Summary :Setting: A key recommendation of the National TB Strategy for England is testing and treatment of latent Tuberculosis infection (LTBI) among new migrants. Programmatic testing is based in primary care; however, this may be inaccessible to some individuals. Current strategies therefore could be complemented with screening in other settings.Objective: To investigate the feasibility and effectiveness of LTBI screening in a community college.Design: We performed a cohort study, based on observational data collected during and after the pilot project. Eligible language students from high TB incidence countries were consented and tested with a single-step Interferon Gamma Release Assay (IGRA) and enrolled in the cohort. We used single and multivariable analyses to estimate effectiveness of LTBI screening and to explore effectiveness in different sub-groups.Results: Screening uptake was 75% and the treatment completion rate was 85%. 71/440 students (16%) were LTBI positive and two had active TB. There was an association of positivity with age and TB incidence in the country of origin. We included costs from a UK National Health Service perspective. Three potential TB incidence thresholds met our cost effectiveness criteria for screening: countries with incidences of more than 40, more than 100 and more than 200 per 100,000 plus students from sub-Saharan Africa. Conclusion:We found that LTBI screening can be offered effectively in a community college setting, and could be a feasible complement to primary care-based programmes in low-incidence countries.

BackgroundTobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes.ObjectivesTo undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm.Eligibility criteria participantsChildren aged 0–18 years undergoing anaesthetic or surgical procedures, any country, English language papers.ExposureETS exposure assessed via questioning, observation or biological marker.Outcome measuresFrequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes.Results28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS.ConclusionsETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections.Trial registration numberReview registration number 42014014557.

BackgroundWorldwide, there are an estimated 15 million individuals with drug use disorders and over five times as many with alcohol use disorders (WHO 1:2, 2005). Most individuals with substance misuse have families who are affected. Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse.Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse.MethodsExtensive electronic and manual searches will be undertaken. Screening, data extraction and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion.The inclusion criteria will be that the study is a systematically undertaken review, the population is individuals with substance misuse problems and the interventions include a family-focused component. Reviews that focus on prevention rather than treatment will be excluded.The reviews will be assessed for quality and relevance. The evidence from included systematic reviews will be mapped by focus of intervention (promoting engagement of user into treatment/joint involvement in treatment of user/treating family member in own right) for both adults and adolescents for drug and/or alcohol misusers to allow assessment of the density of available evidence. The higher-quality, up-to-date evidence for each domain will be identified and described, and conclusions will be drawn with limitations of the evidence highlighted.DiscussionThis systematic review of systematic reviews will be an efficient and robust way of looking at the current state of the evidence in the field of family-based interventions for substance misuse.It will evaluate all the available systematic-review-level literature to report on the effectiveness of family-based psychological interventions in improving substance-related outcomes and improving health and wellbeing of substance misusers and/or their families. This will inform future treatment policies and commissioning decisions.In addition, it will identify areas of poor quality, inconsistency and gaps in the evidence base for family-based psychological interventions in substance misuse with respect to secondary evidence in order to inform future research.Systematic review registrationPROSPERO CRD42014006834

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