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Objectives: We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual- level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs. Design: A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. 'Best' estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models. Studies reviewed: Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs. Results: HIV in Europe remains low among FSWs who do not inject drugs (<1%), but STIs are high, particularly syphilis in the East and gonorrhoea. FSWs experience high levels of violence and structural risk factors associated with HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment. Conclusions: Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better systematically delineate how microenvironmental and macroenvironmental factors combine to increase or reduce HIV/STI risk. [ABSTRACT FROM AUTHOR]

Objectives To assess uptake of community-based capillary thyroid stimulating hormone (TSH) screening in Scotland and determine the optimal frequency of screening, the justification for preschool screening and strategies for treatment. Methods Subjects with Down's syndrome aged 1–19 years underwent capillary TSH measurement. Clinical and biochemical data were collected using proformas. Results 5742 capillary TSH tests were performed on 1329 children in 1997–2009, increasing from 183 children from two health boards tested in 1997 to 630 from 13 health boards tested in 2009. Of 132 children referred by the screening laboratory with elevated capillary TSH, 98 (M:F ratio 1:1.2, median (range) age 8.9 (0.9–17.9) years) had adequate documentation and 76 had thyroid dysfunction (defined as venous TSH >6 mU/l), giving a prevalence of not less than 5.7%. Fifty-six (57%) had tested negative during the previous year, 8 (8%) tested positive on their first screening test and 23/67 (34%) were thyroid peroxidase autoantibody negative on initial venous blood. Two of the 13 (13%) preschool children were severely hypothyroid (venous TSH 71 and 283 mU/l). Of patients with venous TSH 6–10.9 (n=27), 11.0– 20.9 (n=25) and ≥21.0 mU/l (n=24) following referral, initial/subsequent treatment with thyroxine was given in 3/8, 15/5 and 21/1, respectively. Conclusion Capillary TSH screening in Down's syndrome is eminently feasible and should be performed annually from 1 year of age. Nearly all subjects with initial venous TSH ≥11.0 mU/l will require thyroxine treatment but most with TSH 6–10 mU/l only require surveillance initially. [ABSTRACT FROM AUTHOR]

The author discusses the influence of corporate industries on health policy regulations in Great Britain. She provides examples from the tobacco and food industry to demonstrate the government's ineptitude in policy making. One of the reasons for this cited by the author is that regulatory agencies are often funded by the industry. Also, regulations are often projected by industries as expensive and unfeasible. Industries often resort to third-party advocacy to subvert regulation. INSET: OVERSEEING THE REVOLVING DOOR.

The article presents the authors' view on the impact of the Transatlantic Trade and Investment Partnership (TTIP) on the government agency the National Health Services (NHS). Topics discussed include the authors' assessment of the TTIP trade agreement and an account of the trade dispute between the governments of Austria and Slovakia which shows the important issues that are related to the TTIP trade agreement.

A letter to the editor is presented in response to the article ""Any willing provider" vs "any qualified provider" in the NHS reform: different bottle, same contents," by L. Reynolds in a previous issue.