Nursing students' experiences of working as healthcare support workers.

BACKGROUND: Preregistration nursing students frequently seek employment as healthcare support workers (HCSWs). However, little is known about their experience of alternating between these two roles. AIM: To explore the experiences of preregistration nursing students working as healthcare support workers. METHOD: Semi-structured interviews were conducted with three preregistration nursing students working part-time as HCSWs in the NHS. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. FINDINGS: Analysis of the interview data produced the overarching theme of 'walking the tightrope'. The overarching theme contained four subthemes: 'preparing to get on the tightrope'; 'balancing on the tightrope'; 'having the stamina to stay on the tightrope'; and 'preparing to get off the tightrope'. CONCLUSION: Nursing students gained experience and confidence while working as HCSWs, but were challenged by the limitations and demands of the role.

Nurse managers' role in older nurses' intention to stay.

PURPOSE: The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses' intentions to stay with their hospitals. DESIGN/METHODOLOGY/APPROACH: Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. FINDINGS: The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. RESEARCH LIMITATIONS/IMPLICATIONS: The cross-sectional research design does not allow determination of causality. PRACTICAL IMPLICATIONS: It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. ORIGINALITY/VALUE: The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

Cynicism in hospital staff nurses: the effect of intention to leave and job change over time.

AIM: To determine whether cynicism changes over time as a function of job change for nurses with high and low intentions to leave. BACKGROUND: Cynicism develops in reaction to organisational events including leaders' actions and can result in costly passive withdrawal behaviours. METHOD: Hospital staff nurses (n = 436) completed a survey assessing their intentions to leave the job and cynicism and then completed follow-up surveys assessing cynicism and job change 1 or 2 years later. Hierarchical linear modelling was used to examine the effect of the interaction between intention to leave, job change and time on cynicism. RESULT: Nurses who left their hospital and nurses with high initial intention to leave who changed jobs within their hospital reported declining levels of cynicism over 2 years. Cynicism increased for nurses with low intention to leave who remained at the same job and for those who experienced an internal job change despite low intention to leave. CONCLUSION: For those who desire it, an internal job change may allow for a recalibration of cynicism and increase employee engagement. IMPLICATIONS FOR NURSING MANAGEMENT: To attenuate cynicism, hospital leaders need to act and communicate with integrity and be cautious not to arbitrarily change the jobs of nurses with low intention to leave.

Male RNs: Work Factors Influencing Job Satisfaction and Intention to Stay in the Profession.

Males represent approximately 6.8% of registered nurses in Canada and consequently constitute an untapped health workforce resource. The authors investigated environmental work factors in the acute-care setting and their influence on male RNs' job satisfaction and intention to stay in the profession. They conducted a cross-sectional study of male RNs employed in acute-care settings in the province of Ontario. Correlations and multiple regression analyses were used to examine career satisfaction and intentions. Nurses who were most satisfied with their career valued extrinsic rewards (pay, vacation, and benefits), control and responsibility, and opportunities for professional development; those who were least satisfied and voiced their intention to leave the profession tended to work part time, experience gender mistreatment, and be dissatisfied with extrinsic awards, scheduling, and organizational support. A unique finding of this study relates to the significant predictive relationship between gender mistreatment and males' intention to leave.

La profession infirmière compte environ 6,8 pour cent d'hommes au Canada, une main-d'œuvre qui constitue une ressource inutilisée dans le domaine de la santé. Les auteurs ont examiné les facteurs environnementaux reliés au travail dans des services de soins actifs et l'influence qu'ils exercent sur le degré de satisfaction professionnelle chez les infirmiers ainsi que leur intention de demeurer dans la profession. Dans le cadre d'une étude de prévalence chez les infirmiers œuvrant dans des services de soins actifs dans la province de l'Ontario, des corrélations ont été établies et des analyses de régressions multiples ont été réalisées. Les infirmiers dont le degré de satisfaction était le plus élevé accordaient une importance aux récompenses extrinsèques (traitements salariaux, vacances, avantages sociaux), au degré de contrôle et de responsabilité et aux possibilités de développement professionnel. Ceux qui étaient les moins satisfaits et qui ont exprimé leur intention de quitter la profession travaillaient surtout à temps partiel, vivaient des mauvais traitements à caractère sexiste et éprouvaient de l'insatisfaction concernant les récompenses extrinsèques, les horaires et le soutien organisationnel. Cette étude a révélé l'existence d'un important lien prédictif entre les mauvais traitements à caractère sexiste et l'intention des infirmiers de quitter la profession.

Exploring the Impact of Prostate Cancer Radiation Treatment on Functions, Bother, and Well-Being.

Though many studies have explored the effects of radiation therapy on urinary, sexual, and bowel function and/or bother, few have focused on symptom experiences from diagnosis through the first year following completion of radiation therapy. The purpose of this study was to compare the effect of 3 types of radiation treatment on functions, bother, and well-being in men with prostate cancer at 1, 6, and 12 months after completion of treatment. A repeated measures survey (N = 73) found that none of the function, bother, emotional, social, or functional well-being scores were significantly different among the 3 groups. However, within-subjects-only repeated measures ANCOVA suggested that emotional well-being and social well-being are different over time. The findings show that clinical treatment of prostate cancer has an impact on functions, bother, and well-being of patients. Thus, it is important that nurses and other healthcare providers listen to what patients are saying before, during, and after treatment.

Bien que de nombreuses études aient examiné les effets de la radiothérapie sur les fonctions ou les gênes urinaires, sexuelles et intestinales, peu ont mis l'accent sur les symptômes ressentis à partir du diagnostic jusqu'à la fin de l'année suivant le traitement. L'objectif de cette étude était de comparer les effets de trois types de radiothérapie sur les fonctions, les gênes et le bien-être d'hommes atteints d'un cancer de la prostate un mois, six mois et douze mois après la fin du traitement. Un sondage intégrant des mesures répétées (N = 73) a permis de constater qu'il n'y avait pas de variation importante entre les trois groupes quant aux mesures touchant les fonctions corporelles, les gênes physiques ou le bien-être social, émotionnel ou fonctionnel. Toutefois, l'analyse de covariance des mesures répétées touchant les sujets uniquement laisse entendre que le bien-être émotionnel et le bien-être social évoluent dans le temps. Les conclusions de l'étude indiquent que le traitement clinique du cancer de la prostate a une incidence sur les fonctions corporelles, les gênes physiques et le bien-être des patients. Il est par conséquent important que le personnel infirmier et les autres professionnels de la santé prennent le temps d'écouter les patients avant, pendant et après leur traitement.

The prevalence of hepatitis C virus among people of South Asian origin in Glasgow - results from a community based survey and laboratory surveillance.

BACKGROUND: South Asians often present late with HCV or HBV related liver disease which could have been avoided with early diagnosis and subsequent treatment; however the prevalence of HCV/HBV among South Asians in Glasgow is not known. Accordingly, to inform the need for case finding among this group we aimed to examine the prevalence of Hepatitis C virus (HCV) among South Asians living in Glasgow. METHODS: A community-based survey recruited individuals at six mosques and four community centres serving the South Asian community during 2009-2010; participants had predominantly never been HCV tested. Laboratory surveillance data involving all individuals tested for HCV during 1993-2009 were examined and South Asians were identified using Nam Pehchan software. RESULTS: In the community-based survey, 2.6% of 1288 participants tested HCV-antibody positive; the prevalence ranged from 0.6% among those born in the UK to 3.1% among those born in Pakistan. The odds of testing HCV-antibody positive were significantly raised among those who had surgery in South Asia (aOR: 5.0, 95% CI: 2.0-12.3) and had either medical/dental treatment or an injection in South Asia (aOR: 2.2, 95% CI: 1.0-5.0). Of 6404 South Asians identified from laboratory surveillance data, 9.3% tested HCV positive. An estimated 38% (330/870) of HCV-infected South Asians living in Glasgow remain undiagnosed. CONCLUSIONS: South Asians living in Glasgow, particularly those born outside the UK are at greater risk of HCV infection than the general population. Efforts to increase awareness and testing in this population are warranted.

A hepatitis C avidity test for determining recent and past infections in both plasma and dried blood spots.

BACKGROUND: DBS testing has been used successfully to detect HCV antibody positive individuals. Determining how long someone has been infected is important for surveillance initiatives. Antibody avidity is a method that can be used to calculate recency of infection. OBJECTIVES: A HCV avidity assay was evaluated for both plasma and DBS. STUDY DESIGN: To measure antibody avidity a commercial HCV ELISA was modified using 7 M urea. The plasma samples were split into: group 1 (recently infected N = 19), group 2 (chronic carrier N = 300) and group 3 (resolved infection N = 82). Mock DBS made from group 1 (N = 12), group 2 (N = 50), group 3 (N = 25) and two seroconverter panels were evaluated. 133 DBS taken from patients known to have a resolved infection or be a chronic carrier were also tested. RESULTS: The avidity assay cut-off was set at AI≤30 for a recent infection. Using sequential samples the assay could detect a recent infection in the first 4-5 months from the point of infection. Most of the false positive results (AI < 30 among cases known not to have had recent infection) were detected among known resolved infections, in both the plasma and DBS; as a result, a testing algorithm has been designed incorporating both PCR and two dilution factors. The sensitivity and specificity of the assay on plasma was 100% and 99.3%, respectively, while DBS had 100% sensitivity and 98.3% specificity. CONCLUSION: The HCV avidity assay can be used to distinguish between chronic and recent infection using either plasma or DBS as the sample type.

If they do call you a nurse, it is always a "male nurse": experiences of men in the nursing profession.

BACKGROUND AND PURPOSE: Men are underrepresented in nursing, accounting for less than 6% of Canadian nurses. This research explores issues surrounding recruitment, retention, and work life satisfaction for men who are nurses working in acute care settings. METHOD AND FINDINGS: Purposive and snowball sampling was used in this descriptive, qualitative study. Sixteen men participated in four focus groups conducted in three communities in southwestern Ontario. The participants revealed that work stress, lack of full-time opportunities, and gender-based stereotypes contributed to job dissatisfaction. Providing care to patients and making a difference were personal rewards that influenced their desire to stay in the profession. To promote nursing as a viable profession, unrestricted by gender, the participants recommended that recruitment strategies begin at an earlier age. DISCUSSION AND CONCLUSION: Findings are discussed in relation to recruitment and retention issues with implications for education, practice, and management.

Low incidence of hepatitis C virus among prisoners in Scotland.

AIMS: To estimate hepatitis C virus (HCV) incidence and HCV risk among Scottish prisoners. DESIGN: National sero-behavioural survey; dried blood spots were collected in order to identify recent HCV infections (i.e. HCV antibody-negative and HCV polymerase chain reaction (PCR)-positive). SETTING: All 14 closed prisons in Scotland. PARTICIPANTS: A total of 5187 prisoners responded to the survey (79% of available prisoners on survey days) comprising 5076 individuals (after removing incomplete returns and participants surveyed in more than one prison); 95% men, 32% (1625) reported an injecting history (PWID) and median sentence of 9.5 months. HCV antibody samples were available for 4904 participants; there was sufficient sera for HCV PCR for 2446 prisoners who had been in prison for at least 75 days. MEASUREMENTS: The estimate of in-prison recent infections is based on prisoners incarcerated for a sufficient period, i.e. at least 75 days, so that recent infections could be attributed to prison. FINDINGS: Overall HCV prevalence was 19%; 53% among people who reported an injecting history and 3% among other prisoners. Three recent infections probably acquired in prison were detected. None of the cases reported injecting during their current sentence or any other potential exposure. Estimated incidence was 0.6-0.9% overall and 3.0-4.3% among PWID (assuming all infections acquired through injecting). Fifty-seven per cent (929) of PWID were receiving opiate substitution treatment (OST) at the time of the survey. Of all prisoners, 2.5% and 8% of PWID reported injecting during their current period of incarceration. CONCLUSION: The low incidence of HCV infections in Scottish prisons is due most probably to the low occurrence of in-prison injecting and high coverage of OST. Low HCV risk can be achieved in prisons without necessarily introducing needle exchange programmes, but close monitoring of risk behaviours is essential. If risk increases, provision of needle exchange should be considered.

Decrease in health-related quality of life associated with awareness of hepatitis C virus infection among people who inject drugs in Scotland.

BACKGROUND & AIMS: Chronic hepatitis C virus (HCV) infection can significantly reduce health-related quality of life (QoL), but it is not clear if reduction is associated with the infection or with being aware of one's infection status. Understanding the impact of a HCV diagnosis on QoL is essential to inform decision-making regarding screening/testing and treatment. METHODS: Using a cross-sectional design, we assessed QoL in 2898 people who inject drugs (PWID), surveyed in Scotland during 2010 using EQ-5D. Multifactorial regression compared self-reported QoL between PWID who were (i) chronically HCV-infected and aware of their infected status, (ii) chronically HCV-infected but unaware, and (iii) not chronically infected. RESULTS: Median time since onset of injecting was 10years; not chronically infected PWID were younger and had shorter injecting careers than chronically infected PWID. Median EQ-5D was highest for the not chronically infected and the chronic/unaware groups (0.73) compared with the chronic/aware group (0.66). After adjustment for demographic and behavioural co-factors, QoL was significantly reduced in chronic/aware compared with chronic/unaware PWID (adjusted B=-0.09, p=0.005); there was no evidence for a difference in QoL between not chronically infected and chronic/unaware PWID (adjusted B=-0.03, p=0.13). CONCLUSIONS: Awareness of one's chronic HCV status was associated with reduced health-related QoL, but there was no evidence for further reduction attributable to chronic infection itself after adjusting for important covariate differences.

Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland.

BACKGROUND: Prevalence of the hepatitis C virus (HCV) among people who inject drugs (PWID) in Scotland is high. The Scottish Government has invested significantly in harm reduction interventions with the goal of reducing HCV transmission among PWID. In evaluating the effectiveness of interventions, estimates of HCV incidence are essential. METHODS: During 2008-2009, PWID were recruited from services providing sterile injecting equipment across mainland Scotland, completed an interviewer-administered questionnaire and provided a dried blood spot for anonymous anti-HCV and HCV-RNA testing. Recent infections were defined as anti-HCV negative and HCV-RNA positive. Logistic regression was undertaken to examine associations between recent HCV infection and self-reported uptake of methadone maintenance therapy (MMT) and injection equipment. RESULTS: Fifty-four percent (1367/2555) of participants were anti-HCV positive. We detected 24 recent HCV infections, yielding incidence rate estimates ranging from 10.8 to 21.9 per 100 person-years. After adjustment for confounders, those with high needle/syringe coverage had reduced odds of recent infection (adjusted odds ratio [AOR] 0.32, 95% CI 0.10-1.00, p=0.050). In the Greater Glasgow & Clyde region only, we observed a reduced odds of recent infection among those currently receiving MMT, relative to those on MMT in the last six months but not currently (AOR 0.04, 95% CI 0.001-1.07, p=0.055). The effect of combined uptake of MMT and high needle/syringe coverage was only significant in unadjusted analyses (OR 0.34, 95% CI 0.12-0.97, p=0.043; AOR 0.48, 95% CI 0.16-1.48, p=0.203). CONCLUSION: We report the first large-scale, national application of a novel method designed to determine incidence of HCV among PWID using a cross-sectional design. Subsequent sweeps of this survey will increase statistical power and allow us to gauge the impact of preventive interventions.

Examination of the risk of reinfection with hepatitis C among injecting drug users who have been tested in Glasgow.

BACKGROUND: Unsafe injecting practices put injecting drug users (IDUs) at repeat exposure to infection with the hepatitis C virus (HCV). It has not yet been determined if spontaneously clearing one's primary infection influences the risk of reinfection; our aim was to estimate the relative risk of reinfection in IDUs who have cleared the virus. METHODS: We conducted a retrospective study using a large database of HCV test results covering Greater Glasgow Health Board during 1993-2007 to calculate rates of infection and reinfection in current/former IDUs. The relative risk of (re)infection in previously infected compared with never-infected IDUs was estimated using Poisson regression, adjusting for age at study entry, sex, and calendar period of test. RESULTS: Although the rate of reinfection in IDUs who were HCV antibody-positive, RNA-negative at baseline was lower (7/100 person-years, 95% CI: 5-9) than the rate of acute infection in IDUs who were HCV antibody-negative at baseline (10/100 person-years, 95% CI: 9-12), the risk of reinfection was not significantly different than the risk of initial infection (adjusted rate ratio=0.78, 95% CI: 0.57-1.08). CONCLUSION: We found only weak evidence for a reduced risk of HCV reinfection in IDUs who had cleared their previous infection. Further research among those who have cleared infection through antiviral therapy is needed to help inform decisions regarding treatment of IDUs.

Detection of hepatitis C virus RNA in dried blood spots.

BACKGROUND: An estimated 130-170 million people worldwide are chronically infected with HCV.(1) In Europe the highest prevalence of HCV infections is in the IDU population.(2) As traditional HCV screening relies on the detection of HCV antibody or HCV RNA in blood, screening in high-risk groups such as IDU is difficult due to poor venous access caused by damaged veins. OBJECTIVES: In this study DBS was evaluated as an alternative sample type to blood for the detection of HCV RNA. STUDY DESIGN: The endpoint detection limit, inter-assay and intra-assay variability of the method were determined. The DBS method was compared to our routine frontline assay using a panel of paired DBS and blood samples. The effect of different storage temperatures and length of storage time on the stability of HCV RNA in DBS was also assessed. RESULTS: The endpoint detection limit of the method based on results from mock DBS was 250 IU/ml. The method was shown to be precise and robust. The sensitivity and specificity of the method was found to be 100% and 95.8%, respectively. No significant variation in the stability of HCV RNA in DBS over a 1 year period at a range of different temperatures was observed. CONCLUSIONS: A sensitive and stable method was developed for the detection of HCV RNA in DBS. Screening high-risk populations using DBS as a sample type may improve uptake of HCV testing by increasing opportunity for patients to be tested and consequently increasing access to treatment.

A descriptive study of functions, symptoms, and perceived health state after radiotherapy for prostate cancer.

PURPOSE: To explore the impact of prostate cancer treatment on: (a) the experience of symptoms (i.e. sexual, urinary, and bowel), and (b) perceived health state of men with prostate cancer one month following their radiation treatment. METHODS: A prospective pre-test-post-test descriptive survey was conducted on a convenience sample of 73 men with prostate cancer who were recruited from a Regional Cancer Centre in Southwestern Ontario, Canada. Participants receiving radiation treatment (brachy therapy, high dose radiation [HDR] and external beam radiation [EBR], or EBR alone) completed a questionnaire that elicited information pertaining to quality of life (QOL), symptom experiences, and perceived health state prior to, and one month after completion of their radiation treatment. RESULTS: Post-treatment scores showed increased problems with urinary bother (p<0.001) and function (p<0.001), bowel bother (p=0.002) and function (p=0.001), and sexual function (p<0.001). The results also suggested that urinary bother, sexual bother, and pain were independent predictors of the perceived health state of participants after radiation treatment. DISCUSSION: Our findings suggest that prostate cancer treatment presents a challenge with regard to symptom experiences and perceived health state in men with prostate cancer. Therefore, strategies for patient education to assist men to cope with their symptoms and to provide them with support in the initial weeks following treatment are discussed.

Trends in the incidence of HIV in Scotland, 1988-2009.

OBJECTIVES: To estimate temporal trends in HIV incidence and prevalence in Scotland, according to three main risk groups for infection: men who have sex with men (MSM), injecting drug users (IDUs) and heterosexuals. METHODS: The authors extracted data for all single- and multiple-tested individuals from the national HIV test database covering the period 1980-2009 and calculated the incidence of HIV infection in each risk group and estimated RRs by fitting Poisson regression models. RESULTS: 620 of 59,807 individuals tested positive following an initial negative HIV test, generating an overall incidence rate of 3.7/1000 person-years (95% CI 3.4 to 4.0); 60%, 20% and 37% of the 620 were associated with the risk behaviour categories MSM, IDU and heterosexual, respectively. The incidence rate among MSM in Scotland remained relatively stable between the periods <1995 and 2005-2009 (overall: 15.3/1000 person-years, 95% CI 13.8 to 17.0), whereas the incidence among IDUs decreased between the periods <1995 and 2005-2009, from 5.1/1000 to 1.7/1000 person-years, and also decreased among heterosexuals, from 2.9/1000 to 1.4/1000 person-years. CONCLUSIONS: The reduction in the incidence rate among IDUs suggests that harm reduction measures initiated from the late 1980s were effective in reducing HIV transmission in this risk group; however, the absence of a reduction in HIV incidence rates among MSM is disappointing and highlights the need for renewed efforts in the prevention of HIV in this major risk group.

The association between alcohol use and hepatitis C status among injecting drug users in Glasgow.

BACKGROUND: We investigated the association between actual and self-reported hepatitis C virus (HCV) status and alcohol consumption among injecting drug users (IDUs) to determine whether IDUs who self-report as HCV infected comply with UK guidelines on safe drinking and to determine risk factors for drinking. METHODS: We conducted a repeat cross-sectional survey of IDUs accessing harm reduction services in Glasgow in 2005 and 2007. We measured self-reported weekly alcohol consumption, excess drinking (defined as exceeding the UK Royal College of Physician's guidelines for safe drinking of 14 units/week for women and 21 units/week for men) and HCV antibodies (anonymously in oral fluid). RESULTS: Among IDUs who tested HCV antibody positive, 65% drank alcohol and 29% drank to excess, compared to 61% (p=0.3) and 18% (p<0.001) of those who tested negative, respectively. IDUs who self-reported as HCV positive were less likely to drink but as likely to drink to excess as self-reported negatives or those with HCV status unknown, both among all IDUs and those who tested HCV antibody positive. Among the antibody positives, excess drinking was associated with incarceration (aOR=2.56; 95% CI: 1.28-5.12), homelessness within six months of interview (aOR=3.60; 95% CI: 2.00-6.48) and homelessness more than six months before interview (aOR=1.93; 95% CI: 1.06-3.53). CONCLUSIONS: IDUs who believe they are HCV infected are more likely to abstain from alcohol, but those who drink continue to do so to excess. IDUs diagnosed with HCV need greater support to reduce their alcohol consumption.

The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence.

AIMS: To investigate whether opiate substitution therapy (OST) and needle and syringe programmes (NSP) can reduce hepatitis C virus (HCV) transmission among injecting drug users (IDUs). DESIGN: Meta-analysis and pooled analysis, with logistic regression allowing adjustment for gender, injecting duration, crack injecting and homelessness. SETTING: Six UK sites (Birmingham, Bristol, Glasgow, Leeds, London and Wales), community recruitment. PARTICIPANTS: A total of 2986 IDUs surveyed during 2001-09. MEASUREMENT: Questionnaire responses were used to define intervention categories for OST (on OST or not) and high NSP coverage (≥100% versus <100% needles per injection). The primary outcome was new HCV infection, measured as antibody seroconversion at follow-up or HCV antibody-negative/RNA-positive result in cross-sectional surveys. FINDINGS: Preliminary meta-analysis showed little evidence of heterogeneity between the studies on the effects of OST (I2=48%, P=0.09) and NSP (I2=0%, P=0.75), allowing data pooling. The analysis of both interventions included 919 subjects with 40 new HCV infections. Both receiving OST and high NSP coverage were associated with a reduction in new HCV infection [adjusted odds ratios (AORs)=0.41, 95% confidence interval (CI): 0.21-0.82 and 0.48, 95% CI: 0.25-0.93, respectively]. Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR=0.21, 95% CI: 0.08-0.52). Full harm reduction was associated with a reduction in self-reported needle sharing by 48% (AOR 0.52, 95% CI: 0.32-0.83) and mean injecting frequency by 20.8 injections per month (95% CI: -27.3 to -14.4). CONCLUSIONS: There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling-up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population.

Working in Canada or the United States: perceptions of canadian nurses living in a border community.

Recruitment and retention of registered nurses is a critical issue facing nursing leaders. Global shortages of nurses have been projected over the next decade. This study used the theoretical framework of push and pull factors to identify influences on nurses' decision to select work in either their home community or a cross-border community, when that opportunity was available to them. Registered nurses living along the southwest border of Ontario were identified with the assistance of the College of Nurses of Ontario (CNO) and surveyed to determine the factors that influenced their decision to work in Canada or the United States, as well as their intent to remain in their current workplace. Measures included demographic information, reasons for selection of employment, and work environment factors relating to nurses' jobs, work relationships, scheduling/staffing, workload and attachment to their current place of employment. MANCOVA was used to examine differences between the two groups controlling for age, organizational tenure and employment status. Full-time employment was the greatest push factor identified by RNs, and nurses working in the United States were also more satisfied with the pull factors of development opportunities, relationships with physicians and supervisors, and scheduling congruence. Recommendations for recruitment and retention are discussed.

Erratum to 'The management of chronic hepatitis B in the immunocompromised patient: recommendations from a single topic meeting' [J. Clin. Virol. 41 (4) 2008 243-254].

Patients with chronic hepatitis B virus (HBV) infection have a substantial risk of reactivation and jaundice following the use of immunosuppressant therapy. A single topic conference was convened to discuss the management of HBV patients undergoing chemotherapy for haematological malignancy, liver and renal transplantation and with HIV co-infection. In advance of the meeting a draft guideline was prepared and circulated to a participating expert panel. Presentations and consensus views were obtained on the day of conference to allow pragmatic algorithms to be established on each of these topics. Use of lamivudine prophylaxis for HBV patients undergoing chemotherapy and renal transplantation is strongly supported with good evidence. Patients with HBV cirrhosis who are candidates for transplantation should be started on nucleos(t)ide therapy prior to surgery and, in addition, hepatitis B immune globulin given from the time of transplantation onward. Co-infection with HBV and HIV offers unique challenges. If the patient is a candidate for highly active retroviral therapy then dual nucleos(t)ide analogues which are also active against HBV must be used to prevent immune reconstitution hepatitis. In all these conditions, awareness of possible HBV resistance to therapy must be kept in mind and HBV DNA levels monitored.

Musculoskeletal problems experienced by older nurses in hospital settings.

The effects of musculoskeletal problems on older nurses working in hospital settings was examined, including what contributed to the problems, and preferred treatments selected. Inadequate sleep was significantly related to musculoskeletal symptoms in all regions of the body. Most frequent problems were in lower and upper back, neck, and shoulder areas. Rotating and/or 12-hr shifts, inadequate sleep, frequent patient handling, and nurses who felt little control over their work reported more lower back symptoms. Surprisingly, nurses relied on over-the-counter medications to treat their problems. Implications for supporting the nursing workforce and minimizing musculoskeletal problems are discussed.