"I can't be dealing with this brain fog": A workplace focus group study investigating factors underpinning the menopausal experience for NHS staff.

OBJECTIVES: Multiple studies highlight that individuals undergoing menopause are not receiving sufficient support at work. An improved menopausal experience in the workplace has been found to be associated with increased job satisfaction, increased economic participation and reduced absenteeism. This work was undertaken to explore the impact of menopause on the working lives of NHS staff working in Wales, with specific emphasis on their experience of menopausal symptoms and management strategies in the workplace. STUDY DESIGN: This was a qualitative study using semi-structured focus groups and thematic analysis. 14 women working in the NHS in Wales attended four focus groups, lasting up to 1.5 h. Stem questions focused on participants' positive and negative experiences in the workplace, and their receipt of support. Transcripts were analysed using the framework approach. RESULTS: Three major themes were identified: experiences of menopausal symptoms and symptom management, the impact of menopause on work and the impact of work on the menopause. Menopause symptom experience in the workplace was multifaceted and varied, depending on factors such as ongoing or past symptom experience, expectations, social support and effectiveness of management strategies. Inconsistent information was highlighted as a reason why some participants felt confused both about the symptoms that they could attribute to the menopause and the management strategies available to them. A variety of symptom management strategies had been used by participants, including hormone replacement therapy, flexible working hours, working from home, changes to uniform, peer support and lifestyle changes, with varying levels of success. Some women were reticent to ask for support at work even though they felt the workplace response was likely to be supportive. Almost all the women felt that they had to persuade their GP to prescribe HRT and felt that their doctors were too reticent in prescribing this treatment. CONCLUSIONS: Employers have a key role in supporting their staff experiencing menopausal symptoms, and such support has the potential to reduce sickness absence and boost retention. Based on the findings we recommend creating an open culture to break down taboos; protected time for peer support around shared experiences and effective symptom management techniques; and maximising the impact of non-menopause-specific policies such as flexible working to help all staff manage fatigue and become more productive in their roles.

Experiences of menopause in the Welsh NHS workplace: a focus group study.

BACKGROUND: Despite an increased desire to improve women's experiences, the evidence base around how best to support female employees experiencing the menopause is currently lacking. NHS Wales has a workforce with a significant proportion of older female workers, many of whom will experience menopause symptoms. This work aims to explore the impact of menopause symptoms on the working lives of NHS staff in Wales. METHODS: For this service improvement study, four focus groups were held between Jan 12, and March 10, 2023. Women who experienced symptoms related to menopause were invited to participate via a local women's network. 14 women with lived experience of menopause took part, with an average of three women per group. Informed consent was given by participants for this service improvement exercise. Participants worked in both clinical and non-clinical roles in the NHS in Wales. Participants were aged between 34 and 59 years. A semi-structured facilitation approach was used, with women asked to describe their menopause experience and their role in the organisation. Transcripts were analysed using the framework approach and reported using the COREQ reporting checklist. FINDINGS: Menopause symptom experience was multifaceted and varied and dependent on factors such as medical history, social support, and personal management strategies. All women involved in the focus groups felt that their symptoms had negatively impacted their experience. Various symptom management strategies had been used with varying levels of success. Some women were reticent to ask for support at work, despite believing the workplace response would be positive. INTERPRETATION: Peer support is well received by women in the workplace, but it is crucial that opportunities for peer support in the workplace are delivered in a culture where women feel they are able to step away from their core duties to attend and engage with opportunities such as Menopause Café's and lunchtime learning sessions. Further work is needed as participants in these focus groups might not be representative of the full NHS and broader workforce. Conducting focus groups entirely online might also have influenced the group dynamics. FUNDING: None.

An outbreak of Salmonella Typhimurium associated with the consumption of raw liver at an Eid al-Adha celebration in Wales (UK), July 2021.

In July 2021, Public Health Wales received two notifications of salmonella gastroenteritis. Both cases has attended the same barbecue to celebrate Eid al-Adha, two days earlier. Additional cases attending the same barbecue were found and an outbreak investigation was initiated. The barbecue was attended by a North African community's social network. On same day, smaller lunches were held in three homes in the social network. Many people attended both a lunch and the barbecue. Cases were defined as someone with an epidemiological link to the barbecue and/or lunches with diarrhoea and/or vomiting with date of onset following these events. We undertook a cohort study of 36 people attending the barbecue and/or lunch, and a nested case-control study using Firth logistic regression. A communication campaign, sensitive towards different cultural practices, was developed in collaboration with the affected community. Consumption of a traditional raw liver dish, 'marrara', at the barbecue was the likely vehicle for infection (Firth logistic regression, aOR: 49.99, 95%CI 1.71-1461.54, p = 0.02). Meat and offal came from two local butchers (same supplier) and samples yielded identical whole genome sequences as cases. Future outbreak investigations should be relevant to the community affected by considering dishes beyond those found in routine questionnaires.

Working well: Mitigating the impact of menopause in the workplace - A narrative evidence review.

INTRODUCTION: In recent years there has been a much greater recognition by some employers of the need to support female employees experiencing the menopause. However, despite an increased awareness of the need to reduce the impact of menopause on the workforce, employers rarely have the opportunity to implement evidence-based interventions. OBJECTIVES: This evidence review aims to provide an insight into the effectiveness of workplace programmes supporting women experiencing menopause symptoms, and to identify knowledge gaps as drivers for future research. METHODS: A search for papers published in English between 2012 and 2023 was carried out on the PsycINFO, Medline, and Embase databases. Abstract review was used to screen initial returns before a subsequent full-text review determined the final studies included. RESULTS: Twelve studies were selected for in-depth review: four conducted in the UK, seven in continental Europe and one in South America. The findings of the papers fell into five categories: work ability, improved symptom management, mental wellbeing and empowerment, increased openness about menopause in the workplace, and the impact of management/leadership. None of the included interventions were reported to give a significant improvement in measures of work ability. However, there were improvements in women's wellbeing, and their ability to manage symptoms. Interventions to improve workplace openness and managers' skills were well received by participants. CONCLUSIONS: The evidence for effective workplace interventions for women experiencing menopause symptoms is currently lacking. There is considerable need for further high-quality evaluations of interventions designed to support women in the workplace.

Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021.

Most reported cases of human monkeypox occur in Central and West Africa, where the causing virus is endemic. We describe the identification and public health response to an imported case of West African monkeypox from Nigeria to the United Kingdom (UK) in May 2021. Secondary transmission from the index case occurred within the family to another adult and a toddler. Concurrent COVID-19-related control measures upon arrival and at the hospital, facilitated detection and limited the number of potential contacts.

Developing a population data science approach to assess increased risk of COVID-19 associated with attending large events.

Introduction: In summer 2021, as rates of COVID-19 decreased and social restrictions were relaxed, live entertainment and sporting events were resumed. In order to inform policy on the safe re-introduction of spectator events, a number of test events were organised in Wales, ranging in setting, size and audience. Objectives: To design and test a method to assess whether test events were associated with an increase in risk of confirmed COVID-19, in order to inform policy. Methods: We designed a cohort study with fixed follow-up time and measured relative risk of confirmed COVID-19 in those attending two large sporting events. First, we linked ticketing information to individual records on the Welsh Demographic Service (WDS), a register of all people living in Wales and registered with a GP, and identified NHS numbers for attendees. Where NHS numbers were not found we used combinations of other identifiers such as email, name, postcode and/or mobile number. We then linked attendees to routine SARS-CoV-2 test data to calculate positivity rates in people attending each event for the period one to fourteen days following the event. We selected a comparison cohort from WDS for each event, individually matched by age band, gender and locality of residence. As many people attended events in family groups we explored the possibility of also matching on household clusters within the comparison group. Risk ratios were then computed for the two events. Results: We successfully assigned NHS numbers to 91% and 84% of people attending the two events respectively. Other identifiers were available for the remainder. Only a small number of attendees (<10) had a record of confirmed COVID-19 following attendance at each event (14 day cumulative incidence: 36 and 26 per 100,000, respectively). There was no evidence of significantly increased risk of COVID-19 at either event. However, the event that didn't include pre-event testing in their mitigations, had a higher risk ratio (3.0 compared to 0.3). Conclusions: We demonstrate the potential for using population data science methods to inform policy. We conclude that, at that point in the epidemic, and with the mitigations that were in place, attending large outdoor sporting events did not significantly increase risk of COVID-19. However, these analyses were carried out between epidemic waves when background incidence and testing rate was low, and need to be repeated during periods of greater transmission. Having a mechanism to identify attendees at events is necessary to calculate risk and feasibility and acceptability of data sharing should be considered.