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Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019., (© 2024. The Author(s).)

Background: Illness and death are part of life for everyone, including people with intellectual disabilities. This study investigated the extent to which staff communicate about death with people with intellectual disability facing terminal illness or bereavement. Method: Staff who support people with intellectual disability in the UK (n = 690) completed an electronic survey. Detailed data were obtained from staff where a client had died in the past 12 months (n = 111), was terminally ill (n = 41) or had been bereaved (n = 200). Analysis included descriptive and chi‐squared statistics. Results: 52.6% of people with intellectual disability who were terminally ill were told about their illness, and 18.1% were told they would die. Of those experiencing an anticipated bereavement, 32.4% of staff said no one talked about this with them beforehand. A quarter of staff had received training on end of life or bereavement. Conclusion: Death affects many people with intellectual disability. Staff require training and support in communicating death. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: MMK is a member of Independent SAGE.

Background: The communication of a life-changing diagnosis can be a difficult task for doctors with potential long-term effects on patient outcomes. Although several studies have addressed the experiences of individuals with motor neurodegenerative diseases in receiving this diagnosis, a significant research gap exists regarding professionals' perspectives, especially in the UK. This study aimed to assess UK neurologists' current practice and perspectives on delivering the diagnosis of a motor neurodegenerative disease, explore different aspects of the process and detail the potential challenges professionals might face., Methods: We conducted an anonymised online survey with 44 questions, grouped into four sections; basic demographic information, current practice, the experience of breaking bad news and education and training needs., Results: Forty-nine professionals completed the survey. Overall, participants seemed to meet the setting-related standards of good practice; however, they also acknowledged the difficulty of this aspect of their clinical work, with about half of participants (46.5%) reporting moderate levels of stress while breaking bad news. Patients' relatives were not always included in diagnostic consultations and participants were more reluctant to promote a sense of optimism to patients with poorer prognosis. Although professionals reported spending a mean of around 30-40 min for the communication of these diagnoses, a significant proportion of participants (21-39%) reported significantly shorter consultation times, highlighting organisational issues related to lack of capacity. Finally, the majority of participants (75.5%) reported not following any specific guidelines or protocols but indicated their interest in receiving further training in breaking bad news (78.5%)., Conclusions: This was the first UK survey to address neurologists' practice and experiences in communicating these diagnoses. Although meeting basic standards of good practice was reported by most professionals, we identified several areas of improvement. These included spending enough time to deliver the diagnosis appropriately, including patients' relatives as a standard, promoting a sense of hope and responding to professionals' training needs regarding breaking bad news.

In light of recent media coverage, Emeritus Professor Alan Glasper , from the University of Southampton, discusses polices and guidance pertinent to the duty of candour.

As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current practice and reflect on some of the ethical and practical challenges confronting paramedics in these circumstances. I conclude by making three recommendations: first, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; second, I offer a framework for how bad news can be delivered during a lockdown in a less damaging way; and finally, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

A diagnosis of genital herpes may result in psychological as well as physical morbidity. Many patients require on-going help and contact the Herpes Viruses Association (HVA), a UK patient support organisation. The HVA conducts occasional questionnaires relating to various issues surrounding herpes and this study reports on a survey conducted amongst members in 2015. The survey was done using SurveyMonkey and covered diagnosis/treatment, both allopathic and self-help, physical and psychological impact and disclosure to partners. Three hundred and fifty-eight women and 103 men completed the questionnaire. Male respondents were older than women (48.6 versus 42.9 years). The majority were first diagnosed in sexual health clinics. A high proportion had informed partners about the diagnosis and in 83% disclosure did not result in rejection. 57% were taking prophylaxis with more taking treatment episodically rather than continually; 11.3% sourced medications on-line. Alternative treatments were used commonly with Lomaherpan cream ( Melissa officinalis) , lidocaine ointment and a diet with reduced arginine and increased lysine the most frequent choices. Other alternative treatments included olive leaf extract, Eleuthercoccus senticosus and vitamin supplements. Women reported being troubled psychologically more than men. Neuropathic pain was reported by 80.4% of the women and 64.1% of the men. Although antiviral treatment is cheap and well-tolerated it is still being refused by some healthcare providers. There still appears to be a considerable degree of stigma experienced by patients which can be mitigated by support from patients' support groups such as the HVA.

In this paper we compare firms' self-reported overseas sales, as reported in a commonly used UK financial reporting dataset, with their actual exports, as reported by Her Majesty's Revenue and Customs (HMRC). Finding that these flows are in several dimensions quite different, we then explore the implications of these differences more formally. Since several studies within the international trade literature report findings based on the self-reported export values in financial datasets, we discuss these findings in light of the departure of financial dataset-based exports from "true" (HMRC) export values., Competing Interests: The authors have declared that no competing interests exist.

Background: In the United Kingdom, pregnant women are offered foetal anomaly screening to assess the chance of their baby being born with eleven different conditions. How health care professionals (HCPs) deliver news about a child having a congenital anomaly affects how it is received and processed by parents. We refer to this news as different news., Methods: We conducted a mixed methods evaluation of a training intervention to improve how HCPs deliver different news. Twenty-six HCPs self-completed pretraining and posttraining questionnaires on skills, knowledge, and attitudes related to delivering different news. Qualitative interviews were conducted with eight HCPs. Quantitative data were analysed using descriptive statistics, the paired t test to compare the pre and post scores and estimate the difference between pre and post scores, and the 95% confidence interval. Qualitative data were analysed using framework analysis guided by the Theoretical Domains Framework (TDF)., Results: The training intervention was both feasible and acceptable. HCPs indicated that it enhanced or consolidated their knowledge and skills, covered topics relevant to their practice, and that they would recommend it to colleagues. Participants particularly valued integration of the voice of parents with lived experience in the training. Significant increase in mean scores were observed in confidence to deliver different news (2.81, 95% CI [2.43, 3.19] to 4.28, 95% CI [4.09, 4.47]; p < .001) and skills to deliver different news (3.00, 95% CI [2.64, 3.36] to 4.36, 95% CI [4.13, 4.59]; p < .001). HCPs reported feeling more confident in their ability to provide sensitive, responsive, balanced care to families., Conclusions: The significant improvements in confidence and skills reported by HCPs suggest that the training may be effective in equipping HCPs to minimize the distress, anxiety, and depression associated with receiving different news. This represents a key aspect of the prevention of mental ill health across the life course., (© 2020 John Wiley & Sons Ltd.)

Background: Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it., Objective: The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation., Methods: This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph's vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined., Results: Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy. This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter., Conclusions: The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future., (©Wasim Ahmed, Josep Vidal-Alaball, Joseph Downing, Francesc López Seguí. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.05.2020.)

This paper examines the recent upsurge in novels concerned with the history of medicine. It selects a range of different novels and asks how they relate to the work of the professional medical historian. Do these novels stimulate interest in the history of medicine or do they distort historical events? It is concluded that although writers often take liberties with the historical record, on balance, their work helps us to engage with the past and is likely to inspire readers to find out more about the history of medicine., Competing Interests: AB is the History and Medical Humanities Editor of the Journal of the Royal College of Physicians of Edinburgh. This paper has undergone peer review in accordance with JRCPE’s policies.

Despite a medical discourse of the 'normalisation' of HIV, it remains a highly stigmatising condition and makes the issue of disclosing one's HIV status particularly complex. This article reports on the experience of 18 people living with HIV in the United Kingdom of disclosing their HIV+ status in arguably their most important relationship, their intimate partnership. Five main themes arose: disclosure as the battlefield, preparing psychologically to disclose, disclosure as a test of the partner's love, disclosure as an opportunity for the partner to know them more deeply and the renegotiation of the relationship narrative.

Competing Interests: Conflict of interest: We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.

This article addresses duty of candour in relation to radiologists. The legislation underpinning duty of candour, definition of terms and the requirements for its application are explained. Consideration is given as to the differences between duty of candour and openness of discussion. The issue of how duty of candour should apply to radiologists (both diagnostic and interventional) is then addressed.

Australia and the United Kingdom have introduced policies to protect employees who experience mental illness, including depression. However, a better understanding of the experiential issues workers face (e.g. sense of moral failure) is needed for the provision of appropriate and beneficial support. We analysed 73 interviews from the United Kingdom and Australia where narratives of depression and work intersected. Participants encountered difficulties in being (and performing as if) 'authentic' at work, with depression contributing to confusions about the self. The diffuse post-1960s imperative to 'be yourself' is experienced in conflicting ways: while some participants sought support from managers and colleagues (e.g. sick leave, back-to-work plans), many others put on a façade in an attempt to perform the 'well' and 'authentic' employee. We outline the contradictory forces at play for participants when authenticity and visibility are expected, yet, moral imperatives to be good (healthy) employees are normative.

Objective: To study heterosexual and gay couples' relationship with their surrogate and their disclosure decisions when the surrogacy arrangement was completed domestically compared with internationally., Design: Cross-sectional study., Setting: Not applicable., Patient(s): Participants were 40 gay couples and 76 heterosexual couples who had domestic surrogacy in the United Kingdom (UK) (n = 38) or international surrogacy in the United States (n = 58) or Asia (20). Most (75%) of the children were aged <4 years., Intervention(s): Online surveys containing open-ended and multiple-choice questions., Main Outcome Measure(s): Experiences of finding a surrogate, relationship with the surrogate, and disclosure to the child were examined among UK parents who had undergone surrogacy in the UK, United States, or India/Thailand., Result(s): Parents who had surrogacy in the UK and United States felt very involved in the pregnancy compared with those who had surrogacy in Asia. Couples whose surrogacy was completed in Asia were less likely to want contact with their surrogate after the birth and were also less likely to have any current contact with the surrogate. Parents who had surrogacy in the UK and United States described positive relationships with their surrogate. Gay couples intended to tell their child about surrogacy more than heterosexual couples., Conclusion(s): The specific country where couples conducted their surrogacy arrangement (i.e. United States, UK, or Thailand/India) was associated with how involved they were in the pregnancy and their contact with the surrogate over time. Limitations of the study include use of survey methodology and that the representativeness of the sample is not known., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Being able to communicate effectively is an essential skill for all nurses. Communication in paediatric end of life care can be challenging for both the student and lecturer as it is a rare experience and challenging to teach. Innovative approaches to teaching communication skills such as role play, simulation and drama have been used; however there is a dearth of literature examining the use of drama in this specialist context. The aim of this study was to explore the effectiveness of a novel workshop in teaching transferable knowledge and skills in palliative, end of life and bereavement care communication to a convenience sample of first year pre-registration nursing students undertaking clinical skills training at a UK university. Qualitative and quantitative data were obtained from pre and post intervention questionnaires exploring student's perception of communication skills. Qualitative data were analysed thematically and quantitative data presented as standard descriptive statistics. The novel communication workshop facilitated students' exploration of how good and poor communication looks and feels and introduced aids to inform communication in clinical practice. Exposure to different learning approaches provided opportunities to both gain confidence in engaging in new learning activities and develop knowledge and skills through purposeful engagement., (Copyright © 2019. Published by Elsevier Ltd.)

To better understand user conversations revolving around antibiotics and antimicrobial resistance (AMR) on Twitter, we used an online data collection and analysis toolkit with full firehose access to collect corpuses of tweets with "antibiotic" and "antimicrobial resistance" keyword tracks. The date range included tweets from November 28, 2015, to November 25, 2016, for both datasets. This yearlong date range provides insight into how users have discussed antibiotics and AMR and identifies any spikes in activity during a particular time frame. Overall, we found that discussions about antibiotics and AMR predominantly occur in the United States and the United Kingdom, with roughly equal gender participation. These conversations are influenced by news sources, health professionals, and governmental health organizations. Users will often defer to retweet and recirculate content posted from these official sources and link to external articles instead of posting their own musings on the subjects. Our findings are important benchmarks in understanding the prevalence and reach of potential misinformation about antibiotics and AMR on Twitter.

Background: Patients who do not disclose their sexuality, including men who do not disclose same-sex behaviour, are difficult to characterise through traditional epidemiological approaches such as interviews. Using a recently developed method to detect large networks of viral sequences from time-resolved trees, we localised non-disclosed men who have sex with men (MSM) in UK transmission networks, gaining crucial insight into the behaviour of this group., Methods: For this phylogenetic analysis, we obtained HIV pol sequences from the UK HIV Drug Resistance Database (UKRDB), a central repository for resistance tests done as part of routine clinical care throughout the UK. Sequence data are linked to demographic and clinical data held by the UK Collaborative HIV Cohort study and the national HIV/AIDS reporting system database. Initially, we reconstructed maximum likelihood phylogenies from these sequences, then sequences were selected for time-resolved analysis in BEAST if they were clustered with at least one other sequence at a genetic distance of 4·5% or less with support of at least 90%. We used time-resolved phylogenies to create networks by linking together nodes if sequences shared a common ancestor within the previous 5 years. We identified potential non-disclosed MSM (pnMSM), defined as self-reported heterosexual men who clustered only with men. We measured the network position of pnMSM, including betweenness (a measure of connectedness and importance) and assortativity (the propensity for nodes sharing attributes to link)., Findings: 14 405 individuals were in the network, including 8452 MSM, 1743 heterosexual women and 1341 heterosexual men. 249 pnMSM were identified (18·6% of all clustered heterosexual men) in the network. pnMSM were more likely to be black African (p<0·0001), less likely to be infected with subtype B (p=0·006), and were slightly older (p=0·002) than the MSM they clustered with. Mean betweenness centrality was lower for pnMSM than for MSM (1·31, 95% CI 0·48-2·15 in pnMSM vs 2·24, 0·98-3·51 in MSM; p=0·002), indicating that pnMSM were in peripheral positions in MSM clusters. Assortativity by risk group was higher than expected (0·037 vs -0·037, p=0·01) signifying that pnMSM were linked to each other. We found that self-reported heterosexual men were more likely to link MSM and heterosexual women than heterosexual women were to link MSM and heterosexual men (Fisher's exact test p=0·0004; OR 2·24) but the number of such transmission chains was small (only 54 in total vs 32 in women)., Interpretation: pnMSM are a subgroup distinct from both MSM and from heterosexual men. They are more likely to choose sexual partners who are also pnMSM and might exhibit lower-risk sexual behaviour than MSM (eg, choosing low-risk partners or consistently using condoms). Heterosexual men are the group most likely to be diagnosed with late-stage disease (ie, low CD4 counts) and non-disclosed MSM might put female partners at higher risk than heterosexual men because non-disclosed MSM have male partners. Hence, pnMSM require specific consideration to ensure they are included in public health interventions., Funding: National Institutes of Health., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Dementia diagnosis rates are increasing. Guidelines recommend that people with dementia should be told their diagnosis clearly and honestly to facilitate future planning. Aims To analyse how doctors deliver a dementia diagnosis in practice., Method: Conversation analysis was conducted on 81 video-recorded diagnosis feedback meetings with 20 doctors from nine UK memory clinics., Results: All doctors named dementia; 59% (n = 48) approached the diagnosis indirectly but delicately ('this is dementia') and 41% (n = 33) approached this directly but bluntly ('you have Alzheimer's disease'). Direct approaches were used more often with people with lower cognitive test scores. Doctors emphasised that the dementia was mild and tended to downplay its progression, with some avoiding discussing prognosis altogether., Conclusions: Doctors are naming dementia to patients. Direct approaches reflect attempts to ensure clear diagnosis. Downplaying and avoiding prognosis demonstrates concerns about preserving hope but may compromise understanding about and planning for the future. Declaration of interest None.

Though James Lind is renowned as a pioneer of the clinical trial, he records the 1747 trial aboard the Salisbury in passing, never followed up on it, never campaigned for clinical trials as a means of medical discovery, and eventually pronounced scurvy an insoluble enigma. The case can be made that in confessing his lack of an unfailing remedy for scurvy and his trouble making sense of the disease's behaviour, Lind did medicine a greater service than by conducting his now-famous trial. At the time, medical progress was hindered by the all-too-common practice of proclaiming success and concealing failure. With his ethos of candour Lind challenged this practice by example; he may have been among the first to do so. Within a few years of the publication of the third and final edition of his A Treatise of the Scurvy, medical tracts began to appear in which the authors (some of whom knew Lind's treatise) took issue with the practice of concealing failure. A concerted attack on the suppression of evidence vivified the concept of evidence itself. Today, with the selective publication of findings distorting the medical literature, Lind's story of admitted failure holds great meaning.

This article explores the challenges of providing a quantitative measure of domestic violence and abuse (DVA), illustrated by the Composite Abuse Scale, a validated multidimensional measure of frequency and severity of abuse, used worldwide for prevalence studies and intervention trials. Cognitive "think-aloud" and qualitative interviewing with a sample of women who had experienced DVA revealed a tendency toward underreporting their experience of abuse, particularly of coercive control, threatening behavior, restrictions to freedom, and sexual abuse. Underreporting was linked to inconsistency and uncertainty in item interpretation and response, fear of answering truthfully, and unwillingness to identify with certain forms of abuse. Suggestions are made for rewording or reconceptualizing items and the inclusion of a distress scale to measure the individual impact of abuse. The importance of including qualitative methods in questionnaire design and in the interpretation of quantitative findings is highlighted.

Background: Women experiencing domestic violence and abuse (DVA) are more likely to be in touch with health services than any other agency, yet doctors and nurses rarely ask about abuse, often failing to identify signs of DVA in their patients., Aim: To understand women's experience of disclosure of DVA in primary care settings and subsequent referral to a DVA advocate in the context of a DVA training and support programme for primary care clinicians: Identification and Referral to Improve Safety (IRIS)., Design and Setting: A service-user collaborative study using a qualitative study design. Recruitment was from across IRIS trial settings in Bristol and Hackney, London., Method: Twelve women who had been referred to one of two specialist DVA advocates (based at specialist DVA agencies) were recruited by a GP taking part in IRIS. Women were interviewed by a survivor of DVA and interviews were recorded and transcribed verbatim. Analysis was thematic using constant comparison., Results: GPs and nurses can play an important role in identifying women experiencing DVA and referring them to DVA specialist agencies. GPs may also have an important role to play in helping women maintain any changes they make as a result of referral to an advocate, by asking about DVA in subsequent consultations., Conclusion: A short time interval between a primary care referral and initial contact with an advocate was valued by some women. For the initial contact with an advocate to happen as soon as possible after a primary care referral has been made, a close working relationship between primary care and the third sector needs to be cultivated.

Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. The responses demonstrated that whilst the majority of cardiac surgeons (68.8%) were initially opposed to performance tables, the number welcoming their introduction increased significantly (22.9-48.5%) over the four-year period. The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.

Using findings from a qualitative investigation based on in-depth email interviews with 47 Black and South Asian gay men in Britain, this paper explores the cross-cutting identities and discourses in relation to being both gay and from an ethnic minority background. Taking an intersectional approach, detailed accounts of identity negotiation, cultural pressures, experiences of discrimination and exclusion and the relationship between minority ethnic gay men and mainstream White gay culture are presented and explored. The major findings common to both groups were: cultural barriers limiting disclosure of sexuality to family and wider social networks; experiences of discrimination by White gay men that included exclusion as well as objectification; a lack of positive gay role models and imagery relating to men from minority ethnic backgrounds. Among South Asian gay men, a major theme was regret at being unable to fulfil family expectations regarding marriage and children, while among Black gay men, there was a strong belief that same-sex behaviour subverted cultural notions related to how masculinity is configured. The paper concludes by highlighting the importance of social location, particularly education and income, when examining the intersection of ethnicity and sexuality in future research.

Evidence that science is becoming increasingly embedded in culture comes from the proliferation of discourses of ethical consumption, sustainability, and environmental awareness. Al Gore's recent award, along with UN's Inter-governmental Panel on Climate Change (IPCC) of the Nobel peace prize-- provided a recent high profile linking of consumption and science. It is not clear to what extent the public at large engages in evaluating the scientific merits of the arguments about the link between human consumption and global environmental catastrophes. But on a local scale, we are routinely required to evaluate, scientific and pseudoscientific claims in advertising. Since advertising is used to sell products, the discourse of scientifically framed claims is being used to persuade consumers of the benefits of these products. In the case of functional foods and cosmetics, such statements are deployed to promote the health benefits and effectiveness of their products. This exploratory study examines the views of British consumers about the scientific and pseudoscientific claims made in advertisements for foods, with particular reference to functional foods, and cosmetics. The participants in the study all worked in scientific environments, though they were not all scientists. The study found that scientific arguments that were congruent with existing health knowledge tended to be accepted while pseudoscientific knowledge was regarded skeptically and concerns were raised over the accuracy and believability of the pseudoscientific claims. It appears that scientific awareness may play a part in consumers' ability to critically examine scientifically and pseudoscientifically based advertising claims.

Many people with intellectual disabilities will be affected by cancer in their lifetime. There is a lack of available knowledge about people with intellectual disabilities' understanding and experience of cancer, and about their need for cancer information. The principal aim of the study was to explore the information needs of people with intellectual disabilities who are affected by cancer. This was a qualitative, hypothesis generating study. Nine people with intellectual disabilities who were affected by cancer were identified using a purposive sampling method; five of these participated in the study. Data collection included observation of the use of a pictorial cancer information book designed for people with intellectual disabilities, and semi-structured interviews. Data analysis revealed three themes: (1) "Nobody told me": the desperate need for cancer information; (2) "That reminds me": telling my own story; and (3) "I don't know much about cancer": the difficulties of the staff supporting people with intellectual disabilities to read the cancer information book. The people with intellectual disabilities in this study were not provided with information about cancer. They wanted this information, and appeared to be capable of comprehending it. Further development of accessible information materials around cancer and palliative care is needed.

At present the clinical management of intersex is in turmoil. The policy of non-disclosure of diagnosis is widespread and cosmetic genital surgery is routinely performed on infants throughout the world. Some clinicians feel such practices are in the interest of the intersex child and the family, but some intersex adults are calling for a moratorium on sex assignment genital surgery. These widely opposing views have led to distrust between groups. One way to begin to address these critical issues is to facilitate dialogue with equal input from clinicians and intersex people and families. Clinicians are experts by training, but patients and families are experts through lived experiences. Our paper reports the rationale, process and outcome of the first UK forum bringing together these different experts to address some of the most complex issues in clinical services. In communicating our experiences, we hope that it will provide a useful reference point for those seeking similar service-user/provider collaboration in other areas of medicine.

Objectives: To report nutrient intakes for three different ethnic groups living in inner city Manchester and explore under-reporting in each group., Design: Cross-sectional survey. All participants completed one of three food frequency questionnaires, specifically developed for each ethnic group, and took part in a larger international survey of risk factors for diabetes and hypertension., Setting: Participants were drawn randomly from seven GP registers in inner city Manchester, UK., Participants: Men and women aged 25-79 years, 86 European, 246 African-Caribbean origin and 84 Pakistani origin participants were included in the analysis., Results: Body mass index was highest in the Pakistani women, 30.2 kg m-2. European participants had the highest reported energy intakes (EIs) for men and women (10.9 and 9.6 MJ, respectively). Pakistani men and women had the highest percentage of energy from fat (36.7 and 36.6%, respectively). Iron intakes were low in the African-Caribbean group and calcium intakes were low in the Pakistani group. Under-reporting [assessed as EI : basal metabolic rate (BMR) ratio <1.2] appeared to be high and occurred across all ethnic groups, with those apparently under-reporting having higher BMIs in all groups., Conclusion: The data provide nutrient intake estimates in three different ethnic groups using a similar method. Limitations include under-reporting across all ethnic groups in a similar pattern with under-reporters having higher BMIs in all groups, as found elsewhere.

The growth of the "patient-centred" approach to health care has highlighted the importance of quality communication practices. One area that remains problematic, however, is the process of breaking bad new to patients and/or relatives. Hence, there have been calls for more research and training in this domain. Reports the findings of a study that used the critical incident technique to explore the breaking bad news encounter from the perspective of the health care practitioner. In total 33 senior medical and nursing staff reported on situations in which they described specific, vividly recalled, experiences of both "effective" and "ineffective" bad news delivery. These reported incidents were content analysed and a range of key dimensions was identified for both effective and ineffective experiences. Interpersonal communication skills emerged as particularly salient factors and these are discussed in detail, together with implications for future research and training.

The major failures reported in the Bristol inquiry have been highlighted in most hospital inquiry reports over the past 30 years. The tendency to victimise the whistleblower has characterised virtually all inquiries. Inadequate leadership, isolation, system failures, poor communication and disempowerment of staff and service users are the common themes. While organisational reform is essential, the real challenge is to change behaviour. And this depends on the example of senior staff.

Whistleblowing - the public exposure of organizational wrongdoing - presents practical and ethical dilemma for nurses, and needs to be seen as part of a spectrum of increasingly confrontative actions against miscreant organizations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontological view). The consequentialist perspective is unable on its own to resolve problems arising from the balance of good and harm resulting from the act of whistleblowing (where considerable harm might be caused) or of responsibility for that harm. A deontological approach provides an analysis of these problems but raises its own problem of conflicting duties for nurses. However, a strong argument can be made for the precedence of the nurse's duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organization. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way by the fact that the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service (NHS) to remedy this situation.

Using the example of communication about risk in a primary care setting, this paper puts forward a method of developing and evaluating a detailed search strategy for locating the literature for a systematic review of a 'diffuse' subject. The aim of this paper is to show how to develop a search strategy that maximizes both recall and precision while keeping search outputs manageable. Six different databases were used, namely Medline, Embase, PsychLIT, CancerLIT, Cinahl and Social Science Citation Index (SSCI). The searches were augmented by hand-searching, contacting authors, citation searching and reference lists from included papers. Other databases were searched but yielded no extra references for this subject matter. Of the 99 papers included, 80 were indexed on Medline. The Medline search strategy identified 54 of them and the remaining 26 were located on other databases. The 19 further unique references were found using the other databases and methods of retrieval. A combination of several databases must be used to maximize recall and to increase the precision of searches on individual databases, thus improving the overall efficiency of the search.