In rapidly growing and high-burden urban centres, identifying tuberculosis (TB) transmission hotspots and understanding the potential impact of interventions can inform future control and prevention strategies. Using data on local demography, TB reports and patient reporting patterns in Dhaka South City Corporation (DSCC) and Dhaka North City Corporation (DNCC), Bangladesh, between 2010 and 2017, we developed maps of TB reporting rates across wards in DSCC and DNCC and identified wards with high rates of reported TB (i.e. ‘hotspots’) in DSCC and DNCC. We developed ward-level transmission models and estimated the potential epidemiological impact of three TB interventions: active case finding (ACF), mass preventive therapy (PT) and a combination of ACF and PT, implemented either citywide or targeted to high-incidence hotspots. There was substantial geographic heterogeneity in the estimated TB incidence in both DSCC and DNCC: incidence in the highest-incidence wards was over ten times higher than in the lowest-incidence wards in each city corporation. ACF, PT and combined ACF plus PT delivered to 10% of the population reduced TB incidence by a projected 7%–9%, 13%–15% and 19%–23% over five years, respectively. Targeting TB hotspots increased the projected reduction in TB incidence achieved by each intervention 1.4- to 1.8-fold. The geographical pattern of TB notifications suggests high levels of ongoing TB transmission in DSCC and DNCC, with substantial heterogeneity at the ward level. Interventions that reduce transmission are likely to be highly effective and incorporating notification data at the local level can further improve intervention efficiency.

Introduction: Domestic violence (DV) rates in smaller cities have been reported to be some of the highest in Canada. It is highly likely that emergency department staff will come across victims of intimate partner violence (IPV) in their daily practice. However, elsewhere we have found a lack of knowledge of current tools as well as lack of training in ED staff. Furthermore, these findings may also be reflected by low rates of IPV documentation, especially in high-risk cases. The purpose of the current study is to determine if ED staff would be willing to implement a brief IPV screening tool, the Partner Violence Screen (PVS) in their daily practice. It consists of the 3 questions: Have you ever been hit, kicked, punched or otherwise hurt by someone within the past year, and if so, by whom? Do you feel safe in your current relationship? Is there a partner from a previous relationship that is making you feel unsafe now? Methods: A cross-sectional online survey was distributed to ED staff (LPNs, NPs, Physicians, Residents, RNs) via staff email lists three times between July and October 2016, with a response rate of 45.9% (n=55). The survey included a 5-question Likert scale. The primary outcome was whether ED staff are willing to implement a new case-finding tool in their daily practice. The secondary outcome was to assess whether staff would find this tool beneficial in case-finding for IPV. Results: 43.6% of staff responded that they are likely to use the tool routinely, 29.1% were unsure, and 2.7% very likely. 7.27% and 3.64% stated their predicted use as unlikely and very unlikely, respectively. In addition, 43.6% of staff thought that the PVS would be beneficial in case finding for IPV, 40% were unsure, 12.7% thought very likely, 1.82% unlikely, and 1.82% very unlikely. Conclusion: These findings suggest that emergency department staff may be receptive to and find the introduction of the PVS beneficial in identifying cases of IPV. Future directions will include the introduction of this tool through a knowledge translation education piece in order improve the identification process for and awareness of a high-risk condition in a vulnerable population group.

Introduction: Domestic violence (DV) rates in smaller cities have been reported to be some of the highest in Canada. It is highly likely that emergency department staff will come across victims of intimate partner violence (IPV) in their daily practice. Elsewhere we have found low rates of IPV documentation as well as underutilization of current tools in the ED. The purpose of this study is to describe ED staff awareness and knowledge surrounding IPV, currently accepted screening questions, and available screening tools. Methods: To assess awareness and knowledge, a cross-sectional online survey was distributed to ED staff (LPNs, NPs, Physicians, Residents, RNs) via staff email lists three times between July and October 2016, with a response rate of 45.9% (n=55). The primary outcomes were correct identification of appropriate IPV questions. Secondary outcomes included awareness of screening tools (HITS, WAST, PVS, AAS), whose role it is to question patients, and whether or not formal training has been received. Results: When asked to identify recommended questions for asking about IPV, staff were more likely to choose screening questions (75.3%; 95% CI 69.3% to 80.6%) compared to questions that are not recommended (23.8%; 95% CI 19.4% to 30.7%). However, 87.3% of respondents were not aware of current screening tools. 49.1% believed that all patients with typical injuries (ex. facial injury), should have further questioning about IPV, 20% believed that all patients with any injury, and 16.4% believed that all patients should be questioned about IPV. 89.1% also felt that it is both the physician and nurse’s role to question patients about IPV. Finally, 81.8% of ED staff did not receive any formal training on domestic or intimate partner violence. Conclusion: The present study indicates that there may be a gap in education surrounding this high risk condition as seen by the lack of knowledge surrounding current tools, lack of consensus on who should be questioned, and lack of training. Therefore, introduction of a knowledge translation piece may be beneficial to both ED physicians and nurses.

This review will try to address the question of whether we are diagnosing too many people with coeliac disease. The key reasons for diagnosing coeliac disease may be that it is a common condition affecting up to 1% of the adult population. Delays in diagnosis are common. The average time delay reported by Coeliac UK (National Medical Patient Charity), for patients with symptoms prior to the diagnosis being made is 13 years. For every adult case detected, it is estimated that there are eight cases not detected. Patients with coeliac disease have an associated morbidity and mortality. In addition, quality of life studies suggest that the majority of patients benefit from a gluten-free diet (GFD). Furthermore, the GFD reduces or alleviates the risk of the associated complications. All of these facts could even be used to support the argument for screening! However, conversely the tests for coeliac disease are not 100% sensitive and specific. In addition, we do not know whether patients with milder symptoms will derive less benefit from treatment and are at less risk of complications. Furthermore, evidence presented in this review suggests that actual outcomes for screening studies in an adult population have revealed poor uptake and subsequently difficulties with adherence. What little published data that are available also infers that individuals recognised through screening programmes could have been detected if carefully questioned for symptoms. There is evidence to suggest that diagnosing celiac disease is cost-effective and that the diagnostic costs are offset by reduced medical expenditures, reduced hospital and general practice attendances, but this view depends on the population prevalence of coeliac disease. We believe on the basis of the evidence presented in this review that we are not diagnosing too many adults with coeliac disease. However, the authors consider case-finding with a low threshold for serological testing to be the optimal approach. If you look for coeliac disease you will find it.