Molecular typing of enteroviruses: comparing 5'UTR, VP1 and whole genome sequencing methods

Enteroviruses (EV) commonly cause hand, foot and mouth disease (HFMD), and can also cause potentially fatal neurological and systemic complications. In our laboratory, sequencing 5' untranslated region (UTR) of the viral genome has been the routine method of genotyping EVs. During a recent localised outbreak of aseptic meningitis, sequencing the 5'UTR identified the causative virus as EV-A71, which did not fit with the clinical syndrome or illness severity. When genotyped using a different target gene, VP1, the result was different. This led us to evaluate the accuracy of the two different target genome regions and compare them against whole genome sequencing (WGS). We aimed to optimise the algorithm for detection and characterisation of EVs in the diagnostic laboratory. We hypothesised that VP1 and WGS genotyping would provide different results than 5'UTR in a subset of samples. Clinical samples from around New South Wales which were positive for EV by commercial polymerase chain reaction (PCR) assays were genotyped by targeting three different viral genome regions: the 5'UTR, VP1 and WGS. Sequencing was performed by Sanger and next generation sequencing. The subtyping results were compared. Of the 74/118 (63%) samples that were successfully typed using both the 5'UTR and the VP1 method, the EV typing result was identical for 46/74 (62%) samples compared to WGS as the gold standard. The same EV group but different EV types were found in 22/74 (30%) samples, and 6/74 (8%) samples belonged to different EV groups depending on typing method used. Genotyping with WGS and VP1 is more accurate than 5'UTR. Genotyping by the 5'UTR method is very sensitive, but less specific.

Factors influencing uptake of measles, mumps and rubella (MMR) immunization in site-dwelling Gypsy, Roma and Traveller (G&T) communities: a qualitative study of G&T parents' beliefs and experiences

BACKGROUND

Increasing immunization in the Gypsy, Roma and Traveller (G&T) community is a key priority for improving health outcomes in this community. This study aimed to explore G&T parents: (1) beliefs about childhood immunization; (2) beliefs about the risks of immunization and non-immunization; (3) perceived obstacles to, and facilitators of, immunization and (4) views on increasing immunization levels.

METHOD

A cross-sectional, qualitative study was conducted comprising of five focus groups with 16 site-dwelling G&T women with pre-school aged children. Data were transcribed verbatim and analysed thematically.

RESULTS

Five main themes were identified: Lay understandings of causation and risk; Timing of immunization; Children being perceived as vulnerable; The fit between lifestyle and healthcare provision; The impact of living with a high burden of disease.

CONCLUSION

Understanding of the risks and benefits of measles, mumps and rubella immunization did not differ significantly from the wider population or those promoted by the health service. The majority of barriers stemmed from living with the effects of long-standing health inequalities, which posed further barriers to accessing immunization, and shaped beliefs about immunization. Factors facilitating uptake occurred where access to immunization services was made flexible, e.g. immunization on traveller sites.

Testing headings for communicating the personal health record: comparison from the recipients’ perspective

In the spring of 1998, 16 general practitioners and 16 community psychiatric nurses participated in a study to test a draft set of headings for communicating clinical summaries. Eight anonymized psychiatric discharge summaries were used to assess the impact of the presentational format on the time taken by professionals to read the summaries and to answer a series of standard questions about each of them. Respondents also completed a questionnaire on their opinions of the headings. There was considerable variation between individuals in the times taken to read the summaries and answer the questions, but no evidence that any of the formats was associated with decreased reading time or with improvement in retrieving information. Most respondents preferred information structured using the headings rather than the original semi-structured discharge summaries, and information on paper rather than on computer screen.

Respondents were guardedly supportive of the particular draft headings presented. A weak preference was expressed for locally defined headings, with some recognition of advantages in widely agreed headings. There was a view that there were too many headings, and there was overlap between specific heading pairs (for example, ‘aim’ and ‘goal’). Concerns were expressed about specific headings, particularly the ‘softer’ headings, such as ‘informing’ and ‘communicating’.

Barriers and opportunities of empowerment as applied in diabetes settings: a focus on health care professionals' experiences

This exploratory study examines the opportunities and barriers health care professionals (HCPs) working with diabetes patients face when they try to implement the rhetoric of patient empowerment in practice. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and general practitioner (GP) clinics in South-East England, was interviewed through in-depth semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. The analysis showed that empowerment was seen as beneficial for patients and HCPs. Time and resources could be moved from successfully empowered patients and focussed on more complex patients, this was termed 'selective empowerment'. The main barriers to empowerment were identified as a lack of resources, time and HCPs trained in empowerment techniques. Empowerment is a popular concept in theory, and presents HCPs with several opportunities but also important barriers in its practical, clinical implementation day-to-day.

Health care professionals' understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term 'empowerment', their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices - from leading them to the 'right' choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.