Anna Graham

Teenagers' knowledge of emergency contraception: questionnaire survey in south east Scotland.

Abstract Objective: To determine the level of knowledge of emergency contraception among 14 and 15 year olds. Design: Confidential questionnaire survey. Setting: 10 secondary schools in Lothian, south east Scotland. Subjects: 1206 pupils predominantly (98.7%) aged 14 and 15 in the fourth year of secondary school. Main outcome measures: Knowledge of the existence of emergency contraception; of its safety, efficacy, and time limits; and of where to obtain it. Results: 1121 (93.0%) fourth year pupils aged 14-16 had heard of emergency contraception. 194 girls (32.7%) and 168 boys (27.5%) had experienced sexual intercourse. Of girls who had experienced sexual intercourse, 61 (31.4%) had used emergency contraception. Knowledge of correct time limits was poor, sexually active girls being the most knowledgeable. Pupils attending schools ranked lower than the national average for academic attainment were less likely to have heard of emergency contraception and more likely to have been sexually active. 861 (76.8%) pupils knew they could obtain emergency contraception from their doctor. 925 (82.5%) pupils believed emergency contraception to be effective but 398 (35.5%) thought it more dangerous than the oral contraceptive pill. Conclusions: One third of sexually active girls aged under 16 in Lothian have used emergency contraception. This may help explain the fairly constant teenage pregnancy rates despite increasing sexual activity. Scottish teenagers are well informed about the existence of emergency contraception. However, many do not know when and how to access it properly. Health education initiatives should target teenagers from less academic schools as they are more likely to be sexually active at a young age and are less well informed about emergency contraception. Key messages Under 16s have better awareness of the existence of emergency contraception than previously reported Despite good awareness of emergency contraception, teenagers have poor knowledge of specific details—particularly time limits and safety One third of sexually active girls aged under 16 have used emergency contra- ception Health education initiatives should concentrate on the practicalities of emergency contraception and target teenagers at particular risk

Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference

BackgroundChecklists for peer review aim to guide referees when assessing the quality of papers, but little evidence exists on the extent to which referees agree when evaluating the same paper. The aim of this study was to investigate agreement on dimensions of a checklist between two referees when evaluating abstracts submitted for a primary care conference.MethodsAnonymised abstracts were scored using a structured assessment comprising seven categories. Between one (poor) and four (excellent) marks were awarded for each category, giving a maximum possible score of 28 marks. Every abstract was assessed independently by two referees and agreement measured using intraclass correlation coefficients. Mean total scores of abstracts accepted and rejected for the meeting were compared using an unpaired t test.ResultsOf 52 abstracts, agreement between reviewers was greater for three components relating to study design (adjusted intraclass correlation coefficients 0.40 to 0.45) compared to four components relating to more subjective elements such as the importance of the study and likelihood of provoking discussion (0.01 to 0.25). Mean score for accepted abstracts was significantly greater than those that were rejected (17.4 versus 14.6, 95% CI for difference 1.3 to 4.1, p = 0.0003).ConclusionsThe findings suggest that inclusion of subjective components in a review checklist may result in greater disagreement between reviewers. However in terms of overall quality scores, abstracts accepted for the meeting were rated significantly higher than those that were rejected.

The chlamydia screening studies: rationale and design

Background: Screening has been recommended to reduce the prevalence and morbidity associated with genital chlamydia infection in the United Kingdom. Methods: We describe the rationale and study design of the Chlamydia Screening Studies (ClaSS), a collaborative project designed to evaluate screening outside genitourinary medicine clinics. A non-selective, active screening approach in 16–39 year olds randomly sampled from 27 general practice lists in the Bristol and Birmingham areas formed the basis of interlinked studies: a case-control study was used to investigate factors to improve the targeting of screening; participants with chlamydia were invited to enrol in a randomised controlled trial to evaluate partner notification conducted in primary care; and laboratory based studies were used to assess the best specimens and tests. We also explored psychosocial effects of screening and partner notification and modelled the cost effectiveness of the programme. Conclusion: Results from four pilot practices show that mailing of specimens for chlamydia testing is feasible but that it is difficult to achieve high response rates with postal screening. The high prevalence of asymptomatic infection in men suggests that efforts to screen men for chlamydia should be strengthened.

A qualitative study of the views of women aged 18-29 on over-the- counter availability of hormonal emergency contraception

Objective To explore womens views on the deregulation of hormonal emergency contraception (EC) prior to it becoming deregulated on 1 January 2001. Design Qualitative study using face to face, semi-structured interviews. Setting A NHS family planning clinic, a voluntary sector family planning clinic and a general practice in the South West region. Subjects Twenty-seven women aged 18-29 years. Results Most women were in favour of deregulation with over-the-counter provision perceived as quick, convenient and anonymous. Reservations regarding overuse and over-reliance upon EC mirror those of health professionals, although it was not felt that the increased accessibility of EC would lead to changes in sexual activity. Concerns that deregulation would promote an irresponsible attitude towards contraception were largely focused on younger women. Cost was generally regarded as a positive barrier to overuse. However, it was felt that the price should not be prohibitively high. A figure corresponding to the current prescription charge was most often cited. The pharmacy was the preferred choice of provider for most women. Conclusion Although most women in this study would prefer to obtain EC over-the-counter, the current charge of £20 is likely to prove a barrier.

Does population screening for Chlamydia trachomatis raise anxiety among those tested? Findings from a population based chlamydia screening study

BackgroundThe advent of urine testing for Chlamydia trachomatis has raised the possibility of large-scale screening for this sexually transmitted infection, which is now the most common in the United Kingdom. The purpose of this study was to investigate the effect of an invitation to be screened for chlamydia and of receiving a negative result on levels of anxiety, depression and self-esteem.Methods19,773 men and women aged 16 to 39 years, selected at random from 27 general practices in two large city areas (Bristol and Birmingham) were invited by post to send home-collected urine samples or vulvo-vaginal swabs for chlamydia testing. Questionnaires enquiring about anxiety, depression and self-esteem were sent to random samples of those offered screening: one month before the dispatch of invitations; when participants returned samples; and after receiving a negative result.ResultsHome screening was associated with an overall reduction in anxiety scores. An invitation to participate did not increase anxiety levels. Anxiety scores in men were lower after receiving the invitation than at baseline. Amongst women anxiety was reduced after receipt of negative test results. Neither depression nor self-esteem scores were affected by screening.ConclusionPostal screening for chlamydia does not appear to have a negative impact on overall psychological well-being and can lead to a decrease in anxiety levels among respondents. There is, however, a clear difference between men and women in when this reduction occurs.

Evidence based case report. Sore throat: diagnostic and therapeutic dilemmas.

Sore throat is a common condition in general practice. The following cases presented us with diagnostic and therapeutic dilemmas ### Case 1 Ms H, a 21 year old woman, consulted with a one day history of sore throat. She did not complain of cough or of any other associated respiratory symptom. On examination she was feverish (38°C), with exudate on her tonsils and tender cervical lymph nodes. A textbook of diagnostic strategies suggests that this collection of symptoms and signs increases the likelihood of her having group A β haemolytic streptococcus infection to over 40%.1 She was treated with a seven day course of penicillin, and a throat swab was taken to confirm infection with group A β haemolytic streptococcus. Four days later the swab result confirmed the presence of group A β haemolytic streptococcus which was sensitive to penicillin. Nine days after the initial consultation Ms H returned complaining of continuing symptoms of sore throat and requesting further antibiotics. She still had inflamed tonsils but with no exudate; her cervical lymphadenopathy had persisted. In view of her positive throat swab she was given a further course of penicillin. Serology for infectious mononucleosis was negative. A subsequent consultation confirmed that her sore throat had settled two days after the second consultation. ### Case 2 Ms D, a 17 year old woman, consulted with a two day history of sore throat and blocked nose Examination revealed an inflamed pharynx with some exudate, but the patient was otherwise well. She had been treated with two consecutive courses of antibiotics for …

One stop shop versus collaborative integration: what is the best way of delivering sexual health services?

Objectives: To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people’s services) and explore their relative strengths and weaknesses. Methods: Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). Results: The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having “integrated” services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over-centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. Conclusion: Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach.

Provision of emergency contraception in general practice and confidentiality for the under 16's: Results of a postal survey by general practitioners in Avon

Objective To describe the provision of emergency contraception and confidentiality for the under 16s by general practitioners (GPs) in Avon, in order to inform the development of a health promotion intervention in schools in Avon. Design Confidential postal questionnaire survey. Setting All principals in general practice in Avon Health Authority, South West England. Subjects Five hundred and eighty general practice principals were sent the questionnaire. Results Four hundred and eighty-six (84%) principals in general practice responded to the questionnaire. Only three (0.6%) GPs did not provide hormonal emergency contraception. Nearly half (232, 47.7%) would fit the intrauterine device (IUD) as emergency contraception. Fitting an IUD was associated with female gender of the GP (OR = 2.34, 95% CI 1.53-3.71), and whether the GP had a family planning qualification (OR = 4.55, 95% CI 2.41-8.60). Three hundred and fifty-two (72%) respondents would provide emergency contraception on a Sunday if requested to do so by a 14-year-old who reported having had unprotected sex the night before. Practice nurses in 26 (5%) of the respondents practices were available to provide advice and tablets for patients requesting hormonal emergency contraception. However, 74 (21%) respondents employed a family planning trained practice nurse who was not involved in any way in the provision of emergency contraception. Practice nurses remain an under used resource in this area. Conclusion Our findings suggest that most GPs provide hormonal emergency contraception. Only eight (1.6%) of respondents would need to ask for parental consent prior to providing hormonal emergency contraception to a 14-year old-girl. Young people need to be informed of GPs widespread adherence to current confidentiality guidelines.