Criterion-based screening for sexually transmitted infection: sensitivity, specificity, and predictive values of commonly used questions

pre-printBackground: Practice protocols that mandate pre-screening for sexually transmitted infection prior to insertion of an intrauterine device for contraception can pose obstacles for women seeking this highly effective method of birth control. Some practices screen for presumed risk factors for sexually transmitted infection in order to identify those who may be infected, or those in whom laboratory testing should be obtained. The value of such criterion-based screening is unclear. Design: Data from a prospective observational trial of offering the copper intrauterine device for emergency contraception were used to assess the value of several screening questions in predicting the presence of sexually transmitted infection. Criteria evaluated were age under 25, history of a sexually transmitted infection, and having 2 or more sexual partners in the previous 3 months. The sensitivity, specificity, and likelihood ratio of both positive and negative tests, and positive and negative predictive values were calculated for three separate questions, as well as for combinations of these three questions. Results: There were 197 women who received a copper intrauterine device for emergency contraception at the same time they were tested for sexually transmitted infection. In this sample, there were 8 cases of Chlamydia trachomatis identified, and no cases of Neisseria gonorrhea. The sensitivity of individual and combined questions in identifying those who were infected ranged from 0 to 88%; specificity ranged from 37-97%. The positive predictive values for single or combined screening questions were in the range of 4-6%. Likelihood ratios for both positive and negative tests did not change post-test likelihood of disease in any appreciable way

At the Crossroads: The impact of new Irish science curricula on first year post-primary students

In Ireland, new science curricula were introduced at primary and early post- primary levels in 2003, in an effort to reverse declining interest and enrolment in science. This paper reports on a national study that explored first year post-primary students’ experiences of and attitudes towards school science under these new curricula. Data were gathered from 366 pupils using survey and case study approaches. Findings revealed broadly positive attitudes towards post-primary school science, especially the experimental work that is at the heart of the new curriculum. However, it would appear that students were not conducting open-ended investigations or using information and communications technology [ICT] to any great extent; moreover, there was some evidence of traditional teaching methods being utilised. Pupils were highly critical of previous primary school science experiences, reporting a lack of ‘hands-on’ activities, didactic methodologies and, for a significant minority, a paucity of any memorable primary science at all. Improvements in curricular implementation are proposed

Extended and continuous combined contraceptive regimens for menstrual suppression

pre-printMany women have medical indications for menstrual suppression or a personal preference to reduce or eliminate monthly bleeding, which can be achieved with extended and continuous regimens of combined estrogen and progestin contraceptives. Combined contraceptives are traditionally administered in a 28-day cycle with 21 days of a contraceptive pill, vaginal ring, or transdermal patch followed by a hormone-free interval that is usually 7 days. During the hormone-free interval, women either take a placebo pill or do not use their combined contraceptive method. Hormone-related symptoms are higher during the hormone-free interval than the days when the contraceptive is used. Alterations of the standard 28-day cyclic regimen for menstrual suppression include decreasing the frequency of the hormone-free interval, thus extending the time between withdrawal bleeding episodes (extended use), and eliminating the hormone-free interval altogether (continuous use). This article reviews menstrual suppression indications and physiology. Research demonstrating that the effectiveness, safety, and side effects of oral, vaginal, and transdermal extended and continuous regimens are comparable to cyclic regimens is summarized. Findings from studies of women's and health care providers' attitudes toward menstrual suppression are also reviewed. Important topics to include in evidence-based counseling for extended and continuous combined contraceptive use are presented

Expanding Access to Naloxone: A Review of Distribution Strategies

Amidst an ongoing opioid crisis that claimed 47,600 lives in 2017, increasing the availability of the rescue medication naloxone is a high priority. Naloxone reverses an opioid overdose when given intranasally or intramuscularly. But to be effective, naloxone must be available at the time of overdose. Naloxone distribution to laypeople can save a life when first responders are not immediately available, or when people witnessing overdoses are unwilling or unable to call 911. Naloxone is increasingly available through some pharmacies under a standing order; however, even when available, cost and stigma barriers persist. This Issue Brief reviews recent evidence on the outcomes and cost-effectiveness of naloxone distribution strategies in community, pharmacy, and other health care settings

Information Seeking Habits of Environmental Scientists: A Study of Interdisciplinary Scientists at the U.S.Environmental Protection Agency in Research Triangle Park, North Carolina

This study describes a questionnaire survey of interdisciplinary scientists conducting research at the U.S. Environmental Protection Agency in Research Triangle Park, North Carolina. The survey was conducted in order to gain a clearer picture of how the interdisciplinary scientists seeks information, and in particular how the interdisciplinary scientist manages his/her time in regard to information-gathering tasks. Researchers at the Environmental Protection Agency report that they have some difficulty in maintaining a vocabulary in several scientific disciplines at the same time. Results also indicate that while scientists are utilizing the assistance of others in information-gathering, they do not report a heavy reliance on library resources. Analysis of the current status of the researchers' needs shows that researchers are demonstrating an increasing need for assistance in information-gathering

Moving beyond the rhetoric of consumer input in health technology assessment deliberations

At a health system level the importance of patient and public input into healthcare decision-making is well recognised. Patient and public involvement not only provides a mechanism to legitimise decisions but also contributes to improved translation of these decisions into practice, ultimately leading to better patient outcomes. Recent reviews in the health technology assessment space have identified the need for, and increased use of, patient input through systematic methodologies. Yet what does this mean in practical terms? This paper outlines both short and longer-term options for strengthening patient input into health technology assessment deliberations. This is particularly important given the planned reforms in this area and the commitment to public consultation as part of the reform process

Barriers in Obtaining a Bachelor of Science Degree as Perceived by Nurses Prepared Below the Baccalaureate Level

Occupational and Adult Educatio