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Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV‐Ab) and HCV‐RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV‐Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV‐Ab positive and 8.4% of tests (n = 1713) were HCV‐RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV‐Ab and HCV‐RNA positive, respectively. The incidence of new HCV‐Ab and RNA positivity was 5.1 and 3.3 per 100 person‐years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post‐treatment (rate 10.1 cases per 100 person‐years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV‐RNA positivity at prison reception was observed suggesting progress towards HCV elimination. [ABSTRACT FROM AUTHOR]

Summary: Background: Emergency admissions in England for alcohol‐related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD‐specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. Aim: To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver‐related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID‐19 pandemic. Methods: We applied the standard approach and LAA to Hospital Episode Statistics for England (2013–21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7‐day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. Results: Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD‐specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under‐recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven‐day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. Conclusions: The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long‐term rise in ArLD admissions and mortality. [ABSTRACT FROM AUTHOR]

Hepatitis C virus infection (HCV) is common, and injecting drug use is the major risk factor for acquisition. Understanding HCV reinfection following treatment is an important consideration for HCV elimination programmes. The aim of this work was to assess the frequency and patterns of HCV reinfection in our region to develop avoidance strategies. All individuals who completed anti‐HCV treatment with a known outcome in Tyne and Wear, England between January 2016 and May 2021 were included. This was a retrospective analysis of prospectively collected data. HCV reinfection was defined as positive HCV RNA after achieving sustained virological response 12 (SVR12). 788 of 840 patients (76% male; mean age 45.7 ± 11.9 years; 47% Genotype 1; 11% Cirrhosis; 20% started in prison) achieved SVR (94%). 443 patients (56%) had HCV RNA testing post‐SVR after a median 0.82 (range 0.1–5.2) years. 56 reinfections (7.1% of all SVRs and 12.6% of SVRs who had post‐SVR testing) were diagnosed. The median time to reinfection was 1.37 (range 0.1–4.0) years and the rate of reinfection was 10.5 /100 person years. 45 (80%) reinfections became chronic, 17 of whom were retreated and achieved SVR. 5 individuals developed a second reinfection. Younger age was the only factor independently associated with reinfection (HR 0.91 [0.88–0.94] p <.001). In conclusion, HCV reinfection is common and may slow our HCV elimination efforts. In order to address high reinfection rates, harm minimization approaches need improved, and we have implemented an 'HCV track and trace' pilot to try to reduce onwards HCV transmission. [ABSTRACT FROM AUTHOR]

Care proceedings are the most powerful child protection intervention; local authorities make applications for over 20,000 children each year in England and Wales. The Department for Education holds two administrative databases of children who receive services, for children looked after and children in need. These databases do not record the use of care proceedings. Data linkage is a powerful tool for revealing patterns not visible from a single data set; the Outcomes for children before and after care proceedings reform study linked these administrative records with a research database of care proceedings to examine children's care and service journeys associated with care proceedings. The researchers also devised a simplified method for use by local authorities with their own records and tested this with North Yorkshire County Council. Analysis of the linked data reveals how care proceedings are used and the impact of care proceedings on care demand. It provides the basis for analysis of cohorts of children subject to proceedings and feedback to social workers, children's guardians, and the judges and lawyers on their decisions and children's outcomes. [ABSTRACT FROM AUTHOR]

The professed aim of any social welfare or legal intervention in family life is often to bring about "better outcomes for the children." But there is considerable ambiguity about "outcomes," and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing "good outcomes" for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of "normal" child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings. [ABSTRACT FROM AUTHOR]

Court decisions are required to remove children, compulsorily, from their families, and approve permanent care arrangements which restrict or terminate parents’ rights. The children involved are mostly young, have experienced serious abuse or neglect and may require permanent placement away from their parent(s) for their remaining childhoods. In England and Wales, justice to parents has dominated the rhetoric about these proceedings; this has resulted in lengthy proceedings, long periods of uncertainty for children and reduced placement options. In order to reduce delays, reforms in England and Wales have set a time limit for the completion of care proceedings. The Children and Families Act 2014 limits proceedings to 26 weeks; approximately 60% of care proceedings are now completed within this period. This article will discuss the impact of these reforms on decision-making for children, questioning whether they achieve both good decisions for children and justice for families. It uses the findings of an ESRC-funded study: ‘Establishing outcomes of care proceedings for children before and after care proceedings reform (2015–2018)’. [ABSTRACT FROM AUTHOR]

In England, the problem of excessive delay in court proceedings about children is longstanding, and there have been numerous initiatives over the years to tackle it. Under the 2014 Children and Families Act, there is now a statutory limit of twenty-six weeks for care proceedings (with provision for longer where justified). If this is to be achieved, the quality of the work that local authorities undertake with children and families before proceedings are started will be more important than ever, and the courts will have to take due account of it. This paper draws on research into the formal 'pre-proceedings process' in England and Wales, to assess the prospects for the new approach. The research was undertaken in 2010-12, and involved a file survey, observation of pre-proceedings meetings, interviews with key participants (including social workers, lawyers and parents) and a group discussion with judges. The paper considers the implications of the new approach for relationships between the courts and local authorities, in particular how pre-proceedings work should be conducted. The danger is that pre-court practice may become less about family support, more about evidence and timescales, less about prevention of proceedings, and more about preparation for court. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to gain in-depth insight and enhance understanding of service users' experiences of the in utero transfer (IUT) process, in order to inform policy and improve the current service provision of maternal care.Design: Qualitative descriptive study using semi-structured interviews.Setting: Participant's home or hospital in the Midlands, UK.Population: Fifteen women transferred in utero to a tertiary level maternity hospital; five male partners and two grandmothers.Methods: Audio-recorded individual or paired semi-structured interviews transcribed verbatum and analysed thematically using nvivo 9.Main Outcome Measures: Facilitators and barriers of the IUT experience.Results: Findings suggest that IUT is an emotional experience that financially disadvantages patients and their families. Male partners were perceived to be most negatively affected by the experience. The quality of the IUT experience was influenced by a range of factors, including the lack of proximity to home and the lack of information. Patients had little knowledge or awareness of IUT, and most felt unprepared for displacement. Despite this, there was resigned acceptance that IUT was a necessary rather than adverse experience.Conclusions: The experience of IUT for service users could be enhanced by ensuring that they are better informed about the process and the circumstances that necessitate displacement, that they are better informed about the hospital to which they are being transferred, and that they are transferred as close to home as possible. Efforts to minimise the emotional and socio-economic impact of IUT on women and their families also need to be considered. [ABSTRACT FROM AUTHOR]

This paper assesses the nature of parental participation and legal representation in pre-proceedings meetings in England and Wales. These are called when a local authority is considering care proceedings on a child. The parent(s) are invited to a meeting to discuss the concerns, and are entitled to attend with a lawyer. The paper draws on findings from a study of the process which included a file survey of over 200 cases, observations of 36 meetings and interviews with more than 90 key informants, including parents. The aim of the process is (usually) to reach an agreement to prevent the case going to court, but the families are usually well known to children's services, and have been through many meetings and agreements before. What then are the possibilities for parental participation and legal representation in the meetings? The study shows that they may help bring a greater degree of clarity to the local authority's proposals, but are not expected to challenge them. Paradoxically, they serve to reinforce the authority's position. The meetings can help divert cases, but it is important to be realistic about the chances of change in these often long-standing 'edge of care' cases. [ABSTRACT FROM AUTHOR]

Legal action to separate newborn babies from their parents is regarded as 'draconian' by the courts and subject to intense scrutiny. This paper outlines current legal and social work issues relating to such intervention and discusses the potential benefits of the 'pre-proceedings process' to address them. This process enables parents to have legal representation in a discussion with children's services when care proceedings are contemplated. The paper reports the findings of recent socio-legal research by the authors into the use of the process in England and Wales. In six local authorities, 30 per cent of 120 cases where the pre-proceedings process was used related to unborn babies; a pre-proceedings letter was sent in 75 per cent of unborn baby cases where care proceedings were considered, compared with 57 per cent of cases overall. The process could help to secure parental cooperation for pre-birth assessments and short-term protective arrangements at birth, thus avoiding emergency intervention. Families were diverted from care proceedings in 30 per cent of the cases where this was a possibility. Furthermore, the process was valued by social workers and lawyers as being fairer to parents. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages: Local children's safeguarding boards should be more aware of the pre-proceedings process., Local authorities should use the pre-proceedings process in accordance with guidance., Protecting babies requires thorough assessment, good planning and timely decisions., Early use of the pre-proceedings process in pre-birth cases assists assessment and planning., More efforts are required to involve fathers in the pre-proceedings process., The pre-proceedings process can divert cases from care proceedings. [ABSTRACT FROM AUTHOR]

The experiences of carers of children and young people with harmful sexual behaviours have been the subject of little research to date. Consequently, and as part of a larger follow-up study, semi-structured interviews were conducted with nine adoptive or foster-carers who had had such children and young people placed with them during the 1990s. The looked after children were white and male and had come from troubled and often abusive backgrounds. Interviews, which were taped and transcribed, were thematically analysed. Eight themes emerged covering motivations; training and sources of support, information from and relationships with professionals; challenges; commitment and acceptance; managing risk and safety issues; advocacy or fighting the child's corner; the importance of male role models and managing birth contacts. The findings are discussed in relation to the more general literature on fostering and adoption available and the limitations of the current study in terms of, for example, sample size are made clear. Implications for practice include the importance of training and support, the need to recognise the particular role of male carers for this population, and the added value of including carers as respected and valued members of the professional team around the child. [ABSTRACT FROM AUTHOR]

This paper describes the methodological approaches and challenges associated with tracing and contacting former social welfare service users in the course of long-term outcome research. Historical case file data were analysed on 117 ‘hard to reach’ children and young people identified as having behavioural problems, including sexual behavioural problems. Various publicly available internet and social network resources were used to try and trace these individuals in adulthood, at least a decade after the identification of their behaviour problems in childhood. Using these approaches, it was possible to locate individuals in 69 per cent of cases. The use of social network sites, such as Facebook, in social research is discussed, together with an appraisal of the practicalities and ethics of such approaches. The implications for social work practice more generally of the emergence of new technologies for tracing and maintaining contact with service users are also discussed. [ABSTRACT FROM PUBLISHER]

ABSTRACT This paper examines the issue of parental engagement where children's services have brought court proceedings to protect children, from the perspective of specialist lawyers who represent parents. It draws on an in-depth, qualitative study of parents' representation conducted between 2008 and 2010. Parental non-co-operation with children's services is a common feature in these cases. Lawyers are partisans with duties to follow clients' instructions. They seek to build a trusting relationship and keep clients engaged in the process by giving advice, taking instructions and providing emotional support. Lawyers accept that parents have an absolute right to contest but use their power and authority to encourage their most vulnerable clients to concede. They are largely successful in keeping clients engaged in proceedings but parents rarely make the necessary changes in parenting. [ABSTRACT FROM AUTHOR]

ABSTRACT [ABSTRACT FROM AUTHOR]

BackgroundEarly Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural–urban population.MethodA population-based study of FEP (ICD-10, F10–39) in people aged 17–35 years referred between 2002 and 2007; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings.ResultsA total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 person-years [95% confidence interval (CI) 44.5–56.2]. Age- and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95% CI 1.1–3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization.ConclusionsOur findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning. [ABSTRACT FROM PUBLISHER]

The article looks at the use of the term "significant harm" within child protection services in England and Wales. The author notes that, in order to assist children, local authorities must first prove that the child is suffering or likely to suffer significant harm attributed to the caregiver. The threshold test, used to decide what constitutes significant harm in various situations, is reviewed. Several court cases which revolved around differing interpretations of "significant harm" in child care are discussed.

In the context of current developments in children's services in the UK and increased emphasis on workforce development, the authors describe a survey of successful completers of a Post-qualifying (PQ) Child Care Award Programme, one of 18 such programmes in England that ran between 2001 and 2006/7. The survey's aims were twofold: first, to gather the respondents' overall evaluations of their PQ training and information about their past and current work circumstances; and second, to explore their knowledge and opinions on the latest developments in children's services in relation to their own work practices. The findings from the survey are outlined under four themes, which are then discussed in relation to other relevant studies, reviews on the role and tasks of social workers and current developments associated with the Every Child Matters agenda and the integrated workforce. Concerns are raised about whether social work professionalism is being effectively utilised within the current children's services arrangements. [ABSTRACT FROM AUTHOR]

Background: Substance use is implicated in the cause and course of psychosis.Aims: To characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire.Method: Current and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey.Results: Substance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom.Conclusions: Substance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications. [ABSTRACT FROM AUTHOR]

This article examines the use of emergency intervention for child protection in England by the police and social services to establish when and why powers are used and what subsequently happens. It is based on two studies in England between 1998 and 2004: 1) The Police Protection Study (PP), which examined the use of police protection through a survey of 16 (of the 43) police forces in England and Wales and record reading (311 cases) and interviews (57) in eight forces. 2) The Emergency Protection Orders (EPO) study, which examined EPO applications though a national survey of courts, an analysis of cases (86) from six social services departments, and interviews (78) with social workers, lawyers, court staff and magistrates. There are wide variations in the use of emergency powers. The police act independently and in response to social workers' requests. Social workers resort to emergency powers in well-known, serious cases when parents refuse co-operation. EPOs are followed by care proceedings. [ABSTRACT FROM AUTHOR]

Background Homeless people have greater health care needs than those who are housed, yet often experience difficulty in accessing health care. Evidence suggests that the attitudes of doctors can create significant barriers to health care for homeless people. Methods A validated structured questionnaire, the Attitudes Towards the Homeless Questionnaire (ATHQ), was posted to a year group of 211 medical students 2 weeks prior to their starting at the University of Birmingham in 1997, and again during their final clinical placement 5 years later. The results were explored in more depth through semistructured interviews with the 12 students displaying the greatest degree of attitude change. Results The response rates for the 1997 and 2002 surveys were 80% and 82%, respectively, with an overall response rate of 65% of eligible students. The mean ATHQ scores for the 2 time periods were 76·3 and 74·7 (mean difference = 1·66 ± 0·8, paired t test = 2·07, P = 0·04), indicating that attitudes had become more negative during the 5-year period. Semistructured interviews highlighted the importance of professional socialisation and clinical contact on attitude development. Conclusion This study suggests that medical students may hold more negative attitudes towards homeless people at the end of their undergraduate course than they do at the beginning of it. Medical schools may need to address this area of health care more directly in the undergraduate curriculum if tomorrow's doctors are to treat all patients equally. [ABSTRACT FROM AUTHOR]

Investigates the clinical characteristics and metabolic control of diabetic prisoners given structured diabetic care in Liverpool, England. Measurement of diabetic instability, glycated hemoglobin concentrations and body mass; Factors contributing to good diabetic metabolic control; Need for administering structured diabetic care on all prisons.

The author discusses the need for integrated social services that cross organizational and professional boundaries, and the focus on risk assessment as present in this issue of "British Journal of Social Work." He notes that the government in England and Wales has had success in reducing child poverty, increasing employment rates, and improving tax credit levels.

A two year review of clinical practice in a medical antenatal clinic was performed. Forty-six per cent of the patients were diabetics and the other 54% were a mixture of endocrine, cardiac, vascular and other medical disorders. The referral rate was 1.5% of total deliveries during the time period and the perinatal mortality rate was 27/1000. The preterm delivery rate was 20%. The feasibility of this kind of clinic in a single hospital is discussed. [ABSTRACT FROM AUTHOR]

Discusses the problems encountered in a prepregnancy clinic functioning as a medical/obstetric clinic which offers a pregnancy counseling service in Hull, England. Medical conditions that warrant referral for prepregnancy care; Impact of medical disorders on maternal health; Need for patients with medical conditions to be aware of the benefits of prepregnancy counseling.

The impact of atmospheric stability on vertical wind profiles is reviewed and the implications for power performance testing and site evaluation are investigated. Velocity, temperature, and turbulence intensity profiles are generated using the model presented by Sumner and Masson. This technique couples Monin-Obukhov similarity theory with an algebraic turbulence equation derived from the k-ε turbulence model to resolve atmospheric parameters u*, L, T*, and z0. The resulting system of nonlinear equations is solved with a Newton-Raphson algorithm. The disk-averaged wind speed ūdisk is then evaluated by numerically integrating the resulting velocity profile over the swept area of the rotor. Power performance and annual energy production (AEP) calculations for a Vestas Windane-34 turbine from a wind farm in Delabole, England, are carried out using both disk-averaged and hub height wind speeds. Although the power curves generated with each wind speed definition show only slight differences, there is an appreciable impact on the measured maximum turbine efficiency. Furthermore, when the Weibull parameters for the site are recalculated using ūdisk, the AEP prediction using the modified parameters falls by nearly 5% compared to current methods. The IEC assumption that the hub height wind speed can be considered representative tends to underestimate maximum turbine efficiency. When this assumption is further applied to energy predictions, it appears that the tendency is to overestimate the site potential. [ABSTRACT FROM AUTHOR]