John Tripp

School sex education: an experimental programme with educational and medical benefit

Abstract Objective:To develop and teach a school sex education programme that will lead to a decrease in sexual activity. Design:A matched internal and external control experiment, comparing control populations which received their own sex education programmes with populations which received a novel sex education intervention that included medical and peer led teaching. Setting:Comprehensive secondary schools; control and intervention populations within Devon, and distant controls from rural, semiurban, and urban areas of England excluding major conurbations. Subjects:Schoolchildren were taught from age 12 to 16; three successive cohorts of students were evaluated in school year 11 (mean age 16.0) Main outcome measures:Questionnaire conducted under “examinationconditions” and invigilated by the research team and other trained medical staff. Results:In the intervention population, progressive increase in knowledge related to contraception, sexually transmitted diseases, and prevalence of sexual activity (χ2 (trend) P<0.001 for all three series); relative increase between intervention and control populations in knowledge, relative decrease in attitudes suggesting that sexual intercourse is of itself beneficial to teenagers and their relationships, relative decrease in sexual activity, and relative increase in approval of their “sex education” (relative risk >1.00 with 95% confidence limits not including 1.00 for all series and for comparisons with both control populations); odds ratio (control v programme) for sexual activity of 1.45, controlling for sociodemographic variables. Conclusion:School sex education that includes specific targeted methods with the direct use of medical staff and peers can produce behavioural changes that lead to health benefit.

Clinical performance of the levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report

Objectives This study was undertaken to determine the performance of the levonorgestrel intrauterine system (LNG IUS) in British women in routine clinical use. Design Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 678 LNG IUSs. Results Gross cumulative event rates at 5 years per 100 women were pregnancy 1.0, expulsion 5.9, removal for bleeding problems 16.7, removal for pain 4.3, and removal for pelvic inflammatory disease (PID) 1.2. Removals were also required for side effects that may be due to absorbed levonorgestrel. Positive effects include effective contraception and considerably reduced quantity of bleeding for most participants. Conclusions A need was identified to counsel women about the early bleeding problems including the possibility of oligomenorrhoea or amenorrhoea. This is considered to be very important as it will help women to persevere so that they can enjoy the longer-term benefits.

Sex education: more is not enough

Increasing demands for sex education have been associated with a plethora of recommendations, regulations and resources with resulting variability of content, strategy, quality and outcome. While numerous studies confirm that the health behaviour of teenagers is not altered by the teaching of facts alone, other data suggest that appreciation of personal risk and learned assertiveness skills are associated with changes in population behaviours. Peer led teaching is a powerful and probably essential component of school health and sex education. Evaluated interventions with agreed purpose and acceptable methodologies are essential if there is to be any real expectation of health benefit from sex education.

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study.

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term ‘need’. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.

Clinical performance of the Nova T380® intrauterine device in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report

Objectives The purpose of the study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with other published results, in the clinical setting of British general practice and family planning clinics. Design Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 574 Nova T380® intrauterine contraceptive devices (IUDs). The Nova T® (and formerly the identical Novagard®) IUDs have copper with a surface area of 200 mm2. The Nova T380® has copper with a surface area of 380 mm2. Results This is the first 5-year report on this device. The 5-year cumulative life-table event rates per 100 women were pregnancy 2.0, expulsion 13.0, and removal for bleeding problems and bleeding with pain 29.6. Conclusions The increased surface area of copper was associated with a reduced pregnancy rate as compared to the Nova T®, though no statistical comparison is possible. Although the present study was not a direct comparative study with the Nova T®, the result lends weight to the notion that increasing the copper reduces the pregnancy rate. The discontinuation rate for bleeding problems and bleeding with pain and the expulsion rates were higher than in published Nova T® studies.

Dysphagia in cerebral palsy: A comparative study of the exeter dysphagia assesment technique and a multidisciplinary assessment

Eighteen children with cerebral palsy in a special school, most of whom had feeding difficulties, were studied to compare the diagnostic value of the Exeter Dysphagia Assessment Technique (EDAT) with an exhaustive clinical assessment undertaken by a multidisciplinary team experienced in the diagnosis and treatment of dysphagia of neurological origin. Four feeding skills were assessed by each method independently, viz. anticipation, intraoral sensory perception, oral-motor efficiency, and pharyngeal triggering. Comparison of the two sets of results showed agreement in at least 78% of the assessed skills. The possible reasons for the few discrepancies are discussed. The noninvasive EDAT equipment was easy to use with the children, who had a range of type and severity of cerebral palsy. The test was undertaken in their familiar surroundings and took 15 to 20 min per child. Interpretation of the results showed that EDAT provided a rapid, reliable diagnostic aid which assisted in the assessment of the degree of feeding impairment within each of the four feeding skills tested.

Objective Measures of Dysphagia Complexity in Children Related to Suckle Feeding Histories, Gestational Ages, and Classification of Their Cerebral Palsy

Data collected during the routine assessment of 117 dysphagic children with cerebral palsy have been related to both suckle feeding histories and gestational ages and to the classification of cerebral palsy. In addition, a concurrent survey involving 281 children with cerebral palsy in special schools was undertaken which revealed that the sample of referred children appeared to be a true representation of a wider population of dysphagic children with cerebral palsy. A Feeding Difficulty Symptom Score (FDSS) describes the severity of swallowing symptoms reported. A numerical Dysphagia Complexity Index (DCI) quantifies numerically the neurological complexity of the swallowing difficulty. The FDSS correlates closely with the DCI. Twenty-seven percent of mothers of the children who were referred for advice on their present swallowing difficulties stated that they recalled no suckle feeding problems. However, there was no difference in the severity of present swallowing difficulties between those infants who suckle fed well and those who experienced severe difficulties. Those referred children with cerebral palsy born at term exhibited more complex later swallowing problems and were more likely to be classified as athetoid than those born preterm.

Negotiating sexual intimacy: A PAUSE develops an approach using a peer‐led, theatre‐for‐development model in the classroom

Previous authors have noted the difficulty of demonstrating behavioural outcomes from school‐based sex education programmes. It is increasingly accepted that unless such programmes are firmly based in psychological theory, they are unlikely to be effective in changing behaviour. The A PAUSE programme has been cited as one of only three in Britain that set out to rigorously evaluate the outcomes of a major sex education intervention. Despite the changes in knowledge, beliefs and behaviour demonstrated by the A PAUSE programme, it has failed to significantly change young teenagers’ beliefs in their ability to negotiate sexual aspects of their relationships. To address this problem, A PAUSE has been piloting a peer‐led theatre‐based programme designed to give participants opportunities to identify the need for negotiating skills and practise them in role‐play situations. Drawing on the theoretical basis of A PAUSE, the theatre‐for‐development process aims to promote autonomy of the peer educators and empower the target population. Although detailed process evaluation is still in its early stages, this article describes the pilot, examines the results so far, and makes a case for pursuing this theatre model further.

Non-invasive technique for assessment and management planning of oral-pharyngeal dysphagia in children with cerebral palsy

The non‐invasive Exeter Dysphagia Assessment Technique (EDAT) was evaluated as a method of assessing the aetiology of dysphagia in children with cerebral palsy (CP). Data were collected from a group of 20 typically developing children (nine girls, 11 boys; age range 7 to 14 years) for comparison with 125 dysphagic children with CP (81 boys, 44 girls; age range 1 to 18 years). The swallowing mechanism has been separated into physiological phases: anticipatory, delivery, oral transit, and oral‐pharyngeal. Normal or abnormal function in each phase was recorded and the common causes of any impaired phase were considered, starting with generalized possibilities before focusing on specific parts of swallowing physiology. Data from 125 dysphagic children with CP show marked differences from the data for the typically developing children. Interpreting individual results was valuable in assisting the assessment team to formulate management strategies; two examples are presented. The technique appears to provide a cost‐effective, non‐invasive, and valuable clinical tool.

Sex education — whose baby?

Sex is an extremely powerful human drive. Anthropologists have argued that consciousness of sexuality is an important distinction of man from other mammals and psychologists have based whole systems of psychology on sexual awareness and functions. Literature related to sexuality provides both beautiful and tragic poetry available in all written languages. Love, desire, and compulsive fascination with the human form are common to all cultures. Sexual desire and jealousy are common reasons for violence. Un-wanted sex related health contacts cause major medical, social and financial problems.