Level Of Personal Risk Research Articles

'What is my risk really?': a qualitative exploration of preventive interventions among individuals at risk of rheumatoid arthritis.

Intervention in the pre-arthritis phase of RA could prevent or delay the onset of disease. The primary aim of this study was to explore perspectives of being at risk and potential preventive interventions among individuals at risk of developing RA and to identify factors influencing their engagement with prevention. A secondary aim, established during the analytical process, was to understand and compare different approaches to health-related behaviours related to prevention of RA. Anti-CCP-positive (CCP+) at-risk individuals with musculoskeletal symptoms but no synovitis participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, followed by a secondary ideal-type analysis. Nineteen CCP+ at-risk individuals (10 women; age range 35-70years) participated. Three overarching themes were identified: being CCP+ at risk; aiming to prevent RA; and influencers of engagement. Participants described distress related to symptoms and uncertainty about disease progression. Many participants had concerns about medication side effects. In contrast, most participants expressed willingness to make lifestyle changes with the aim of preventing RA. Engagement with preventive measures was influenced by symptom severity, personal risk level, co-morbidities, experiences of taking other medications/supplements, knowledge of RA, risk factors and medications, and perceived effort. Three types of participants were identified from the data: proactive preventers, change considerers and fearful avoiders. Overall orientation to health behaviours also impacted the attitude towards preventing RA. Findings could inform recruitment and retention in RA prevention research and promote uptake of preventive interventions in clinical practice.

Is There a Role for Molecular Testing for Low-Risk Differentiated Thyroid Cancer? A Cost-Effectiveness Analysis.

Molecular testing for thyroid nodules has been rapidly developed in recent years, aiming to predict the presence of malignancy and aggressive features. While commonly utilized to predict malignancy, its role in guiding the management approach is still developing. The high cost of genetic tests and long-term sequences of thyroid cancer is limiting to real-life studies. Objective: To evaluate the cost effectiveness of molecular testing for low-risk differentiated thyroid cancer (lrDTC). Methods: We developed a Markovian decision tree model of a simulated lrDTC cohort, comparing two management strategies: (I) Conducting genetic tests (GT)-patients are stratified into three risk groups for distant metastasis by the identified molecular markers: low-, intermediate- and high-risk molecular profile; followed by management accordingly: patients with low-risk will undergo hemithyroidectomy (HT), patients with intermediate-risk will undergo total thyroidectomy (TT), and high-risk patients will undergo TT with central neck dissection; (II) Without genetic tests (wGT)-all patients will undergo HT according to the ATA recommendations for lrDTC. Outcomes were measured as quality-adjusted life years (QALYs) and costs of each strategy. Results: GT was found as cost effective, leading to a gain of 1.7 QALYs with an additional cost of $327 per patient compared to wGT strategy. This yielded an incremental cost-effectiveness ratio of $190 per QALY. Sensitivity analysis demonstrated robust results across the variables' ranges. The most impactful variable was the benefit from performing TT rather than HT for intermediate to high-risk patients. Conclusions: Our model found that molecular testing for lrDTC is cost-effective, allowing tailored management according to the patient's personal risk level reflected in the genetic profile, hence improving outcomes.

Optimal breast cancer risk reduction policies tailored to personal risk level.

Depending on personal and hereditary factors, each woman has a different risk of developing breast cancer, one of the leading causes of death for women. For women with a high-risk of breast cancer, their risk can be reduced by two main therapeutic approaches: 1) preventive treatments such as hormonal therapies (i.e., tamoxifen, raloxifene, exemestane); or 2) a risk reduction surgery (i.e., mastectomy). Existing national clinical guidelines either fail to incorporate or have limited use of the personal risk of developing breast cancer in their proposed risk reduction strategies. As a result, they do not provide enough resolution on the benefit-risk trade-off of an intervention policy as personal risk changes. In addressing this problem, we develop a discrete-time, finite-horizon Markov decision process (MDP) model with the objective of maximizing the patient's total expected quality-adjusted life years. We find several useful insights some of which contradict the existing national breast cancer risk reduction recommendations. For example, we find that mastectomy is the optimal choice for the border-line high-risk women who are between ages 22 and 38. Additionally, in contrast to the National Comprehensive Cancer Network recommendations, we find that exemestane is a plausible, in fact, the best, option for high-risk postmenopausal women.

The Moral, Ethical, Personal, and Professional Challenges Faced by Physicians during the COVID-19 Pandemic.

The COVID-19 pandemic, apart from the main problems concerning the health and life of patients, sparked a discussion about physicians’ moral and social professional attitudes. During a pandemic, physicians have the same ethical, moral, and medical responsibilities, however, the situation is different since they are self-exposed to a danger, which may influence their willingness to work. The problem of the professional moral attitudes of health care workers, recurring in ethical discussions, prompts us to define the limits of the duties of physicians in the event of a pandemic, hence this research aimed to assess these duties from an ethical perspective and to define their boundaries and scope. The study was conducted in May and June 2020 in the city of Lublin, covering all medical centers, and the questionnaire was completed by 549 physicians. The research was conducted in four areas: emergency standby in the event of a disaster, even if it is not requested; willingness to work overtime in the event of a disaster, even without payment; willingness to take health risks by caring for people who are infectious or exposed to hazardous substances; readiness to be transferred to other departments in the event of a disaster. Although most of the respondents declared to be agreed on personal sacrifices in the performance of professional duties, they were not prepared for a high level of personal risk when working in a pandemic. Excessive workload, its overwhelming nature, and personal risk are not conducive to readiness to work overtime, especially without pay. Research shows how important it is to respect the rights and interests of all parties involved in a pandemic. Physicians’ duty to care for a patient is also conditioned by the duty to protect themselves and should not be a tool for intimidating and depersonalizing their social and professional lives.

Risk perception and risk realities in forming legally binding agreements: The governance of plastics

The effectiveness of a legally binding treaty to manage plastic pollution will depend on how people perceive the risk of the problem in terms of both whether and how much they fear it. Plastic pollution caught the attention of the global public owing to uncertainty surrounding potential human health impacts. Despite an initial concern about human exposure, especially to microplastics, scientific evidence started emerging that the risks of ingesting and even inhaling microplastic was relatively small, suggesting low levels of personal risk. Still, at UNEA5 in Nairobi in 2022, a resolution was passed to start negotiations towards a legally binding agreement for the governance of plastics throughout its life cycle. We compare the trajectory of marine plastics as an environmental governance issue with other global challenges and do a comparative analysis using culture theory to assess how individual risk perception and worldviews inform collective attitudes on governance. We conclude by considering how different risk perceptions may have changed when even more knowledge became available concerning the implications of microplastics breaking down further into nanoplastics and being registered in human blood samples. We argue that this may have contributed to shifting public perception about personal risk and given the requisite push for coordinated global governance of this material.

Sleep patterns of US healthcare workers during the first wave of the COVID-19 pandemic.

Purpose During the first few months of the COVID-19 outbreak, healthcare workers (HCW) faced levels of personal risk, emotional distress, and professional strain not seen in their lifetimes. This study described how these stressors influenced various aspects of their sleep patterns.MethodsFrom May 19 to June 20, 2020, an electronic, cross-sectional survey was administered to a convenience sample of in- and outpatient HCW in a large, nonprofit healthcare system. Respondents described the pandemic’s initial impact on personal and professional life and various sleep dimensions: regularity, efficiency, duration, timing, quality, and daytime sleepiness.ResultsTwo hundred seven providers responded, representing 17 different healthcare roles. Most (82%) were women with a median age of 39 years (IQR1–3, 31–53). A majority of respondents (81%) worked in an inpatient setting, with half (46%) primarily on the “frontline.” Approximately one-third of respondents (37%) were physicians and one-quarter (28%) were nurses. Overall, 68% of HCW reported at least one aspect of sleep worsened during the beginning of the pandemic; the most impacted were daytime sleepiness (increased in 43%) and sleep efficiency (worse in 37%). After adjusting for COVID exposure and burnout, frontline providers had twofold higher odds of poor pandemic sleep, aOR 2.53, 95%CI 1.07–5.99. Among frontline providers, physicians were fivefold more likely to develop poor pandemic sleep compared to nurses (OR 5.73, 95%CI 1.15–28.57).ConclusionsDuring the initial wave of COVID-19, a majority of HCW reported a decline in sleep with an increase in daytime sleepiness and insomnia. Frontline workers, specifically physicians, were at higher risk.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11325-021-02515-9.

Estimating Exposure Risk to Guide Behaviour During the SARS-COV2 Pandemic.

The end of 2020 and the beginning of 2021 was a challenging time for many countries in Europe, as the combination of colder weather, holiday celebrations, and the emergence of more transmissible virus variants conspired to create a perfect storm for virus transmission across the continent. At the same time lockdowns appeared to be less effective than they were earlier in the pandemic. In this paper we argue that one contributing factor is that existing ways of communicating risk—case numbers, test positivity rates, hospitalisations etc.—are difficult for individuals to translate into a level of personal risk, thereby limiting the ability of individuals to properly calibrate their own behaviour. We propose an new more direct measure of personal risk, exposure risk, to estimate the likelihood that an individual will come into contact with an infected person, and we argue that it can play an important role, alongside more conventional statistics, to help translate complex epidemiological data into a simple measure to guide pandemic behaviour. We describe how exposure risk can be calculated using existing data and infection prediction models, and use it to evaluate and compare the exposure risk associated with 39 European countries.

The Power of an Active Shooter Simulation: Changing Ethical Beliefs.

IntroductionDuring a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.MethodsForty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.ResultsPreparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.ConclusionSimulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

Communicating Personal Risk Profiles of Alzheimer's Disease to Older Adults: A Pilot Trial.

Communicating personal Alzheimer's disease risk profiles based on validated risk algorithms may improve public knowledge about risk reduction, and initiate action. This proof of concept pilot trial aimed to test whether this is feasible and potentially effective and/or harmful. Older at-risk adults (N=24) were provided with their personal Alzheimer's disease risk profile online, which contained information on their personal risk level, scores and tailored recommendations to manage modifiable risk factors. After receiving the risk profile, participants were significantly more accurate in identifying risk and protective factors, and revised their perceived risk to be lower than their initial estimate. There was no apparent harm seen in psychological distress or dementia-related worry. This shows preliminary support for the feasibility of delivering personal dementia risk profiles to low risk, help-seeking older adults in an online format. A definitive trial examining behavioural outcomes and testing in groups with higher risk profiles is now warranted.

Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT

Aims/hypothesisUsing variable diabetic retinopathy screening intervals, informed by personal risk levels, offers improved engagement of people with diabetes and reallocation of resources to high-risk groups, while addressing the increasing prevalence of diabetes. However, safety data on extending screening intervals are minimal. The aim of this study was to evaluate the safety and cost-effectiveness of individualised, variable-interval, risk-based population screening compared with usual care, with wide-ranging input from individuals with diabetes.MethodsThis was a two-arm, parallel-assignment, equivalence RCT (minimum 2 year follow-up) in individuals with diabetes aged 12 years or older registered with a single English screening programme. Participants were randomly allocated 1:1 at baseline to individualised screening at 6, 12 or 24 months for those at high, medium and low risk, respectively, as determined at each screening episode by a risk-calculation engine using local demographic, screening and clinical data, or to annual screening (control group). Screening staff and investigators were observer-masked to allocation and interval. Data were collected within the screening programme. The primary outcome was attendance (safety). A secondary safety outcome was the development of sight-threatening diabetic retinopathy. Cost-effectiveness was evaluated within a 2 year time horizon from National Health Service and societal perspectives.ResultsA total of 4534 participants were randomised. After withdrawals, there were 2097 participants in the individualised screening arm and 2224 in the control arm. Attendance rates at first follow-up were equivalent between the two arms (individualised screening 83.6%; control arm 84.7%; difference −1.0 [95% CI −3.2, 1.2]), while sight-threatening diabetic retinopathy detection rates were non-inferior in the individualised screening arm (individualised screening 1.4%, control arm 1.7%; difference −0.3 [95% CI −1.1, 0.5]). Sensitivity analyses confirmed these findings. No important adverse events were observed. Mean differences in complete case quality-adjusted life-years (EuroQol Five-Dimension Questionnaire, Health Utilities Index Mark 3) did not significantly differ from zero; multiple imputation supported the dominance of individualised screening. Incremental cost savings per person with individualised screening were £17.34 (95% CI 17.02, 17.67) from the National Health Service perspective and £23.11 (95% CI 22.73, 23.53) from the societal perspective, representing a 21% reduction in overall programme costs. Overall, 43.2% fewer screening appointments were required in the individualised arm.Conclusions/interpretationStakeholders involved in diabetes care can be reassured by this study, which is the largest ophthalmic RCT in diabetic retinopathy screening to date, that extended and individualised, variable-interval, risk-based screening is feasible and can be safely and cost-effectively introduced in established systematic programmes. Because of the 2 year time horizon of the trial and the long time frame of the disease, robust monitoring of attendance and retinopathy rates should be included in any future implementation.Trial registrationISRCTN 87561257FundingThe study was funded by the UK National Institute for Health Research.Graphical abstract

Sun-safe behaviours, personal risk, level of concern, and knowledge about cutaneous melanoma in italy: time for social marketing?

SummaryIntroductionThe incidence of cutaneous melanoma is increasing, although 80-95% of all deaths caused by melanoma can be avoided through protective behaviours. There is evidence that social marketing as an approach in public health can improve health-related behaviours and encourage sun-safe behaviours.MethodsA multicentre survey was conducted to collect and compare data about cutaneous melanoma risk, knowledge, concern, and protective behaviours across Northern, Central, and Southern Italy, and explore how these data could potentially inform a social marketing intervention to improve sun-safe behaviours. Data were analysed using descriptive and inferential statistics.ResultsA total of 1,028 questionnaires were collected. Apart from ‘Personal Risk’ no statistically significant differences were found between the three regions. About 30% (n = 344) of the total sample had high levels of personal risk, and low levels of concern and protective behaviour, and over 70% (n = 711) gave priority to sun tanning. The worst scores were related to knowledge about melanoma (30% wrong answers, and over 40% ‘don’t know’). Protective behaviour was moderately correlated with age (p = 0.03). Personal risk was significantly higher in women (10.84 vs 10.05), and lower in individuals with a degree (9.46 vs 11.38; p < 0.001).ConclusionsOver 70% of our sample gave priority to sun tanning, which combined with low levels of concern and knowledge about melanoma, and high levels of personal risk, confirm that much still needs to be done in terms of melanoma prevention, but all these are aspects that could be effectively addressed through social marketing interventions.

Comparison of Hungarian and Vietnamese Cultural Differences in Classic Behavioural Economics Experiments

Nowadays behavioural economics is widely studied and referenced. Well-known classic experiments (e.g. prospect theory) have provided many results which prove that we are human, but most of these studies did not deal with the background and origin of these problems. In this paper we use classic ex-periments on one sample each of Hungarian and Vietnamese students. The respondents are not just geographically distant, but their cultures differ greatly. Cultural differences can be described through cultural comparisons (e.g. the Hofstede, GLOBE, and Schwartz studies) which explain the main differ-ences between our two studied samples. But each actor has a different personality, and the way we handle risky situations colours our decisions. Due to this fact, we applied the DOSPERT Scale to each respondent, measuring their personal risk-taking levels. Our main research question focuses on how cultural background and personal risk level matter in economic decisions. Based on the relevant state of the art, we have added to classic experiments the DOSPERT Scale and extended it with cultural dimen-sions using Hofstede’s theory; the impact of gender differences was also observed. Altogether seven hypotheses were defined and tested using an online survey in order to compare cultural differences between Vietnamese and Hungarian samples (n=190). We found significant differences between the two samples; we can therefore conclude that the final decision is in many cases associated significantly with participants’ cultural background.

Assessment of aging processes in individual dynamics of health and work capacity indicators

The purpose of the review is to identify the effects of natural aging processes and accompanying age-related diseases on the personal labor potential of a person in modern conditions of socio-economic development. Personal labor potential is subject to the processes of natural biological aging. Improvements in living conditions and advances in health care lead to an increase in the proportion of the elderly in the population structure, but these same processes can reduce the rate of individual aging, the risks of age-related diseases and death. The aging process reduces overall viability, which is accompanied by an increased risk of age-related chronic diseases. For these diseases, personal risk levels should be assessed, and preventive measures should be taken in a timely manner. There are risk markers for various diseases that increase in frequency with age, as well as markers of increased overall mortality. The assessment of individual aging is based on indicators of biological age, which should be considered to assess personal labor potential.

Safety, Efficacy and Cost Effectiveness of Individualised Screening for Diabetic Retinopathy: The ISDR Randomised Controlled Trial

Background: Varying diabetic retinopathy (DR) screening intervals, informed by personal risk-levels, empowers people with diabetes (PWD), and offers reallocation of resources to high risk groups, while addressing the increasing prevalence of diabetes. Safety data on extending intervals is minimal. We evaluated the safety, efficacy and cost effectiveness of individualised risk-based variable-interval population screening compared to usual care, with design input from PWD. Methods: Two-arm, parallel assignment, equivalence randomised controlled trial (minimum 2 year follow-up) in PWD aged ≥12 years registered with one English screening programme. Randomisation was 1:1 to individualised screening (6, 12 or 24 months for high, medium and low risk) determined by a risk calculation engine, using local demographic, screening and clinical data, or to annual screening (control). Primary outcome was attendance (safety). A secondary safety outcome was the development of sight threatening DR (STDR). Cost effectiveness was evaluated within a 2 year time horizon from NHS and societal perspectives. Findings: 4534 participants were randomised, 2265 to the individualised and 2269 to the control arm. Attendance rates at first follow-up were equivalent between individualised (1754/2097, 83·6%) and control (1883/2224, 84·7%) arms (difference -1·0, 95% CI -3·2 to 1·2). STDR detection rates were non-inferior: individualised 1·4%, control 1·7% (- 0·3, -1·1 to 0·5). Sensitivity analyses confirmed findings. Incremental QALYs/person were non-significant: EQ-5D-5L 0·035 (CI -0·04, 0·13), HUI3 0·009 (CI -0·09, 0·10). Incremental cost savings were £21·31 (CI 15·24, 26·79)/person for the NHS and £28·87 (CI 21·08, 35·78) including societal costs. 43·2% fewer screening appointments were required in the individualised arm. Interpretation: Stakeholders involved in diabetes care can be reassured by this largest ophthalmic RCT in DR screening to date that extended and individualised risk-based intervals can be safely and cost effectively introduced in established screening programmes. Trial Registration Number: ISRCTN 87561257. Funding Statement: This study was funded by the UK National Institute for Health Research (NIHR) (Programme Grants for Applied Research, RP-PG-1210-12016). Declaration of Interests: We declare no competing interests. Professor Mark Gabbay is part-funded by the NIHR Collaboration for Leadership in Applied Health Research and Care North West Coast. Ethics Approval Statement: A UK NHS Research Ethics Committee approved the trial (14/NW/0034).

Acceptable Limitations on Paramedic Duty to Treat During Disaster: A Qualitative Exploration.

The authors employed qualitative methods to gather paramedic and community member perspectives in Victoria, Australia. These findings suggested that both paramedic and community member participants agree that acceptable limitations on paramedic duty to treat during disaster are required. These limitations should be based on consideration of the following factors: personal health circumstances (eg, pregnancy for female paramedics); pre-existing mental health conditions (eg, posttraumatic stress disorder/PTSD); competing personal obligations (eg, paramedics who are single parents); and unacceptable levels of personal risk (eg, risk of exposure and infection during a pandemic). It is only with the engagement of a more broadly representative segment of the prehospital profession and greater Australian community that appropriate guidance on limiting standards of care under extreme conditions can be developed and integrated within prehospital care in Australia. SmithE, BurkleFM Jr., GebbieK, FordD, BensimonC. Acceptable limitations on paramedic duty to treat during disaster: a qualitative exploration. Prehosp Disaster Med. 2018;33(5):466-470.

Targeting breast cancer outcomes-what about the primary relatives?

BackgroundUp to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation. This study assessed whether their primary relatives are, in turn, assessed appropriately.MethodsAn ethically approved prospective study involving 274 primary relatives of women diagnosed with breast cancer, between 2009–2012, at a symptomatic breast unit in Ireland. Telephone interview established: demographics, menstrual history, family history verification, breast screening history. Personal risk level was calculated and whether current screening met screening guidelines. Participants were enrolled into appropriate screening programs if currently not in one and results analyzed.ResultsTwo hundred and fifteen of the 280 (76.8%) newly diagnosed patients responded giving details of their 274 primary relatives; this made up the study cohort. Mean age 50 ± 10 (35–75). Thirty two percent were low risk, 64% moderate and 4% high. 190/274 (69%) were being screened appropriately. Seventy five relatives were then assessed with: mammography in 55, Mg and US in 16. Four underwent a biopsy and to date none had cancer. Surveillance was: annual screening in 48%; national screening program and General Practitioner (GP) in 33%; GP only in over 65s in 13%; 6% await further assessment at specialist genetics clinics where their surveillance will be decided.ConclusionsThis study has identified an opportunity to improve the delivery of appropriate screening to higher risk primary relatives of patients with breast cancer. This necessitates an integrated national approach involving providers of primary care, patients and screening breast programs.

Recruitment and Retention of Volunteers in a Citizen Science Network to Detect Invasive Species on Private Lands.

Volunteer citizen monitoring is an increasingly important source of scientific data. We developed a volunteer program for early detection of new invasive species by private landowners on their own land. Early detection of an invasive species, however, subjects the landowner to the potentially costly risk of government intervention to control the invasive species. We hypothesized that an adult experiential learning module could increase recruitment and retention because private landowners could learn more about and understand the social benefits of early detection and more accurately gauge the level of personal risk. The experiential learning module emphasized group discussion and individual reflection of risks and benefits of volunteering and included interactions with experts and regulatory personnel. A population of woodland owners with >2 ha of managed oak woodland in central Minnesota were randomly assigned to recruitment treatments: (a) the experiential learning module or (b) a letter inviting their participation. The recruitment and retention rates and data quality were similar for the two methods. However, volunteers who experienced the learning module were more likely to recruit new volunteers than those who merely received an invitation letter. Thus the module may indirectly affect recruitment of new volunteers. The data collection was complex and required the volunteers to complete timely activities, yet the volunteers provided sufficiently high quality data that was useful to the organizers. Volunteers can collect complex data and are willing to assume personal risk to contribute to early detection of invasive species.

Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone

IntroductionThe mortality and morbidity of Ebola extends far wider than those contracting the disease. Surgical activity in Sierra Leone has been severely disrupted by the epidemic.MethodThis is a retrospective study...

Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia.

IntroductionThe incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group.MethodsA cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population.ResultsOf 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90).ConclusionsThis survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.

Local energy generation projects: assessing equity and risks

Micro- and small-scale low-carbon energy generators embedded within villages, towns and cities can provide a valuable income stream for local communities among other potential benefits. There are a range of social, political, technical and environmental factors that may impact upon the success of a planned energy generation project; however, these factors are rarely considered in unison. The aim of this research is to investigate and understand the concerns relating to equity and distributional justice that impact upon local groups interested in developing energy projects and to determine whether a whole systems approach can be used to draw out perceived issues. This has been achieved by working with two small village groups to test a newly developed energy equity assessment tool. This paper reports research findings from two villages in the UK both planning energy projects that intended to benefit their respective villages and examines perceived issues relating to equity and distributional justice associated with the proposed schemes. The research highlights some challenges facing community groups when planning micro- and small-scale energy projects and demonstrates the commitment, tenacity and high levels of personal risk that these groups have to bear in order to bring their projects to fruition and comments as to the type of actions that may be required to more wholly consider equity issues while developing future energy policy.