Public Health Wales Research and Development 2013/14
Purpose of Document:
The following table contains all research and development projects which have already concluded, or are still on-going in the 2013/14 financial
year. This document will be updated on a quarterly basis throughout the financial year.
Date Updated: August 2013
1
Public Health Wales – PUBLIC HEALTH SERVICES
#
1
Project Title
Biomarkers in Baseline HPV
2009 v1.0
2
SUPERLY Pro-Ex
3
FH02 Mammographic
sureveillance in women
aged 35 to 39 years at
Lay Summary
Human Papillomavirus (HPV) is a very common viral infection and most
women will be infected at some point in their lives. This is a study to see if
carrying out new tests for HPV status on cervical screening samples could
identify women at a higher risk of cervical disease development.
Occasionally, HPV can cause abnormal cell growth by interfering with the
normal cell controls. The tests will start to look for possible changes in the
virus status that could be the cause of this loss of control. This study will be
performed on stored residual smear material (80°C) that has been
previously collected as part of a pseudoanonymous study and will not affect
patient treatment and will not require additional samples. HR HPV positive
samples will be tested further with for viral integration status. The results of
these tests will be compared with available smear and biopsy results
collected pseudoanonymously over 2 rounds of screening (up to 6 higher
risk of cervical disease development.
This is a study of two additional tests to be carried out on cervical screening
samples, in order to find out if it might be possible to safely reduce the
number of women referred to hospital as a result of having abnormal
smears. Taking part in the study will not involve having any extra samples
taken or any change of treatment. Women will be invited to take part if
they have been referred to colposcopy clinic after having had at least two
abnormal smears. If they consent to being included in the study, their most
recent smear will be tested with the new test (ProExC) and for human
papillomavirus (HPV). The results of these tests will be compared with the
results of the biopsies taken in colposcopy as part of routine practice and
then with the result of any subsequent smear tests or biopsies taken as part
of their normal clinical care over the next two years.
Women with a family history of breast cancer are at increased risk of
developing the disease themselves and this risk is particularly increased at
younger ages. Only 1 in 200 people develop breast cancer before age 40, but
2
Lead
Organisation
Cardiff University
Public Health Wales
Investigator
Dr Sam Hibbitts (Senior
Lecturer, Cardiff University)
hibbittssj@cf.ac.uk
Cardiff
University
Dr Amanda Tristam (Senior
Lecturer and Honorary
Consultant in
Gynaecological Oncology,
University Hospital of
Wales.
Honorary Contract with
Public Health Wales.)
tristamaj@cf.ac.uk
Central
Manchester and
Manchester
Dr Rosemary Fox (Director
of Screening Division,
Public Health Wales)
enhanced familial risk of
breast Cancer
4
Understanding healthcare
utilisation of responders
and non-responders
to the bowel screening
programme in Wales
(NAEDI)
5
Exploring attitudes to HPV
self-sampling among a
socially-stratified sample of
Welsh women
6
Bangor Mycolic Acid study
2011 – Development of
women at high and moderate risk due to family history at this very young
age have a risk between 1 in 10 and 1 in 60. The benefits of an annual
mammography in terms of early diagnosis and potential lives saved needs to
be balanced against the risks such as earlier radiation exposure and false
positive tests that may lead to unnecessary surgery. This trial will inform the
NHS as to whether mammographic surveillance will be cost effective in
terms in the likelihood of saving lives and whether whether there is an
adequate trade off between these benefits and the attendant risks
In order to be effective at a population level, national screening
programmes need to achieve a high uptake. The bowel screening
programme in Wales has been established for two years and its uptake is
about 58%. Unlike other cancer screening tests, the sample is taken at home
and does not require a visit to a clinician. Little is known about the
characteristics of non-responders to understand why they do not access the
opportunity for prevention or early detection of bowel cancer and whether
there may be opportunities to improve uptake through opportunistic
contact with health care professionals. Previous work on non-responders to
other screening programmes has focussed on socio-demographic and
adaptive factors. The role of co-morbidities, and hence opportunities for
intervention at other points of contact with healthcare services, has not
been examined.
The introduction of HPV self-sampling is being discussed however as yet, no
policy has been set. Self-sampling is a method where a woman can collect a
sample of her own cells for HPV DNA testing. HPV self-sampling has been
shown to have similar specificity and sensitivity to clinician sampling, is more
sensitive than cytology and potentially avoids embarrassment and
discomfort concerns associated with smear testing. This doctoral research
aims to investigate women’s attitudes towards HPV self-sampling by
incorporating the theoretical framework of the Extended Health Belief
Model (EHBM) and particularly focusing on the concept of self-efficacy.
Children’s
University
Hospital
Rosemary.fox@wales.nhs.u
k
Cardiff University
Dr Rosemary Fox (Director
of Screening Division,
Public Health Wales)
Rosemary.fox@wales.nhs.u
k
Cardiff University
Dr Sharon Hillier (Deputy
Director of Screening,
Public Health Wales)
Sharon.hillier@wales.nhs.u
k
We have shown that synthetic antigens related to components of
tuberculosis cells are recognized by antibodies present in the serum of
Bangor
University
Dr Michael Ruddy
(Consultant Microbiologist,
3
point of care TB diagnostic
assay
7
Validation and application
of cryptosporidium oral
fluid immunoglobulin assays
8
Blood Stream Infections
focus on outcomes Phase 1
patients infected with tuberculosis. In a population with high endemic tb
levels we can distinguish TB positive from TB negative in laboratory assays to
the standards of sensitivity and selectivity required by the WHO and we are
developing point of care diagnostic devices. The method we employ has the
capacity to identify and compensate for population variations and in
principle to identify other mycobacterial infections. The aim of this study is
to show that this method also works in a population with a low TB burden
and to provide proof of concept that we can provide a simple and efficient
device for point-of-care diagnosis and monitoring the effect of treatment.
Options for assessing whether an individuals or groups of people have had
recent exposure to the parasite Cryptosporidium, a major cause of gastrointestinal illness, are limited. For individuals, diagnosis of ensuing illness by
testing stool samples for the parasite is usual. However, routine laboratory
tests are not very sensitive for detection of the parasite, and not everyone
will become sick and seek diagnosis. To study groups of people, blood
samples can be tested for antibodies (specifically immunoglobulin G) which
develop following infection. However, this is invasive, and not desirable for
children who are of special interest as they are at high risk of infection.
Newly-published methods for detecting antibodies in oral fluid involve a
non-invasive, convenient sample collection process but the assays need
further evaluation and validation as indicators of recent infection. If proven
successful, the assays will be of great benefit for outbreak investigations and
population exposure and risk studies into Cryptosporidium.
Infection is a major concern in British hospitals and it is estimated that there
are around 90100,000 cases of Blood Stream Infections (BSI) every year. The
death rate from these infections can be very high 10-30% and for certain
organisms can reach 50%. Blood stream infections with Methicillin resistant
Staphylococcus aureus, Pseudomonas aeruginosa, extended spectrum
Blactamase producing E.coli or Klebsiella spp and Candida spp. have been
particularly associated with high levels of mortality following infection. A
number of factors are thought to play a role in poor outcome, in particular
underlying disease and the site and severity of infection. In contrast, timely
appropriate use of antibiotics and removal of infected prosthetic materials
4
Public Health Wales)
Michael.ruddy@wales.nhs.
uk
Public Health
Wales NHS Trust
Dr Rachel Chalmers
(Clinical Scientist, Public
Health Wales Health
Protection)
Rachel.chalmers@wales.nh
s.uk
Bristol University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
9
Probiotics for Antibiotic
Associated Diarrhoea
(including C.Diff) in Care
Homes (PAAD ) Phase 2
10
Diagnosis of Urinary Tract
Infection in Young Children
(DUTY)
11
Giardia Typing Pilot Study
are thought to be beneficial from small single centre studies. Ward staffing
levels are also thought to have a role. All these factors will be examined in
more depth in this multicentre study to see what effect they have and how
they can be changed to improve patient care and outcome of disease
following a BSI. The results of the study will then be fed back into the NHS to
modify practice to improve patient care and outcome.
Phase 1: Phase 1 is a prospective observational study that aims to collect
data (e.g. amount and type of antibiotics used, episodes of Antibiotic
Associated Diarrhoea (AAD) and Clostridium difficile associated diarrhoea
(CDAD) and outcome) for 12 months in a purposive sample of care homes.
270 Service users’ in nine care homes in South Wales will be recruited. An
optional baseline stool sample will be taken to assess C.difficile carriage.
Should the service user develop diarrhoea either during the course of
antibiotics or within eight weeks from stopping the antibiotic, a stool sample
will be collected. This phase will provided reliable incidence data and
confirm the basis of our sample size calculation for the randomised
controlled trial (RCT) (Phase 2). Research procedures, including
administering the probiotic, for Phase 2 will be piloted. Family focus groups
around the issues of consent and assent will be conducted. Additional
interviews will be conducted with study participants capable of consent.
Urinary Tract Infection (UTI) is one of the most common bacterial infections
in children. UTIs in young children can cause acute morbidity and recurrent
symptoms and a delayed or missed diagnosis may lead to rare but serious
complications. In our study we want to establish the best way to diagnose
UTI in children under the age of five who present to primary care with an
acute illness of less than or equal to 28 days duration. This study will provide
novel, clinically important information on the epidemiology and
presentation of childhood UTI that will be used to develop a feasible and
cost-effective clinical tool to help primary care clinicians in the UK and
worldwide improve the efficiency of diagnosing UTI in young children. This
will help minimise acute suffering and may help prevent serious long-term
complications.
Up to 200 cases of the gastrointestinal illness giardiasis, caused by the
5
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
Public Health
Dr Rachel Chalmers
12
Chromatic Reasoning In
Treating Infectious
Conditions (CRITIC)
protozoan parasite Giardia duodenalis (syn. lamblia), are reported in Wales
each year. Some cases are acquired abroad but outbreaks have occurred
here, especially in institutional settings resulting in exclusion and ensuing
impact on carers. Clusters of cases are reported in Wales among people who
have not been abroad, but it is often unclear what links, if any, there are
between them. Current methods of detection rely on microscopical
examination of stools to observe the presence of the parasite. However, due
to the organism’s invariant morphology, this does not differentiate between
“strains” (assemblages). Differentiation of assemblages may assist
investigations into case relatedness, and source identification, as has been
demonstrated during outbreak investigations abroad. Although two
assemblages are found in humans, it is suspected that assemblage A
contains more subtypes originating from animals and that assemblage B
may be predominantly human in origin, but we do not know what the
distribution is in Wales. Assemblage typing could be readily implemented by
the national Cryptosporidium Reference Unit (CRU), Public Health Wales
Microbiology ABM, where the technological platforms and proven scientific
expertise in molecular parasitology are already in place for Cryptosporidium
typing. In a one year pilot study, stool samples submitted for routine
investigation of gastrointestinal illness in which Giardia is detected, will be
blind coded and further tested by assemblage typing. The typing data will be
added to patient exposure data which is collected as part of routine
investigation and follow-up of cases, and analysed for trends and statistical
associations to see if the additional information helps explain sources of
infection and links between infections. If it is found to be of help, then
Giardia typing can be considered for inclusion as part of Public Health Wales'
service delivery.
Around 80% of all antibiotics in the UK are prescribed in primary care. With
the development of antibiotic resistance and few new antibiotics, the need
for change is paramount. Point of care tests are considered to be a useful
tool in helping GPs to make a decision as to whether to prescribe antibiotics
or not. Though many point of care tests (POCTs) have been developed many
are not used as they are not feasible for practical use in settings like GP
6
Wales NHS Trust
(Clinical Scientist, Public
Health Wales Health
Protection)
Rachel.chalmers@wales.nh
s.uk
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
13
DURESS Study Cryptosporidium in Upland
Hosts and Vectors
surgeries. This is because they are often to complex, expensive or timely.
This project focuses on the development of a potential new point of care
test to guide GPs in prescribing antibiotics to patients with suspected urinary
tract infection (UTI) or acute cough. The test uses a new technology called
chromatic sensing. If successful this test would be inexpensive, easy to use
without the need for reagents or laboratory equipment and produce results
within minutes. Chromatic sensing uses current information technology such
as laptop computers and mobile phone systems to capture and analyse
images of samples. Images of urine (for UTI) or sputum (for acute cough) are
analysed according to the red, blue and green (RBG) wavelengths of the
image of the sample. The RBG signals are translated into effective signal
strength, dominating wavelength and signal spread synonymous with the
parameters of colour science. We hope to determine a difference between
bacterial positive and bacterial negative urine and sputum samples
according to these parameters. The aim of this study is to explore whether
chromatic sensing can distinguish between bacterial positive or negative
urine and/or sputum samples and be helpful in guiding clinicians in their
decision to prescribe antibiotics. The primary objectives are to refine and
optimise the setup for taking images of urine and sputum samples using
either laptop and webcam system or a mobile phone and to determine
whether chromatic sensing can distinguish between bacterial culture
positive or negative urine and/or sputum samples.
The protozoan parasite Cryptosporidium represents a major health concern
associated with surface waters. Outbreaks of gastrointestinal illness have
been linked to upland supplies. Unlike most waterborne pathogens,
Cryptosporidium is not controlled by chlorination. Kill or removal from water
requires expensive treatment technologies mainly applied in high income
countries. Further, there are increased risks of exposure for people served
by small, often private, water supplies. Cryptosporidium causes an acute
gastroenteritis (cryptosporidiosis), with between 3000 and 6000 laboratory
confirmed cases reported each year in the UK. Two species, C. parvum and
C. hominis, account for most cases. Not all species of Cryptosporidium are
infectious to humans and some species are more adapted to some hosts
7
Cardiff University
Dr Rachel Chalmers
(Clinical Scientist, Public
Health Wales Health
Protection)
Rachel.chalmers@wales.nh
s.uk
14
Children with Eczema
Antibiotic Management
Study (CREAM)
15
Point Of carE Testing for
urinary tract Infection in
primary Care (POETIC)
(Stage 1 and Stage 2)
than others. We know that farmed animals and sewage from septic tanks
can be sources of contamination in upland rivers, but little is known about
the possible role of aquatic animals in the transmission of Cryptosporidium
as there is a limited amount of previous research in this topic area. It has
been shown that some animals such as birds, flies and shellfish may act as
transport vectors of human infectious Cryptosporidium species without
becoming infected themselves. Birds can become infected but with different
species. Nothing is known about whether other filter feeders, such as
aquatic insect larvae, may also have a similar role in harbouring the parasite.
We aim to find out whether insect larvae can harbour Cryptosporidium and
to find out more about the role of insectivores, fish and birds in transmission
of the parasite in upland catchments.
CREAM is a doubleblind, randomised controlled trial based in general
practices in Wales, Scotland, and the West of England. Children suitable for
the study will be identified by General Practitioners. If the child’s
parent/carer agrees, children will be randomly put into one of three
treatment groups (for one week): 1. Oral antibiotic and placebo cream; 2.
oral placebo and antibiotic cream; or 3. oral placebo and placebo cream.
Children taking part will be followed-up over 12 months. A trained research
nurse will visit each child during the first 4 weeks and use established
questionnaires to assess the severity of eczema; effect on quality of life;
healthcare consultations; impact on the family; and take swabs from the
skin, nose and mouth. The child’s parent/carer will be asked to complete a
diary during the first 4 weeks to record symptom severity and use of
medication. At 3 and 12 months, the parent/carer will be asked to complete
questionnaires and repeat swabs. These swabs will be used to assess impact
of treatments on subsequent development of antibiotic resistance; and to
measure the antibiotic sensitivity of bacteria found on the skin, nose and
mouth.
One approach to improving the management of women with symptomatic
UTI is to use technologies that incorporate near patient culture techniques.
One such technology is the Flexicult system, which is a novel point of care
test. This POCT uses specific chromatogenic agar to identify bacteria, and
8
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
16
A prospective randomised,
multicentre trial to assess
the impact of laboratory
based RAPId Diagnosis on
Outcome in patients with
Blood Stream Infections
(RAPIDO)
can be impregnated with antibiotics of choice to identify any antibiotic
resistant bacteria. The results of this test are available to the Clinician within
24 hours, enabling a more accurate diagnosis and better decisions about
treatment regime. Timely identification of a bacterial pathogen, and its
antibiotic resistance profile, in urine samples from women presenting with
symptomatic UTI in primary care, could help reduce the overall use of
antibiotics and help ensure that the most appropriate antibiotic is used for
women who are likely to benefit from antibiotic treatment (avoiding the use
of antibiotics where no bacterial infection is identified, and ensuring the
narrowest spectrum antibiotic to which the infecting bacteria is sensitive
to).This will not only improve the care of patients presenting with
symptomatic UTI, it will also help reduce the selective pressure that comes
from widespread unnecessary antibiotic use which is an important
contributory mechanism in the development of antimicrobial resistance. The
two stages described here will allow us to: 1. Assess the feasibility of
integrating such a test into general practices as well as the acceptability for
both prescribers and patients. 2. Assess the variation in current
management that could be changed by utilising a new POCT. Both of these
are required before a full scale implementation RCT of the test can be
undertaken.
Blood stream infections (BSI) are a major problem and about 8% of hospital
inpatients have a BSI. Some will be admitted with a BSI and others will
develop an infection during their hospital stay. Recent improvements in
infection control have reduced the number of patients that acquire an
infection during their hospital stay, but BSI still occur and there are currently
around 90100,000 cases a year. In certain infections the death rate can be as
high as 50% and every patient that contracts an infection has a longer
hospital stay. BSI is diagnosed by taking a blood sample from patients with
suspected infection. Antibiotic treatment is commenced within hours, but
processing of blood cultures takes several days to reach a definitive
diagnosis and identify the correct antibiotic. The initial antibiotic selected
will be a broad spectrum antibiotic, based on the clinician's judgment of the
clinical picture. However, until definitive bacterial analysis is performed it is
9
Bristol University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
17
Laboratory Evaluation and
Development of Rapid
Diagnostic Tests for Urinary
Tract Infection
18
Investigating Long-Term
Health Effects of
Cryptosporidium occurring
unknown if the correct antibiotic has been selected and there can be a time
lag of up to 35 days before patients receive appropriate antibiotic therapy
for their BSI. Administration of the correct antibiotics has been shown to
reduce death by up to 50% in some patient groups. This study will assess the
impact of new technology designed to speed up laboratory diagnosis. The
new technique should produce information within ½ hr of commencing
laboratory processing of positive specimens. A five centre, randomised
controlled trial design will be used and all patients with BSI will be
randomised into two groups, one which will be subjected to the current
diagnostic approach and the other group will have the current diagnostic
approach plus the new rapid diagnostic technology as well. Outcome will be
assessed by collecting the same set of clinical information on each patient in
the study.
Around 80% of all antibiotic's in the UK are prescribed in primary care. With
the development of antibiotic resistance and few new antibiotics, the need
for change is paramount. Point of care tests are considered to be a useful
tool in helping GPs to make a decision as to whether to prescribe antibiotics
or not. Though many point of care tests (POCTs) have been developed many
are not used as they are not feasible for practical use in settings like GP
surgeries. This is because they are often too complex, expensive or timely.
This study focuses on the development and laboratory evaluation of new
rapid diagnostic tests to aid the diagnosis of urinary tract infection (UTI).
The aims of this study are to:
• Evaluate the performance of UK Flexicult™ SSI urinary test in a laboratory
setting;
• Develop and evaluate a new technology, Chromatic sensing, for use as a
future rapid diagnostic test for UTI;
• Evaluate chromatic sensing as an improved alternative to user based
interpretation of dipsticks for UTI
The study will follow-up a group of people who were part of an outbreak of
cryptosporidiosis occurring in the North of England and Scotland during May
2012. We will approach potential participants, seek informed consent, and
10
Cardiff University
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
Swansea
University
Dr Rhianwen Stiff
(Specialty Registrar, Public
Health Wales)
in the 12 months following
Acute Infection: an
Outbreak Follow-Up Study
19
A pilot study on the risk
factors for Toxoplasma
Gondii infection in England
and Wales
20
Long-term health sequelae
of cryptosporidiosis
ask them to complete a health related questionnaire at 3 months and again
at 12 months after they were diagnosed with Cryptosporidium infection.
Environmental Health Officers routinely conduct 'exposure' questionnaires
with cases of Cryptosporidium at the time of their diagnosis. We will link
data from exposure and follow-up study questionnaires. The outbreak
follow-up study aims: To
investigate those health sequelae of Cryptosporidium infection which occur
after the acute infection has resolved (postacute health sequelae) To
investigate whether people who have had Cryptosporidium infection are at
an increased risk of Developing symptoms consistent with post-infectious
irritable bowel syndrome.
Toxoplasma is a common single-celled parasite that infects about 5 in 1000
of the UK population each year. Once an individual is infected, the parasite
forms cysts in heart and CNS tissues and can remain there for life. In
otherwise healthy individuals Toxoplasma infection often passes unnoticed
or causes only mild to moderate flu- or glandular fever-like symptoms that
require no treatment. If the infection is acquired during pregnancy,
however, this can be severe or life-threatening for the unborn child.
Toxoplasma is acquired either by eating raw or undercooked meat from
animals that are infected, or by inadvertently ingesting oocysts (microscopic
parasite eggs) from the environment. Thus, infection may be food borne or
may be associated with a wide range of occupational or social activities
involving exposure to the environment. In the UK it is not known which of
these routes is the most important and this information is critical in ensuring
health protection advice is targeted towards the highest risk activities. The
findings will also inform national strategy and policy on food safety. This
study involves finding out, through a 30 minute telephone interview and
questionnaire, what exposure to risk factors has been encountered by
individuals recently infected with Toxoplasma.
Relatively little is known about the spectrum of illness caused by
Cryptosporidium, particularly long-term health consequences following
acute infection. It is these consequences we would like to investigate using a
combination of methods:
11
Rhianwen.stiff@nhs.wales.
uk
Health Protection
Agency (HPA)
Dr Edward Guy (Head of
Toxoplasma Reference
Unit, Public Health Wales)
Edward.guy@wales.nhs.uk
Public Health
Wales
Dr Rhianwen Stiff
(Specialty Registrar, Public
Health Wales)
Rhianwen.stiff@nhs.wales.
21
Role of chronic urinary
infection in the
pathophysiology of
overactive bladder
syndrome (OAB and
Infection)
1. Systematic review of the literature
2. Retrospective study - We will securely link anonymised laboratory results
(diagnosis date, species found) with health record data
3. Prospective study - We will approach potential participants, seek
informed consent, and ask them to complete a health related questionnaire
at the time of diagnosed with Cryptosporidium, and also at 3 and 12 months
afterwards.
Overactive bladder (OAB)is characterised by urgency(a sudden compelling
desire to pass urine which is difficult to defer), with or without urge
incontinence (complaint of involuntary leakage accompanied by or
immediately preceded by urgency), usually with frequency and nocturia
(complaint that the individual has to wake at night one or more times to
void).It effects 13% of the population and the incidence rises with age. It has
significant adverse effect on quality of life; sleep quality and emotional
wellbeing. OAB has been proposed to have a greater negative effect on the
health related quality of life (HRQoL) than diabetes mellitus, hypertension,
asthma or depression. Various hypotheses have explained the
pathophysiology of OAB symptoms but no concrete evidence exists which
supports these hypotheses. In recent years, subclinical urinary infection has
been explored as an etiological factor for OAB symptoms, but robust data is
still lacking. The aim of our study is to investigate whether women with OAB
symptoms (and no evidence of overt clinical infection by conventional Mid
Stream Urine for culture) have significant markers of subclinical
infection when compared to individuals with no OAB symptoms. We aim to
compare the urine samples of patients with OAB with healthy controls. We
will be looking for the following markers of infection 1) microscopy of fresh
urine for pus cells 2) culture of urine for
bacterial growth 3) Detection of inflammatory biomarkers in the urine.
4)Molecular testing for bacterial DNA in the fourth sample. explained the
pathophysiology of OAB symptoms but no concrete evidence exists which
supports these hypotheses. In recent years, subclinical urinary infection has
been explored as an etiological factor for OAB symptoms, but robust data is
still lacking. The aim of our study is to investigate whether women with OAB
12
uk
Abertawe Bro
Morgannwg UHB
Eugene Rees (Head of
Bacteriology, Public Health
Wales Swansea)
22
A prospective study of
faecal parasite infections
among children in Cambodia
23
Protecting the health of
Europeans by improving
methods for the detection
of pathogens in drinking
water and water used in
food preparation:
AQUALVALENS
symptoms (and no evidence of overt clinical infection by conventional Mid
Stream Urine for culture) have significant markers of subclinical infection
when compared to individuals with no OAB symptoms. We aim to compare
the urine samples of patients with OAB with healthy controls.
We will be looking for the following markers of infection 1) microscopy of
fresh urine for pus cells 2) culture of urine for bacterial growth 3) Detection
of inflammatory biomarkers in the urine. 4)Molecular testing for bacterial
DNA in the fourth sample.
Cambodia has some of the poorest health indicators in Southeast Asia, with
high rates of malnutrition. Just under a third of the population have access
to improved sanitation facilities, and rainwater is the main source of water
for most homes. It is therefore not surprising that infection with gut
parasites is a common problem in children, causing detrimental effects on
nutrition, growth and cognitive development and contributing substantially
to childhood anaemia. The primary purpose of this study is to define the
incidence and range of faecal parasites causing infections in Cambodian
children presenting to hospitals; the R&D approval sought here is specifically
for the work that will be undertaken at the national Cryptosporidium
Reference Unit in Public Health Wales Microbiology Swansea: the analysis of
DNA extracted from stools for the detection and characterisation of the
Cryptosporidium parasite. The DNA will have already been extracted from
stools at Liverpool University.
AQUAVALENS is an EU funded collaborative project centered on the concept
of developing suitable platforms that harness the advances in new
molecular techniques to permit the routine detection of waterborne
pathogens and improve the provision of hygienically safe water for drinking
and food production. It is vital for improving risk assessment and risk
management of water supplies that robust techniques are developed that
can inform better our knowledge of the occurrence and abundance of
waterborne pathogens presenting a threat to individual water supplies. Our
work will centre on the applied parasitology aspects of AQUAVALENS for the
detection, virulence assessment and subtyping of major waterborne
protozoa: Cryptosporidium and Giardia.
13
Oxford University
Professor Rachel Chalmers
(Head of Cryptosporidium
Reference Unit)
Rachel.chalmers@wales.nh
s.uk
University of East
Anglia
Professor Rachel Chalmers
(Head of Cryptosporidium
Reference Unit)
Rachel.chalmers@wales.nh
s.uk
24
25
Validation of MALDI-TOF for
identification of Neisseria
Gonorrhea
The purpose of this project is to determine which identification system is
the most sensitive and specific for the identification of cultured N.
Gonorrhoea from clinical specimens and also to determine which method
will provide results within the time and budget constraints of the laboratory.
The study also aims to evaluate the antibiotic susceptibility to
Cephalosporins and Macrolides within these bacteria.
Public Health
Wales NHS Trust
As new technology is being developed and entering clinical laboratories, it is
important to determine if this technology will be of benefit to the Cardiff
laboratory and not implemented because it is new. Also it is important to
determine a method that will provide the laboratory with reproducible
results in a timely manner, as well as providing the clinician with a confirmed
positive or negative result which will ultimately help with treatment efficacy.
Point Of carE Testing for
Fifteen percent of community antibiotic prescriptions are for uncomplicated Cardiff University
urinary tract Infection in
urinary tract infections (UTI’s). Most women presenting with UTI symptoms
primary Care: Study Stages 3 are prescribed an antibiotic agent. However, 34% 60% of patients treated
& 4: Randomised controlled with an antibiotic do not have a microbiologically proven UTI and 25% of
trial and
those with a positive culture are not prescribed antibiotics. This is important
post RCT
in terms of improving outcomes for women with symptoms of UTI.
observational study (POETIC Unnecessary use of antibiotics contributes to the development of resistant
3&4)
bacteria, an important and increasing public health threat. We propose a
two stage study (stages 3 & 4) that follows on from our previous study
(POETIC: stages 1 & 2) that aims to improve the management of UTI in
women through use of a novel point of care test (POCT), based on an
overnight culture technique that is carried out within general practice and
provides a diagnosis of bacterial UTI and resistance profiles of any identified
pathogen, within 24 hours. Stage 3 will be an individual randomised
controlled trial to assess the effectiveness of the device in targeting
appropriate use of antibiotics (i.e. avoiding the use of antibiotics where no
bacterial infection is identified, and ensuring the narrowest spectrum
antibiotic to which the infecting bacteria is sensitive to is prescribed for
women with proven UTI). The fourth stage will only be done if the POCT
guided strategy is shown to be effective in stage 3. It will be a pragmatic
14
Paula Brookes
(Operational ManagerBacteriology Public Health
Wales Cardiff)
Paula.brookes2@wales.nhs
.uk
Dr Robin Howe (Consultant
Microbiologist, Public
Health Wales)
Robin.howe@wales.nhs.uk
assessment of the uptake and use of the POCT when provided to general
practices outside of trial conditions. For both stages participants will be
adult women presenting in general practice with symptoms suggestive of
UTI.
Public Health Wales – PUBLIC HEALTH DEVELOPMENT
26
Pilot Blood and Tissue Bank
for Patients with Chronic
Fatigue Syndrome
27
Using the All Wales Clinical
Governance Practice Self
Assessment Tool for general
medical practices –
assessing the opinions of
health care professionals
The study intends to develop a bank of research participants, including at
least 50 patients with Chronic Fatigue, and two groups of Control
participants. Firstly, a group of 25 Household Controls, each of whom will
share the home of a patient with Chronic Fatigue. Only one control
participant will be recruited from any given household. Secondly, a group of
50 Community Controls, who will be drawn from the wider community.All
participants will be asked to complete an initial screening questionnaire and
provide an initial blood sample. They may then be asked to provide a blood
sample, complete a questionnaire or undertake tests of physical function up
to twice a year.
Clinical governance is a framework for the improvement of patient care
through commitment to high standards, reflective practice, risk
management and personal and team development. The Clinical Governance
Practice Self Assessment Tool (CGPSAT) for general medical practices is
about monitoring outcomes, identifying errors, reviewing activity and
continually learning and developing. It is about sharing knowledge and
experience, both good and bad. This study proposes to develop a
questionnaire-based evaluation tool that can be used by Public Health Wales
to determine what benefits(or not) have been derived by health care
professionals who have completed the CGPSAT. If Public Health Wales
decide that the service tool develop as part of this study is fit for purpose
they will adopt it and provide feedback to the researcher based on the
responses they receive from the questionnaire. If the questionnaire is not
adopted they will provide feedback as to why. The researcher will review the
feedback and information receive from Public Health Wales to review the
service evaluation tool and identify any further improvement that are
required or can otherwise be made.
15
Cardiff
University
Dr Hugo Van Woerden
(Director of Health and
Healthcare Improvement,
Public Health Wales)
Hugo.vanWoerden@wales.
nhs.uk
Swansea
University
Dr Paul Myres
(Professional Lead, Primary
Medical Care Advisory
Team, Public Health Wales)
Paul.myres@wales.nhs.uk
28
29
Preventing alcohol misuse in
young people. An
exploratory trial of the Kids,
Adults Together (KAT)
Programme
Randomised Controlled Trial
of All-Wales Licensed
Premises Intervention to
Reduce Alcohol-Related
Violence - Cardiff University
Licensed Premises
Intervention (CULPrIt)
This study is developing and evaluating a school-based intervention – Kids,
Adults Together (KAT), which draws on the Social Development Model and
seeks to prevent alcohol use by strengthening pro-social communication in
families.
Cardiff
University
The KAT programme aims to prevent alcohol misuse by young people
through integrating specially designed classroom activities with a family
education evening and a DVD to promote pro-social communication. A
recently completed formative evaluation of KAT demonstrated high levels of
programme reach and acceptability, and impacts on pro-social
communication in families - click here for further information.
This Project examines the effectiveness of an intervention, delivered to pubs Cardiff
and clubs, that is designed to reduce violence. Environmental Health Officers University
(EHO) will deliver the intervention as they have a history of enforcement
and partnership working and are trained to deliver interventions and advice
to small and medium sized businesses. Furthermore, EHOs have available
statutory powers, they can require entry to premises and are able to enforce
change.
The intervention itself is made up of four components. First, EHOs will host
"Safety and Health Awareness Days" across Wales for Intervention premises.
This will help engage those involved with premises operation and includes
regional managers to serving staff. Second, they will audit premises to
identify those areas where premises operation might increase the risk of
violence (e.g. inappropriate alcohol promotions, which are associated with
violence). Third, based on this audit, EHOs will formally require premises to
make changes (where risks are covered by existing legislation), advise
premises to make changes, and if appropriate refer premises to police and
Local Authority licensing officers who are able to place conditions on
premises licenses. Reducing known risks will reduce alcohol-related
violence. Finally, EHOs will conduct a second audit one month later to assess
whether premises have made the required changes and if not they will
enforce as required.
16
Dr Jeremy Segrott
(Research Fellow in Public
Health, DECIPHer, Cardiff
University)
SegrottJ@cardiff.ac.uk
Dr Simon Moore (Reader,
School of Dentistry, Cardiff
University)
Mooresc2@cardiff.ac.uk
30
31
Fathers, Social Interventions
and Children's Well-being
Pilot Study of Alcohol Policy
and Social Norms in Welsh
Universities
Social care and other helping services to engage with fathers is a relatively
Cardiff
recent innovation and not very much is yet known about the effectiveness of University
different approaches. Three studies will contribute to the evidence base for
more effective work with fathers and especially the impact of this work on
the emotional well-being of children.
Study 1 involves analysis of existing data on families and child health over
time. It will examine which social factors, attitudes and behaviours in fathers
are associated with children’s emotional well-being. (Note that ‘fathers’
here means all father figures, including biological fathers, step fathers and
mothers’ boyfriends).
Study 2 will try to identify which kinds of approaches and services are most
commonly being used by practitioners who see themselves as working to
engage fathers.
Study 3 is a pilot study of two social interventions for fathers. The pilot study
will explore the potential for future experimental research on outcomes for
children of interventions with fathers, and in particular emotional health
outcomes.
Although originating in the USA, interest is growing in applying the social
norms approach to reducing drinking behaviours in UK universities. This
approach is based on the assumption that students perceptions of the
norms of their peers are highly influential, but that these perceptions are
often incorrect. That is, students often believe that their peers drink more,
and experience more alcohol-related consequences, than they actually do.
Social norms interventions therefore aim to correct these inaccurate
perceptions, and in turn, to change behaviours.
Earlier in 2011, a survey was conducted by the Cardiff Institute of Society
and Health, in partnership with NUS Wales and Drinkaware to assess first
year university students perceptions of peer drinking behaviour and
consequences in four Welsh Universities. Data from this survey have
informed the development of materials which aim to correct incorrect
perceptions of drinking norms, which will be delivered through university
17
Cardiff University
Professor Jonathan
Scourfield (Professor of
Social Sciences, Cardiff
University)
scourfield@cf.ac.uk
Dr Simon Murphy (Senior
Research Fellow, CISHE,
Cardiff University)
MurphyS7@cf.ac.uk
halls of residence.
32
Randomised Control Trial of
the Strengthening Families
10-14 UK programme (SP1014 UK)
33
Families Households and
Health Improvement
34
The Role of Protozoa like
Organisms in Respiratory
Diseases
35
Barriers to Uptake of
Smoking Cessation Services
in Pregnant Women in Cwm
Taf (BASICS)
This study aims to examine the impact of these materials on first year
students drinking and alcohol related consequences in four universities, and
to establish the feasibility of a larger national trial.
The use of alcohol, tobacco and illegal drugs by young people impacts on
their health in the short and long term, and is also associated with antisocial behaviour, crime and dropping out of school. Many of the factors
which protect young people from misusing drugs and alcohol, or put them at
greater risk of doing so, are linked to family life and parenting. The
Strengthening Families Programme 10-14 UK (SFP10-14 UK) aims to
strengthen these protective factors (parenting, family communication, and
young people’s resilience skills) and simultaneously reduce key risk factors
that are located within families.
The research will focus on how families negotiate roles and responsibilities
for health through their interaction with each other and wider social
structures. Families and households will be investigated through in-depth
case study research. Individual and group interviews will be conducted with
household members and activity diaries will be used to record relevant
aspects of everyday life, relationships and behaviour. The findings will
provide an insight into how health improvement messages and
interventions can be better targeted and supported and should sensitize
health care professionals to how families negotiate health decisions.
1. Can we use molecular techniques to identify the precise nature of the
protozoa observed in the sputum of respiratory patients under light
microscopy?
2. Are these protozoa also present in dust mite faeces?
The study aims to identify ways to improve the support for pregnant women
who wish to give up smoking in the region served by the Cwm Taf Health
Board, South Wales. A questionnaire will be used to ascertain the views of
recently pregnant mothers on the opportunities available to give up smoking
18
Cardiff
University
Professor Laurence Moore
(Professor of Public Health
Improvement, Cardiff
University)
Moorel1@cf.ac.uk
Cardiff
University
Sarah MacDonald
(Research Associate, CISHE,
Cardiff University)
macdonals@cf.ac.uk
Public Health
Wales NHS Trust
Dr Hugo Van Woerdon
(Director of Health and
Healthcare Improvement,
Public Health Wales)
Hugo.vanWoerden@wales.
nhs.uk
Mrs Angela Jones
(Consultant in Public
Health, Public Health
Wales)
Glamorgan
University
during pregnancy.
36
(APP-cohol awareness)supporting people to drink
less alcohol using a smart
phone app and scratch card
recorder
Project objectives are to:
Public Health
a) identify appropriate target ‘user’ groups
Wales NHS Trust
b) determine how best to direct the target users to the app and scratch
card
c) determine what health messages should be used to support
behaviour change by the users
d) determine whether and to what extent the app and scratch card can
effect behaviour change and reduce alcohol consumption.
37
Models for Access to
Maternal Smoking Cessation
Support (MAMMS Study)
CWM Taf
Addressing smoking in pregnancy is a high priority area for the NHS in Wales
and the Welsh Government. Wales has higher rates of smoking in pregnancy
than any other UK country, and levels before or during pregnancy is highest
at 33% compared to 26% in England (Infant Feeding Survey, 2010). There is
unequivocal evidence of the association between smoking and poor
outcomes for mother and baby in the short, medium and long term. Uptake
of NHS smoking cessation support in Wales is currently low and there is a
requirement to review the current delivery model supporting pregnant
women in order to improve the uptake of cessation support and achieve
higher numbers of women successfully quitting. A review of the evidence
(NICE), on the barriers to smoking cessation in pregnancy suggests that
pregnant smokers
are different to other adult smokers who are motivated to quit and self refer
to smoking cessation services, and that a flexible approach is needed for
pregnant women, particularly those who are disadvantaged, with the
services being offered in a client centred way throughout pregnancy and
following childbirth.
This research aims to test the hypothesis that the uptake of evidence based
smoking cessation services by pregnant women will increase, if flexible
models of support are delivered by a Maternity Support Worker sited within
the Midwifery team. A nonrandomised intervention approach will be
19
Cwm Taf Health
Board
Angela.jones26@wales.nhs
.uk
Dr Sarah Jones (Consultant
in Environmental Health
Protection, Public Health
Wales)
Sarah.jones27@wales.nhs.
uk
Margaret Munkley
(Principal Public Health
Specialist)
Margaret.Munkley@wales.
nhs.uk
38
Models for Access to
Maternal Smoking Cessation
Support (MAMMS Study)
Comparison Analysis
undertaken to establish the effectiveness compared to that provided by the
usual care, i.e, existing Stop Smoking Wales service. Consistent data
collection and analysis will be used to measure improvement in uptake of
smoking cessation services by pregnant women, and subsequent smoking
quit rates. Data will be extracted and analysed from the all Wales Maternity
Record, Summary of Labour database and Stop Smoking Wales database.
The study aims to compare the effectiveness of new models of service Public Health
delivery for specialist smoking cessation services for pregnant women with Wales NHS Trust
existing services delivered by Stop Smoking Wales. The new models of
service delivery (pilots) will be implemented over a maximum 12 month
period in selected sites across four health boards in Wales using an
integrated approach between maternity services, local public health teams
and stop smoking Wales. Core recommendations from NICE guidance will be
implemented across pilot and usual care sites within the participating Health
Boards. In usual care sites, stop smoking support for pregnant women will
be delivered by the existing Stop Smoking Wales service. In pilot sites,
support will be provided by a maternity support worker, a midwife or a
dedicated Stop Smoking Wales advisor and will be delivered more flexibly
than in usual care sites. Each health board has identified plot and usual care
sites based on geographical areas or community midwife teams depending
on how maternity care is organised in the Health Boards. Routine data
collected by Health Board ,maternity team and Sop Smoking Wales for a
cohort of women who participate in either a pilot or usual care service
across the four Health Board areas will be extracted, linked and analysed for
a maximum 12 month period. The primary outcome is engagement with
specialist smoking cessation services defined by at least one face to face
therapeutic contact. Secondary outcomes are pregnant smokers who set a
quit date; pregnant smokers who quit at 4 weeks follow up (CO verified);
smoking status of pregnant smokers during third trimester and birth
outcomes (birth weight, gestational age). Process measures will assess
fidelity to protocols, feasibility acceptability, maintenance and sustainability
should the pilots be rolled out on a wider level.
20
Siobhan Jones (Consultant
in Public Health)
siobhan.jones2@wales.nhs
.uk
21