June 2017
August 2017
Welcome to the ebulletin Welcome to the August issue of the e-bulletin which this month focuses on Sexual Health. Sexual Health Week 2017 runs from 11 – 17 September. This year’s theme is talking about pornography. Family Planning Association (FPA) are highlighting how professionals can promote Sexual Health Week. For sexual health professionals, this might be spreading the word about how the sex in most pornography doesn’t show how to protect yourself from sexually transmitted infections (STIs) or unwanted pregnancy. For parents and teachers, you might want to talk to young people about a whole range of issues connected to pornography, such as: • separating fantasy from reality • self-esteem and body image • importance of consent and communication • keeping safe, and the law. FPA have plenty of resources, materials and advice that they can provide during Sexual Health Week. http://www.fpa.org.uk/campaigns/sexual-health-week We are in the process of evaluating the Network to ensure we continually improve the website and e-bulletins and provide events that members find most useful. We have asked all members to complete a short survey which can be accessed here. Don’t forget, you can be in with the chance of winning £25 in Amazon vouchers! We do have a number of events in the planning stage and as soon as we have confirmed the details we will send out emails with further information. Please get in touch with any information you would like to include on the website or e-bulletin by contacting us at publichealth.network@wales.nhs.uk
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Sexual Health - A T
Touchy Subject? Spotlight on Sexual Health The Sexual Health Week campaign which is run by Family Planning Association (FPA) informs the public, influences service providers and supports health professionals. FPA will provide resources for the week that will help you talk about sex. For example, most pornography doesn’t show people using condoms or dams – which can contribute to a false impression that they aren’t needed, or will hinder sexual pleasure. In the study we carried out for Sexual Health Week last year, more than half of people didn’t think it was true that you can get an STI from oral sex. FPA are providing FREE resource packs for Sexual Health Week 2017 to Secondary School Workers in the UK. For more information click here http://www.fpa.org. uk/campaigns/sexual-health-week
Sexual Health and Sexual Activity in Later Life
Dr Paul Nash- Director for Gerontology & Ageing Studies, Swansea University The population is ageing and the rights, welfare and wellbeing of this age cohort are becoming more globally prominent and the focus of much policy development. Whilst research is leading the way and informing this in many spheres of an older person’s life, this is not the case for sexual health. Campaigns of sexual health literacy and intervention are targeted at ‘at-risk’ cohorts, largely ignoring those over 60 years of age. With increases in sexually transmitted infections (STIs) in this age group and the potentially serious nature of untreated conditions, this review highlights the need for increased research, health literacy and targeted interventions. Social, societal and physical barriers preventing older adults engaging with safer sex have been identified, highlighting the extent of the attitudinal and policy shifts required to provide age parity. Introduction The transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) remains a global issue of ‘epidemic’ proportions. According to the World Health Organisation, 35 million people are estimated to be currently living with HIV and more than 1 million people acquire STIs every day around the world.1,2 Some infections are curable, such as syphilis, gonorrhoea, chlamydia and trichomoniasis, while others require life-long management and treatment, including HIV and herpes. Within Europe there has been a reported 80% increase in HIV diagnosis since 2004, despite expanding access to screening and treatments.3 The HIV epidemic has been described as ‘ageing’ in parallel with an ageing population globally and improved rates of longevity in economically advantaged nations.4 However, the health needs of older adults living with HIV and other STIs and the diagnosis of STIs in later life are still neglected areas of research and policy. In this review we explore issues relating to sexual health in older adults by drawing on international research literature. Before turning to the needs of older adults, we first discuss the social context informing sexual health priorities and campaigns in contemporary Britain. The sexual landscape in the UK is changing, or at least the perception of its consumption. Safe sex campaigns of the 1980s (Tombstone/AIDs) have long since left the public psyche and the younger generations now embarking on an active sex life have never encountered them. Whilst it is clear that safe sex campaigns (for example, ‘Condom, No condom’, 2012) do exist, they are not at the same profile. In 2013, there were 446,253 new STI diagnoses,1 more than doubling those reported just over a decade earlier, in 2003. This is not the whole picture, however, as there are certain diseases and demographic groupings that have shown increases that are particularly marked. Between 2012 and 2013 there was a 15% increase in new cases of gonorrhoea and, in the same time period, a 9% increase in syphilis.1 Set against the social backdrop of increased legal equality in terms of gender and sexuality, ease of access to sexual health information and increased protection from STI transmission, it can be expected that greater numbers of the adult population will feel more informed of their sexual health status and more willing to access sexual health services. This may initially lead to further increases in numbers of diagnoses. While STI transmission is not specific to sexual identity or orientation,5 there are cohorts targeted by public health agencies that are at higher risk of STI transmission. Men who have sex with men (MSM) are identified as a ‘high risk’ population and accounted for 74% of new syphilis diagnoses in 2014,5 an alarming increase when considering the potential health complications if left untreated. Though health promotion campaigns are often targeted at this group, there are clear shortcomings in getting the message across, primarily around population engagement and illustrated by increasing incidence rates. Much like other social groups, MSM are not a homogeneous group and public health agencies need to take into account intersecting differences in ethnicity, culture, faith, ability and of course age that influence men’s engagement with health campaigns. Syphilis has a well-documented disease progression which details not only the phases, but also the symptoms and potential end-stage complications. With the advent of penicillin, syphilis was almost eradicated and as such has become an almost forgotten STI, yet one that is now experiencing a resurgence. In 2008 there were 11 times the number of primary and secondary diagnoses in GUM (genitourinary
medicine) clinics than in 1999, with MSM experiencing the largest increase and heterosexual men following not too far behind6.. Considering the potential serious effects, particularly of neuro-syphilis, if left untreated and the long symptom-free latent phase, increased screening and public awareness appears to be the best recourse to tackle this resurgence. Similar increases have been seen in HIV diagnoses. When mapping the incidence of HIV diagnosis from the early 1980s, there was a relatively continuous rise until 2000 when the trajectory took a steep incline and infection diagnosis rates increased.7 Despite the very prominent health campaign in the 1980s, the incidence of HIV transmission continues to increase.8 It can be argued that the development of combination anti-retroviral treatments to manage the condition, changing it from a life-limiting infection to that of a chronic condition, has lessened the impact of safe sex campaigns.9,10 This discovery also coincides with the marked increase in diagnosis rates and the decrease in both number of AIDS diagnoses and deaths.3 What is not evident from the above information is that the available research pertains largely to younger adults. Adults over 50 years of age have previously represented a hidden population in relation to STI and HIV diagnosis, and ageing is yet to be fully recognized within sexual health strategies and planning as a significant social factor shaping transmission, diagnosis and treatment. New diagnoses of HIV among adults over 50 more than doubled between 2002 and 2011, rising from 442 in 2002, to 990 in 2012.11 Not only is this one of the fastest growing age groups to be given a HIV-positive diagnosis, but it is also one of the fastest growing cohorts living with the condition. In 2012, one in four adults living with diagnosed HIV were aged 50 years and over compared with only one in eight in 2003.11 This means that this age group is not only living with HIV, but also age-related decline in physical and mental health and other health co-morbidities, some of which like reactive arthritis can be exacerbated by the condition.12 A common misconception about older adults is that they do not engage in sexual intercourse or sexual behaviour. Indeed they are often viewed as asexual13 or, if they are viewed as engaging in sex, then they are assumed to be heterosexual.14 Despite this pervasive myth,15 the above statistics on STI transmission indicate this is clearly not the case. Older adults over 60 years of age report being sexually active in spite of identified declines in sexual functioning and arousal.16,17 More recently, the National Survey of Sexual Attitudes and Lifestyles 3 in Britain included respondents up to 74 years of age to capture the sexual attitudes and activities of older British adults. This was the first time the survey has included adults over 59 years of age. The survey findings show that older adults continue to engage in sexual activity in later life, albeit with less frequency than younger age cohorts.18 The findings also indicate increases in the number of adults of all ages reporting sexual activity with a same-sex partner, with 11.5% of women and 8.0% of men reporting same-sex experiences. While it is extremely difficult to make population estimates on the basis of sexual identity, crude estimates suggest that there are 1.2 million older people identifying as lesbian, gay and bisexual (LGB) in the UK.19 Sexual activity is an important facet in older adults’ wellbeing. Gott and Hinchliff15 indicated that of those older adults in their sample who were engaging in sexual activity, all rated it as either ‘important’ or ‘very important’. Furthermore, respondents indicated a wide range of sexual relationships experienced including new, multiple and ‘casual’ relationships.15 However, whilst research clearly indicates that older adults are indeed sexually active, it is not examining their health literacy or their behaviour. Likewise, sexual health strategies and policies are not immune from ageist beliefs that remain prevalent in academic and scientific communities. This evident gap in health and social research raises some pertinent questions. How are the sexual lives of older adults discussed in contemporary research literature? How are the health and wellbeing needs of this cohort being addressed within existing frameworks? What are the unique issues facing these cohorts that are not currently being addressed? This systematic review of international literature seeks to address these questions. Continue reading here: https://www.cambridge.org/core/journals/reviews-in-clinical-gerontology/article/sexual-health-and-sexualactivity-in-later-life/747AE870467ACEA1BFFB96FCFBDE8670
PrEPARED for PrEP - Pre-Exposure Prophylaxis study launched in Wales Adam Jones – Public Health Practitioner, Public Health Wales A study into the uptake and adherence related to a new method of preventing HIV infection was launched via NHS Wales Integrated Sexual Health Clinics in July 2017. Pre-Exposure Prophylaxis (PrEP) is the use of an antiretroviral medication by people who are uninfected to prevent the acquisition of HIV infection. PrEP presents an additional option for the prevention of new HIV infections in Wales. There has been a steady increase in the number of people living with HIV in Wales, reflecting both an increase in survival and new diagnoses - on average, over the last six reporting years (2010-2015), there have been 153 new cases diagnosed annually. In light of an increasing awareness of, and demand for, PrEP, Public Health Wales was asked by Welsh Government to convene an independent HIV Expert Group (HIVEG). The HIVEG is comprised of practitioners representing public health protection, public health promotion, public health policy, epidemiology, pharmacy, sexual health and HIV clinical services and academia. The HIVEG was tasked with reviewing the available evidence related to PrEP, and this review - Preparing for PrEP?’ - was submitted to Welsh Government in November 2016. At the same time, a submission by the pharmaceutical company Gilead Sciences Inc. for their drug Truvada® to be licensed for use as PrEP was sent to the All Wales Medicines Strategy Group (AWMSG). Welsh Government considered the ‘Preparing for PrEP?’ paper and the findings of the AWMSG in April 2017 before announcing, through a Written Statement from the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething AM, that an all-Wales study was to be undertaken, providing Truvada® as Pre-Exposure Prophylaxis (PrEP) to all those who would benefit from the preventative treatment. Public Health Wales was asked to devise the study protocol and help arrange the implementation of the service into NHS Wales Integrated Sexual Health Clinics. The study – PrEPARED - will see potential recipients of PrEP - as defined in the eligibility criteria outlined by the Independent HIV Expert Group - offered PrEP within Integrated Sexual Health Clinics or HIV Treatment Clinics within Wales. Patients taking up the offer of PrEP will be closely monitored as per the PrEP Management Guidelines, with data collated and analysed by Public Health Wales on a quarterly basis. Reasons for those declining the offer of PrEP will also be collected and analysed to understand these decisions. It is neither a clinical trial nor a feasibility study. Rather, this project focuses on monitoring the acceptability of PrEP to the relevant population, HIV/STI acquisition and the health outcomes of those who accept or reject it. An evaluation of the project will be undertaken at its conclusion.
Eligibility Criteria The criteria should be taken as a minimum, and should not substitute clinical judgement. It relates to someone who is already engaged in care. Populations Necessary Aspects
Further Guidance Population Necessary Aspects
Further Guidance
Population Necessary Aspects
Further Guidance
MSM, transgender people • A documented confirmed 4th generation HIV negative test at initiation of PrEP • Reporting condomless anal intercourse in the previous three months • Considered likely to engage in repeated condomless intercourse in the next three months • Proof of welsh residency provided Where available, use point of care testing (fourth generations test) HIV negative partner of a HIV positive person • HIV positive partner's viral suppression is unknown • Condomless intercourse is anticipated or has occured within the past three months • Proof of Welsh residency provided PrEP should be recommended where the treating clinician recommends and monitors treatment as part of wider risk reduction (e.g. health education, safer sex promotion). Treatment as prevention for the HIV positive partner should be considered HIV negative heterosexuals • Known to have had condomless sex with a person with HIV within unknown viral suppression within the past three months • Anticipated to have condomless sex with person, or person of similar status, again • Proof of Welsh residency provided PrEP should be recommended where the treating clinician recommends and monitors treatment as part of wider risk reduction (e.g. health education, safer sex promotion)
Timeline November 2016 March 2017 April 2017 June 2017 July 2017
'Preparing for PrEP?' Evidence Review completed PrEP Management Guidelines developed for clinicians to oversee the care of patients accessing PrEP outside of NHS AWMSG Decision on Truvada as PrEP, followed by Cabinet Secretary's decision to fund three year study PrEPARED Study Protocol finalised and ratified PrEP made available in NHS Wales Integrated Sexual Health clinics
Further information about the PrEPARED project are available on the Frisky Wales website: http://friskywales.org/wales-prep-project.html If you have any queries about PrEP in Wales, please contact Public Health Wales’ Sexual Health Programme Lead, Zoë Couzens (zoe.couzens@wales.nhs.uk) or Lead Consultant in Health Protection, Dr. Giri Shankar (giri.shankar@wales.nhs.uk).
Review of Sexual Health in Wales at the half-way stage - Zoe Couzens – Principal in Public Health, Public Health Wales In 2010, the Welsh Government renewed its commitment to improve sexual health and wellbeing in Wales with the launch of the Sexual Health and Wellbeing Action Plan for Wales (2010-2015) (Welsh Assembly Government, 2010). This Plan built on, and strengthened, the work previously undertaken as part of the earlier framework for sexual health and the programme to modernise sexual health services. The Sexual Health and Wellbeing Action Plan for Wales (2010-2015) provided a platform on which to build local and national responses resulting in increased collaboration between agencies that have a role to play in improving the sexual health of Wales both through education and clinical service provision. In spite of the significant achievements in reducing teenage conceptions and improving diagnosis of STIs there are opportunities to continue to build on the work undertaken between 2010-2015. As such, a review of Sexual Health and HIV services was identified as a priority by the Minister for Social Services and Public Health in November 2016 (Welsh Government, 2016c). As we reach the half-way stage of the review, it is a good time to update on progress to date, as well as provide insight into the approach taken for undertaking the review. Public Health Wales’ Approach to the Review The individual delivery expectations and specific priorities set out in the new Review of Sexual Health & HIV Services in Wales should help to realise the following overarching ambitions for improved sexual health and wellbeing in Wales: • Everybody has the opportunity to access high-quality sexual health care and services • People are empowered to look after themselves and support others to prevent sexual ill-health. The formal request for Public Health Wales to commence a review of sexual health services in Wales envisaged the following areas being addressed: • A needs assessment of those accessing integrated sexual health services; • An assessment of unmet need; • An assessment of risky behaviours, engagement and understanding of risk in those at highest risk of unintended consequences from their behaviour; • Consideration of the current provision of integrated sexual health services, including an evaluation of the cost effectiveness of existing models of service and data quality; • Consideration of the sharing of patient information in line with National Health Service (Venereal Diseases) Regulations 1974; and • Consideration of the potential for targeted health promotion campaigns to effect behaviour change. To oversee the Review, the Minister for Social Services and Public Health has agreed to establish a Sexual Health Programme Board, chaired by the Chief Medical Officer, Dr. Frank Atherton, with the intent to establish the priorities for sexual health and sexual health services in Wales over the next few years. Public Health Wales will be represented on this Board, and will be responsible for providing ongoing updates to the Board regarding the progress of the Review. To deliver the requirements of this review, working groups of relevant representatives have been established and will function as ‘Task and Finish’ groups, each focused on the area of work identified in the request from Welsh Government.
Public Health Wales is working collaboratively with key partners and stakeholders, both from within NHS Wales and non NHS sectors (from across Wales), to deliver the requirements through two Task and Finish groups: 1) Service Group which will oversee: a. Review of current service provision b. Development of service specification c. Gap analysis between current provision, need and service specification d. Legislation for sharing patient information (a separate sub-group of the Service Group) 2) Risk Behaviour Group which will oversee: a. Needs assessment b. Assessment of risk behaviour c. Behaviour change interventions Sexual Health Review - Key Developments to date ‘A needs assessment of those accessing integrated sexual health services’ • Service user survey underway (until end of September 2017) across Integrated Sexual Health Services in Wales, which asks service users how they attended service and experiences in that attendance. ‘An assessment of unmet need’ • In conjunction with colleagues from 1000 Lives Improvement, a workshop was undertaken on 26th July, where professional representatives of the following population groups were in attendance: young people; vulnerable/excluded young people; older people; LGB; transgender; substance misuse; learning disability; looked-after children. The workshop was in two parts; firstly, looking at information requirements and the format of this information, and secondly Practitioners have been invited to run the workshop with their service users and feedback to the project team. ‘Consideration of the current provision of integrated sexual health services, including an evaluation of the cost effectiveness of existing models of service and data quality’ • All LHBs were asked to provide data for the same week in May in their sexual health clinics, allowing the Project Team to analyse each aspect of the clinic fairly across Wales. Data collected included type of clinic, whether it was walk-in or appointment based, number of staff in clinic, service provided in clinic, number of patients seen, number of patients turned away, services required by patients, any further referrals made. Staffing levels and budget for the services were also requested. • A ‘State of the Nation’ report was compiled by the Project Team, with the Public Health Wales Observatory Analytical Team providing for the report maps of latest statistics showing: location of sexual health clinics in Wales; conception rates in females aged under 18; rate of legal abortions in females resident in Wales aged 15-44; location of pharmacies that provide emergency hormonal contraception in Wales, STIs diagnosed in sexual health clinics in Wales (March – September 2016) and location of C-Card Schemes, location of GP services in Wales that provide long-acting reversible contraception. Public Health Wales’ Communicable Disease Surveillance Centre provided data tables/charts for STI rates, attendances at sexual health clinics (2011-2015) • A draft service specification was prepared in advance of ‘Services’ Task & Finish Group on 24th May, with group to consider best approach going forward. Specialty Registrar to support writing of revised draft based on Task & Finish Group feedback, with a view to have final draft by September 2017. Current and forthcoming service standards and care pathways for inclusion in new service specification are being mapped. • A National Dataset for Sexual Health in Wales is to be developed, with this work commencing in Q4. • The Frisky Wales website (www.friskywales.org) has been expanded to include patient information pages on Syphillis, Hepatitis A,B and C, Chlamydia, Gonorrhoea, Herpes and Genital Warts, and is also hosting details of the PrEP project.
‘Consideration of the sharing of patient information in line with National Health Service (Venereal Diseases) Regulations 1974’ • An options paper for future considerations regarding patient data sharing between Integrated Sexual Health Clinics and Primary/Secondary Care is in first draft form, and was shared with ‘Legislation’ Task & Finish Group on 14th July and discussed at T&F Group on 21st July. Options paper approved at meeting, and final draft to be shared by first week of September. For further information on any aspect of the Sexual Health Review, please contact the Project Team: Senior Responsible Officer, Dr. Giri Shankar Project Manager, Zoe Couzens Policy Practitioner, Adam Jones
giri.shankar@wales.nhs.uk zoe.couzens@wales.nhs.uk adam.jones2@wales.nhs.uk
References Public Health Wales (2016) Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales – Executive Summary. [Online]. Available from: http://www.wales.nhs.uk/sitesplus/documents/888/PHW%20Making%20a%20difference%20ES%28Web%5F2%29.pdf. Public Health Wales NHS Trust (2016a) Making a Difference: Eight infographics focusing on key health challenges for Wales and suggested evidence-based solutions. [Online]. Available from: http://www.wales.nhs.uk/sitesplus/documents/888/PHW%5FMaking%5Fa%5FDiffernce%5FInfographics%5FE%28web%29.pdf [Accessed: 9 May 2017]. Public Health Wales NHS Trust (2016b) Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales – Supporting Evidence. [Online]. Available from: http://www.wales.nhs.uk/sitesplus/888/opendoc/293342 [Accessed: 9 May 2017]. Welsh Assembly Government (2010) Sexual Health & Wellbeing Action Plan for Wales, 2010-2015. Welsh Government (2016a) Taking Wales Forward 2016-2021. [Online]. Available from: http://gov.wales/docs/strategies/160920-taking-wales-forward-en.pdf [Accessed: 9 March 2017]. Welsh Government (2016b) Taking Wales Forward Welsh Government’s Well-being Objectives (2016). [Online]. Available from: http://gov.wales/docs/caecd/publications/161104-well-being-a-en.pdf [Accessed: 9 March 2017]. Welsh Government (2016c) Written Statement - Sexual Health in Wales. [Online]. 23 November 2016. Available from: http://gov.wales/about/cabinet/cabinetstatements/2016-new/sexualhealth/?lang=en [Accessed: 16 June 2017].
Can’t Pass It On
Aderinola Omole - Health Promotion Specialist, Terrence Higgins Trust This summer, Terrence Higgins Trust launched ‘Can’t Pass It On’, a major campaign to get the message out that people who are on effective HIV treatment cannot pass the virus on to others. For the past 20 years, evidence has been building to show that the likelihood of passing on HIV is linked to the amount of the virus in a person’s blood – the HIV viral load. Effective treatment reduces the viral load to undetectable levels, which can take up to six months from starting treatment, meaning the HIV virus can’t be detected or passed on. Last year, the landmark PARTNER study (a) looked at more than 58,000 instances of sex without a condom, where one partner was HIV positive and one was HIV negative. Results found that where the HIV positive partner was on effective treatment there were zero cases of HIV transmission. This is an extraordinary breakthrough that gives us the robust evidence to say, with confidence that people on effective HIV treatment can’t pass on the virus. They are not infectious. There is no reason they can’t date, fall in love, have a healthy sex life, work or have families just like anyone else. A global movement has started to spread the word that ‘Undetectable = Uninfectious’, often expressed as #UequalsU. This began with one individual in the US, named Bruce Richman, who has galvanised a coalition of hundreds of expert organisations around the world to commit to getting this message out. Terrence Higgins Trust is among these organisations and one of the first to adapt its messaging following the PARTNER study’s findings. We did not take this step lightly and we wouldn’t have done this if we were not confident in the science. We are one of the largest HIV charities so we have a responsibility to communicate the facts and challenge the often dangerous and stigmatising myths about HIV that still persist. This is especially important given the results of a recent survey we carried out with YouGov, (b) which found that just nine per cent of people in Wales were aware that people on effective treatment cannot pass on HIV. The survey also found that around one in five (20%) Welsh people would feel uncomfortable giving First Aid to someone living with HIV who is on effective treatment. Meanwhile, nearly 22% of people from Wales would be uncomfortable going on a date with someone living with HIV who is on effective treatment, and nearly 1 in 6 (15%) felt the same way about playing contact sport. Fear of infection has long been the biggest source of stigma and discrimination around HIV, and this stigma in turn prevents people coming forward to be tested. It is still shocking, however, that in 2017 these views persist and that people in Wales are still being treated differently because of their HIV status. We need to completely reset the way we think about HIV as a society. Myths about how HIV is transmitted are not just deeply embedded in individual attitudes to HIV, they are embedded in our healthcare structures and practices, from blood tests to dentistry. Now we have the medical evidence that can help us to change attitudes fundamentally – it’s time to listen to science, not stigma. (a) The PARTNER Study Rodger et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIVpositive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. It can take up to six months from starting treatment to become undetectable. (b) YouGov survey All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2022 adults. Fieldwork was undertaken between 6th -7th June 2017. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).
Trans Ageing and Care (TrAC): Dignified and inclusive health and social care for older trans people in Wales Heneiddio a Gofal Traws (TrAC): Iechyd a gofal cymdeithasol cynhwysol gydag urddas i bobl draws hŷn yng Nghymru.
Seeking health and social care professionals to take part in a short survey. We are running a study looking at health and social care delivery for older trans people in Wales, of which we know very little. As well as interviewing older trans people to hear about their experiences, needs and hopes, we’re conducting a survey with health and social care professionals working in Wales. For a fuller description of our study, please visit our web-site: http://trans-ageing.swan.ac.uk/. Would you like to help us? If you choose to participate, it would take no more than 20 minutes of your time. As a small token of thanks, participants are free to enter a prize draw (four winners; £50 One4all vouchers), and entering the draw will not compromise their anonymity. What do I need to do to participate? Simply click on the following link: http://psy.swan.ac.uk/questionnaires/transageing / Many thanks for your time!
Rydyn ni'n chwilio am weithwyr proffesiynol ym maes iechyd a gofal cymdeithasol i gymryd rhan mewn arolwg byr.
Rydyn ni'n cynnal astudiaeth i edrych ar sut mae gwasanaethau iechyd a gofal cymdeithasol yn cael eu darparu i bobl draws hŷn yng Nghymru - maes na wyddom lawer amdano. Yn ogystal â chyfweld â phobl draws hŷn am eu profiadau, eu hanghenion a'u dyheadau, rydyn ni'n cynnal arolwg ar gyfer gweithwyr proffesiynol sy'n gweithio ym maes iechyd a gofal cymdeithasol yng Nghymru. I gael rhagor o wybodaeth am ein hastudiaeth, ewch i'n gwefan: http://trans-ageing.swan.ac.uk/?lang=cy Hoffech chi ein helpu? Os byddwch yn dewis cymryd rhan, ni ddylai'r arolwg gymryd mwy nag 20 munud i'w lenwi. Fel arwydd bach o ddiolch, mae cyfle i ymatebwyr ennill un o bedair gwobr (talebau gwario One4all gwerth £50), ac ni fydd cymryd rhan yn y gystadleuaeth yn risg i gyfrinachedd – bydd eich atebion yn yr arolwg yn aros yn ddienw. Sut mae cymryd rhan? Cliciwch ar un o'r dolenni isod: http://psy.swansea.ac.uk/questionnaires/tra nsageing_cymraeg/ Diolch i chi am roi o'ch amser!
Podcasts
You asked us for podcasts and we listened! Public Health Network Cymru have worked with a number of organisations to produce podcasts which can be downloaded and listened to on the go. All the podcasts are available in the ‘Get Involved’ section of the website. Podcasts currently available to download focus on Heart Health, Mental Health, The Wellbeing of Future Generations & ACEs, Sun Safety & Skin Cancer, and Trans Health.
Shared Practice This month’s project is the Safe, Well And Independent Living (SWAIL) project. The Safe, Well And Independent Living (SWAIL) project is limited to the Llanelli and Carmarthen areas of Carmarthenshire and is targeted at individuals over the age of 60 years of age with the following vulnerabilities: • Individuals with mental and/or physical health illnesses • Individuals with alcohol or substance misuse • Living alone and/or Living in rented property • Fire Interaction e.g. smoking, cooking, candles • Victim of crime/threat of a crime • A frequent user of 999 Services The Project provides an Holistic Home Safety Check, which includes a basic Crime Prevention Survey/Advice and where appropriate the fitting of some items of fire/crime reduction equipment. If you would like to add your own project to the Shared Practice Directory there is an easy online form (only accessible to members) and once approved by one of the coordinators your project will then appear on the directory. There is also a Self Assessment Toolkit which can be printed off or completed online and allows coordinators to quality assure the development and delivery of new and existing projects. If you need help completing the toolkit or have any questions please contact one of the coordinators at publichealth.network@wales.nhs.uk
On The Spot This month we have Adam Jones ‘On the Spot’. Adam is a Public Health Practitioner for Policy in Public Health Wales and was previously the All Wales Sexual Health Network Coordinator.
Where do you currently work and what is your area of expertise? Since October 2015, I’ve been the policy practitioner for Public Health Wales. In this role, I provide guidance and support for Public Health Wales colleagues with policy work (such as responding to consultations, providing evidence to inquiries, developing position statements). With Public Health being such a broad topic (what isn’t public health?), this is a very busy and demanding role. I’m a graduate of Politics, and as such I think I’ve always brought a different perspective to a profession that is largely made up of medically-trained practitioners. My qualification definitely suits the role that I’m in today.
As a previous coordinator of the All Wales Sexual Health Network, what do you think are the positive and negative aspects of becoming one all-encompassing Network? I was still part of the Networks team during the transition period from the individual, topic-focussed networks, and it was important during the web development stage for the new Network that people still had the option to tailor the content to their needs – not everyone is going to need to know about substance misuse developments if they work in environmental health, for example – so it’s great that people still have that option. The other major advantage is the sheer breadth of topics now covered. When we had the separate Networks, covering four topics individually, we frequently had practitioners ask us why there wasn’t a smoking cessation network, or when there will be an alcohol network. Public Health Network Cymru addresses this issue successfully. And that leads to the only negative I can think of. We need all agencies to be aware of Public Health Network Cymru and to actively promote it and contribute towards it. The Network Team is small, and can’t possibly be expected to be on top of all topics to the same degree as when I oversaw the All Wales Sexual Health Network, looking at one topic, for example. Public Health Network Cymru is more reliant than ever on contributions from members. (I hasten to add that even though I’m no longer a network co-ordinator, I’m now a pro-active member!!)
This month’s e-bulletin spotlights Sexual Health, what do you think are the main challenges facing us in addressing this issue in Wales? What is the most important message that should be conveyed to professionals and the public around sexual health? It’s a very interesting time to be having this issue of the E-Bulletin, falling as it does midway through a Sexual Health Review being conducted by Public Health Wales at the request of Welsh Government. The Review is highlighting some of the differences in sexual health service delivery across Wales, with examples of great practice that we need to replicate all across Wales. It’s also great to see how much of priority sexual health is for the Chief Medical Officer, Dr. Frank Atherton, and the Cabinet Secretary for Health, Social Care and Sport, Vaughan Gething AM. The recent decision to fund Pre-Exposure Prophylaxis (PrEP) highlights how seriously the Welsh Government is taking sexual health. Nevertheless, at times where budgets are being stretched to their limits, practitioners need to continue to fight for sexual health. In previous periods of precarious funding, in the UK and beyond, sexual health has often been one of the first areas to have budgets reduced. We all need to continue to make the case for investment in good sexual health, and ensure that we demonstrate how we are making the best use of the budgets we have.
What do you think Wales could be doing to actively promote or participate in Sexual Health Week? I think that the more we can do to promote sexual health – let alone Sexual Health Week – the better. The ‘Sextember’ campaign conducted in Betsi Cadwalladr UHB for the last few years has been great; it would be great to see this replicated across Wales. To give one example, we definitely need to move away from just resorting to leaflets and posters, and take the messages to the spheres where high-risk individuals are meeting; increasingly this is online. With this year’s theme of pornography, do we honestly believe consumers of online pornography are looking for a leaflet or a poster to enhance their sexual health? Let’s be bold!
If you were granted 3 wishes what would they be? • Professionally, for Sexual Health to be a top priority for all health organisations; we’re all sexual beings to one degree or another, let’s recognise that fact. • Personally – to get my novel published (but first, I’d better finish it!) • Personally – for someone else to come round and clean the oven; my most hated of tasks!
What are your personal interests/hobbies? I’m a vociferous reader, who has asked Waterstones to issue me with a restraining order (they haven’t). I’m also a photographer, with a particular interest in street photography; you can find me on Instagram/Twitter @adamthomasjones if you fancy a peek.
The Grapevine This section of the ebulletin is dedicated to news from the network members. You can submit news on the work being undertaken in your area, write us an article, showcase an upcoming project or show off your achievements! If you would like to submit an article for the Grapevine, please email publichealth.network@wales.nhs.uk The article should be no longer than 500 words and pictures are always welcome!
Decipher Short Courses
DECIPHer sHort CoursEs - sEPtEmbEr 2017
CoursE 1: ProCEss EvaluatIon of ComPlEx IntErvEntIons
DECIPHEr
dECIpHer, the Centre for the development and Evaluation of Complex Interventions for Public Health Improvement, is one of five UKRC Public Health Research Centres of Excellence coordinated by the Medical Research Council.
DuratIon: 1 Day DatE: 27 september 2017 venue: Glamorgan building, Cardiff university Cost: £225
The aim of this one-day course is to provide participants with a working knowledge of the theory and practice of process evaluation of complex interventions. The course is led by Dr Rhiannon Evans (Research Fellow, DECIPHer). The teaching team (Dr Graham Moore, Dr Micky Wilmott, and Dr Jeremy Segrott) includes authors of numerous empirical and methodological works related to process evaluation, including recent Medical Research Council guidance.
DECIPHer is a strategic partnership between Cardiff, Bristol and Swansea Universities. It is a leading centre of methodologically innovative multidisciplinary public health research, and has a strong track record of working with partners from public health policy and practice, and of public involvement in research.
Course will cover: •The role of process evaluation in understanding complex interventions; •The importance of intervention theory and logic models; •Fidelity and implementation of complex interventions; •Relationships and resource issues; •Identifying questions and combining methods and data sources; •Analysis and dissemination of evaluation findings. Who is it for? Academics, practioners and policymakers interested in the development and evaluation of complex interventions, specifically in public health. No prior knowledge is assumed. How to Book: www.decipher.uk.net/decipher- short-courses
(029) 2087 5274
train@cardiff.ac.uk
/
CardiffUniCpd
Health Impact Assessment (HIA) introductory training and Mental Wellbeing Impact Assessment (MWIA) Briefing opportunities. Following the passage of the Public Health (Wales) Act 2017 HIA is to become a statutory assessment in Wales within certain circumstances. Currently the regulations are being drafted ready for consultation. The regulations will define the specific circumstances for the application of HIA. Aside from the Public Health Act HIA is a key tool in the ‘tool box’ of PH practitioners. These introductory sessions provide an opportunity to learn about HIA, including: • How HIA supports the Health in All Policies (HiAP) approach to policy making • How it can support the implementation of the sustainable development principle and ways of working that underpin the Well-being of Future Generations Act • The principles and process that underpin HIA • How HIA draws on key Public Health skills • For PH practitioners undertaking the Practitioners Registration the introductory course will support a number of the competencies. The MWIA briefing session will have the following learning outcomes: • Knowledge of the MWIA wellbeing and resilience framework, development, methodology and the evidence base underpinning the MWIA Toolkit • Knowledge of the application of MWIA in a range of sectors and settings as a tool for “Mental Health in all Policies” • The relevance of MWIA to the Wellbeing of Future Generations Act • The benefits and outcomes from using MWIA The course dates: • Introduction to HIA, Thursday 21st September, morning at The Optic St. Asaph, n. Wales • Introduction to HIA, Monday 25th September, morning, Training Room, Capitol Qtr 2 Cardiff • Mental Wellbeing Impact Assessment Briefing, afternoon, Training Room, Capitol Qtr 2 Cardiff For further details and registration form contact ODLearning@wales.nhs.uk or tel. 02920827639
Learning Disability Wales Annual Conference Love your health: Because everyone’s health matters Wednesday 25 - Thursday 26 October 2017 Newport, South Wales (Accessible venue) Learning Disability Wales will be holding their annual conference which this year will be focusing on the theme of health and health issues that children, young people and adults who have a learning disability face. There will be a lively mix of interactive and informative workshops, speakers and drama along with lots of great exhibitors looking at topics such as: • Access to health services • Lifestyle • Mental health • Aging and end of life care • Dental care • Eye care and hearing loss/impairment • Well-being
News Round-Up Welcome to the News Round-Up. Click on the headings of the news item to take you to the full news story on the Public Health Network Cymru Website.
Research and Evidence
2017 Knowledge Exchange Grant Scheme Launched
For Policy Makers and Practitioners in Wales working in health and/or social care The central support team at NCPHWR is always looking for new ways to ensure that the research the Centre produces has an impact in ‘real life’ and that we are working on the questions that really matter to policy makers and practitioners. One of the most effective ways to do this is through involving the users of research right from the start.
Nutrition Why Sugary Drinks and Protein-Rich Meals Don’t Go Well Together Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.
Physical Activity Sport Wales calls for Welsh women and girls to join ‘Our Squad’ Sport Wales has launched the first phase of a new campaign to unite women and girls programmes and projects across Wales in celebrating, encouraging and empowering more women and girls to get active, and stay active.
Natural Environment Ordnance Survey launches greenspaces maps The new free Greenspace layer in OS Maps is the easiest way to discover greenspaces across Britain.
Dementia Dementia education on risk inspires people in midlife to consider healthier lifestyles Three quarters of people in midlife would make lifestyle changes now to reduce their risk of developing dementia in future, the UK’s biggest dementia charities have found.
Early Years Nearly a third of under-fives aren’t getting enough outdoor play With the school holidays well underway, a new report from Public Health Wales has revealed that while almost all parents in Wales (97 per cent) think it is important for their child to play outdoors every day, nearly a third of children under-five (29 per cent) aren’t getting the time outdoors that they need.
Click Here for more news on the Public Health Network Cymru website
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September
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Putting Participation into Practice With Young People Cardiff
Child Sexual Exploitation Aberaeron
Sexual Health Week National Event
‘Sextember’ Conference Bangor
National Principles for Public Engagement in Wales Webinar
Sexual and reproductive health conference London
Click Here for more events on the Public Health Network Cymru website
Contact Us Capital Quarter 2 Floor 5 Tyndall Street Cardiff CF10 4BZ www.publichealthnetwork.cymru If you have any news or events to contribute to the next edition please submit them to publichealth.network@wales.nhs.uk Deadline for submission is the 3rd Friday of every month.
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Edition: World Mental Health Day