lack of understanding of the health care needs of this group, on the part of the women themselves and health care services.Lesbians and health care providers are sometimes unsure of whether cervical screening is necessary, particularly for women who have never been or who are no longer sexually active with men. [8][9][10][11] Although human papillomavirus (HPV) infection, a causative factor in cervical cancer, can be transmitted sexually between women, the general belief is that cervical cancer is associated with heterosexual intercourse, and advice is still aimed predominantly at heterosexual women or women who have sex with men. Whether lesbians are at greater, similar or lower risk of cervical cancer compared to heterosexual women is contested. However, nonattendance for screening would put this group at higher risk of late diagnosis of cervical cancer, where prognosis is likely to be poorer. The lesbian populationThere is no universally agreed definition of the word 'lesbian', and it is not the aim of this review to fully capture the complexities of sexual orientation. Sexual orientation can incorporate different dimensions such as behaviour, desire or attraction, and identity. 12 It is a common misconception that lesbians have only ever had sex with attendance for cervical screening is much higher in lesbian than heterosexual women, which is linked to a belief that lesbians are less susceptible to cervical cancer and have less need for screening. Despite sharing most of the same risk factors as heterosexual women, lesbians are much less likely to undergo regular screening. ConclusionsThe NHSCSP should take a clear and consistent stance on the need for cervical screening in lesbians. Both the health care and the lesbian communities must be made aware of the fact that regular cervical screening is as important in this group as it is in the heterose...

Three young women, aged 18-24 years, presented to general practice with signs and symptoms of exertional rhabdomyolysis in 2016. All attended the same gym and had undertaken an intensive physical workout. Presenting symptoms were severe muscle pain and swelling, significantly reduced range of motion in affected muscles and, in two cases, dark-coloured urine. One case had presented to the out-of-hours service 4 months previously with similar symptoms but rhabdomyolysis was not considered, although retrospective history taking suggests that was the likely diagnosis. All three women were admitted to hospital, treated with intravenous fluids and discharged between 1 and 6 days later. All made a full recovery with no renal sequelae. The cases were questioned about potential risk factors, and the only commonality was unaccustomed strenuous exercise.

This study shows that most care homes are not fully compliant with current infection prevention and control guidance, and that some unacceptable practices are occurring. In order to reduce potential for transmission of CDI and other diarrhoeal infection in care homes, infection prevention and control practices must be improved, with early diagnosis and control.