Testing for sexually transmitted infections among students: a discrete choice experiment of service preferences

Objectives To assess preferences among students for sexually transmitted infection (STI) testing services, with a view to establishing strength of preference for different service attributes. Design Online discrete choice experiment (DCE) questionnaire. Setting South East of England. Participants A convenience sample of 233 students from two universities. Outcomes Adjusted ORs in relation to service characteristics. Results The study yielded 233 responses. Respondents’ ages ranged from 16 to 34 years with a mean age of 22 years. Among this sample, the respondents demonstrated strong preferences for a testing service which provided tests for all STIs including syphilis, herpes and HIV (OR 4.1; 95% CI 3.36 to 4.90) and centres staffed by a doctor or nurse with specialist knowledge of STIs (OR 2.1; 95% CI 1.78 to 2.37). Receiving all test results, whether positive or negative, was also significantly preferable to not being notified when tests were all negative (‘no news is good news’; OR 1.3; 95% CI 1.16 to 1.5). The length of time waiting for an appointment and the method by which results are received were not significant service characteristics in terms of preferences. Patient level characteristics such as age, sex and previous testing experience did not predict the likelihood of testing. Conclusions This study demonstrates that of the examined attributes, university students expressed the strongest preference for a comprehensive testing service. The next strongest preferences were for being tested by specialist STI staff and receiving negative as well as positive test results. However, it remains unclear how strong these preferences are in relation to characteristics which were not part of the study design and whether or not they are cost-effective

Will I? won't I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures?

Background: Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure. Understanding why men who have sex with men (MSM) access PEPSE on some occasions and not others may lead to more effective health promotion and disease prevention strategies Methods: A qualitative study design using semi-structured interviews of 15 MSM within 6 months of them initiating PEPSE treatment at an HIV outpatient service in Brighton, UK. Results: PEPSE seeking was motivated by a number of factors: an episode that related to a particular sexual partner and their behaviour; the characteristics of the venue where the risk occurred; the respondent’s state of mind and influences of alcohol and recreational drug use; and their perceived beliefs on the effectiveness of PEPSE. Help was sought in the light of a “one-off” or “unusual” event. Many respondents felt they were less likely to behave in a risky manner following PEPSE. Conclusion: If PEPSE is to be effective as a public health measure, at risk individuals need to be empowered to make improved risk calculations from an increased perception that they could be exposed to HIV if they continue their current behaviour patterns. The concern is that PEPSE was sought by a low number of MSM implying that a greater number are not using the service based on failure to make accurate risk calculations or recognise high-risk scenario

A decline in patient disclosure of heterosexuality in the English general practice patient survey: a longitudinal analysis of cross-sectional data

Background: Persistent health inequalities in relation to both healthcare experiences and health outcomes continue to exist among patients identifying with a marginalised sexual orientation. Objective: To compare the patterns of sexual orientation disclosure within primary care in England over a five-year period. Methods: Descriptive analysis of cross-sectional, repeat measure, fully anonymised survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808,332 (2017) and 1,037,946 (2011/2012). Results. The analysis samples comprised between 396963 and 770091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or ‘other’ sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or ‘other’ increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56% to 0.99%). Conclusion. We found a year on year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, ‘other sexual orientation’ or preferring not to say. Heteronormative environments extend to healthcare settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients

Patient sexual orientation and gender identity disclosure

Background In the UK , 2.3% of men and 1.6% of women identify as lesbian, gay or bisexual (LGB ). Of the UK population, 1% are estimated to identify as transgender (T). Of the LGB population, 46% do not disclose their sexual orientation to health care professionals (HCP s) and 18% of transgender patients avoid health care altogether. Non‐disclosure of sexual orientation and/or gender identity contributes to worse health outcomes for LGBT patients. Objectives This study aimed to explore medical students’ perceptions of the barriers to health care for LGBT patients and the importance of patient disclosure of sexual orientation or gender identity. Methods Focus groups included medical students across five year‐groups from a medical school in the South East of England. Discussions followed a pre‐approved topic guide with a primary and co‐facilitator present. Focus groups were audio‐recorded, transcribed verbatim and the data underwent framework analysis. Results Forty‐five undergraduate medical students participated (40% of whom were non‐heterosexual). Most participants believed that the incorrect use of pronouns and discrimination would be a cause for non‐disclosure of gender identity and sexual orientation to HCP s. Several participants thought it was more important to know a patient's gender identity than sexual orientation. Many participants felt that collecting sexual orientation information on healthcare registration forms is acceptable. Discussion More education regarding LGBT health needs and ways to encourage patient disclosure of sexual orientation or gender identity should be included in the undergraduate medical school curricula to increase the competency of future doctors when interacting with LGBT patients

Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a “feminisms” systematic review

BackgroundRecent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe.MethodsThe review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied.ResultsEight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access.ConclusionsThe design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive

Clarifying Values: An updated review

Background: Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods: Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results: Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions: Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness

Anabolic androgenic steroid abuse in the United Kingdom: An update

© 2020 The British Pharmacological Society. This is the peer reviewed version of the following article: Mullen, C, Whalley, BJ, Schifano, F, Baker, JS. Anabolic Androgenic Steroid Abuse in the United Kingdom; An Update The increasing popularity of anabolic androgenic steroids. Br J Pharmacol. 2020, which has been published in final form at https://doi.org/10.1111/bph.14995. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Anabolic androgenic steroids (AASs) are prescribed for medical conditions related to low testosterone. Abuse of AASs has surged as they become recognised as potent image enhancement drugs. The primary goal of most abusers is to obtain a more attractive outward appearance. Abuse is complex. There are a vast range of AAS substances illegally available, the nature of their true composition is difficult to evaluate. Users follow dosing patterns which incorporate a number of different AASs, in addition to other pharmaceutical substances believed to complement the desired physical effects or manage unwanted effects. Animal work and medical case reports suggest potential to cause serious hepatotoxicity, plus possible neurotoxicity, nephrotoxicity and damage to the cardiovascular and reproductive systems. As the long-term AASs users reach maturity, further controlled experimentation, with larger sample sizes, is required. Data gathering should be directed towards the most vulnerable group of AAS users, females and adolescent boys.Peer reviewedFinal Accepted Versio

Talking about links between sexually transmitted infections and infertility with college and university students from SE England, UK: a qualitative study

Background Sexually transmitted infections (STIs) such as chlamydia and gonorrhoea are largely symptomless diseases which, left untreated, can result in serious complications including infertility. Fertility problems currently affect approximately one in seven couples in the UK and there is increasing demand for couples seeking reproductive technologies. Young people are at greatest risk of contracting STIs, therefore this study aimed to identify young people’s knowledge and beliefs about the link between untreated STIs and infertility. Methods Focus groups were conducted with participants aged 16–24 years old inclusive in college or university settings in the SE of England. Groups were quota sampled on the basis of age and gender. A topic guide was used. The data were analysed using a framework analysis approach. Results Ten single-sex focus groups were conducted with sixty participants: six groups of college students and four groups of university students. Participants were generally aware of the link between STIs and potential infertility and considered the discussion of this subject very relevant at their age. Knowledge about how and why STIs potentially lead to fertility complications was poor. The issues of blame relating to infertility following an STI emerged, although most participants did not think that access to free reproductive technologies after an untreated STI should be limited. Conclusions Young people would benefit from more education in order to improve their understanding of the long-term consequences of untreated STIs, such as infertility. Participants in our sample felt these were extremely relevant and important issues for them to understand alongside current education about STIs