Not so different after all? Comparing patients attending general practice-based locally enhanced services for sexual health with patients attending genitourinary medicine.

We did a cross-sectional survey of patients attending genitourinary (GU) medicine clinics (n = 933) and general practice-based Locally Enhanced Services for Sexual Health (GP-LESSH, n = 111) in Cornwall, England, in 2009/2010, to compare patients' characteristics and experiences. Patients completed a pen-and-paper questionnaire that was then linked to an extract of their clinical data. GP-LESSH patients took longer both to seek and to receive care: medians of nine and seven days, respectively, versus GU medicine patients: medians of seven and one day, respectively. GP-LESSH patients were less likely than GU medicine patients to report symptoms (19.6% versus 30.6%) and sexual risk behaviours (33.3% versus 44.7% reported new partners) since recognizing needing to seek care; 5.0% versus 10.2% were men who have sex with men). However, they were equally likely to have sexually transmitted infections (STIs) diagnosed (23.3% versus 24.8%). As GP-LESSH may operate infrequently, local services must work collaboratively to ensure that those seeking care for suspected STIs receive it promptly. Failing to do so facilitates avoidable STI transmission

'Selling it as a holistic health provision and not just about condoms ?' Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in - or closely linked with - schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop 'young people friendly' services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision - and inter-professional collaboration - in a climate where, in many schools, there is still considerable ambivalence about discussing 'sex' openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools

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

How much do delayed health care seeking, delayed care provision and diversion from primary care contribute to the transmission of STIs

Objectives: To explore the changing pattern of condom use from 1990 to 2000; to identify sociodemographic and behavioural factors associated with condom use; and reasons for condom use in 2000. Methods: Large probability sample surveys administered among those resident in Britain aged 16–44 (n = 13 765 in 1990, n = 11 161 in 2000). Face to face interviews with self completion components collected sociodemographic, behavioural, and attitudinal data. Results: Condom use in the past year among sexually active 16–24 year old men increased from 61.0% in 1990 to 82.1% in 2000 (p<0.0001), and from 42.0% to 63.2% (p<0.0001) among women of the same age, with smaller increases among older age groups. Among individuals reporting at least two partners in the previous 4 week period, approximately two thirds reported inconsistent or no condom use (63.1% (95% CI 55.9% to 69.8%) of the men and 68.5% (95% CI 57.6% to 77.7%) of the women). Conclusions: Rates of condom use increased substantially between 1990 and 2000, particularly among young people. However, inconsistent condom use by individuals with high rates of partner acquisition may contribute significantly to the recent resurgence in STIs. This group is an important target for intensive and specific sexual health interventions

Life is sexually transmitted: Live with it

This article explores issues of sexual health relevant to client care that is, could, or should be offered by nurses in general practice. Sexual health is often the most important element of a person’s holistic health and well-being to be overlooked during consultations. Sadly, some professional carers consider it is not their job, is too embarrassing, morally ‘problematic’ or outside their area of expertise. Sexual health is part of life: not to address it means that health professionals fail to fully address all aspects of their clients’ holistic health and well-being. The result is selective or reduced—not holistic—care. This article will point to ways for practice nurses to remedy this situation

An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

Background: It was alleged that the termination of pregnancy (TOP) services in a certain district health facility were forgoing the opportunity to offer screening tests for human immunodeficiency virus (HIV) and syphilis for women seeking legal medical abortions. In addition, there were concerns regarding the lack of provision of contraceptive services, particularly in view of media reports of young women having repeated TOP procedures as a family planning method. It was therefore decided to perform an audit of the TOP services at this district health facility.Method: A semi-structured questionnaire was used to obtain information from all women undergoing a TOP during a sixmonth period at a district hospital in KwaZulu-Natal. Demographic information, clinical details and attitudes towards TOP were obtained. All women were interviewed in private prior to discharge from the clinic.Results: A total of 645 women were enrolled. Their mean age was 23 (range 15-44) years and 437 (67.8%) were primiparous. Of the 645 women, contraceptive failure (condom) occurred in 38 cases (6%). Two hundred and twenty-two (34.4%) had previously used a family planning method, the most common being depot preparations (35.1%), followed by condoms (28.9%) and oral contraception (15.8%). One hundred and nine (16.9%) women accepted the condoms offered while the remainder indicated that they would obtain contraceptives from the family planning clinic in their area of residence. Twentynine (5%) had at least one previous TOP while 25 (86%) and four (14%) had second and third requests for TOP respectively. None of the women had any serological screening tests performed or were given information about testing for sexually transmitted diseases, including HIV screening, prior to discharge from the clinic.Conclusion: Women having TOP at this district hospital are not offered counselling and information on screening for sexually transmitted diseases. In addition, few women take up the offer of contraceptives. There is a need for health care providers to strengthen reproductive health services at TOP clinics.Keywords: surgical termination of pregnancy, contraception, unwanted pregnancy, Durban, South Afric

Mihin eksyi haikara? : Yliopisto-opiskelijoiden mietteitä perheen perustamisesta

Opinnäytetyömme tavoitteena on auttaa Tampereen toimipisteen Ylioppilaiden terveydenhoitosäätiötä (YTHS) kehittämään perhesuunnitteluun liittyvää neuvontaa. Tarkoituksena on selvittää tamperelaisten yliopisto-opiskelijoiden tietämystä ja asenteita perhesuunnitteluun liittyvistä asioista. Työmme toteutettiin yhteistyössä Ylioppilaiden terveydenhoitosäätiön kanssa. Työmme on laadullinen ja hankimme aineistomme kahden ryhmähaastattelun avulla, joissa käsittelimme ennalta määrittelemiämme teemoja. Haastattelimme nais- ja mies-ryhmät erikseen. Aineiston analyysissä käytimme sisällön analyysiä. Tutkimustulostemme perusteella yliopisto-opiskelijat useimmiten siirtävät lasten hankintaa hedelmällisyysiän loppupäähän taloudellisen tilanteen, parisuhteen, vapaan nuoruuden, keskeneräisten opintojen ja uran luomisen takia. Toisaalta lasten hankintaa saattaa siirtää miesten osalta myös tietämättömyys naisten hedelmällisyysiästä. Naiset sen sijaan suhtautuivat positiivisemmin lasten hankintaan opiskeluaikana. Yliopisto-opiskelijat haluaisivat enemmän lisääntymisterveyden edistämiseen liittyvää terveysneuvontaa, joka tavoittaisi paremmin myös miehet. Jatkossa lisääntymisterveyden edistämiseen liittyvää tutkimusta voisi kohdistaa opiskeluterveydenhuollon terveydenhoitajiin ja lääkäreihin. Opinnäytetyömme kehittämistehtäväksi muodostui Terveydenhoitaja-lehdessä julkaistava artikkeli, jonka tarkoituksena on laajentaa lisääntymisterveyden edistämisen näkökulmaa.Our thesis aims to help Tampere Finnish Student Health Service (FSHS) to develop their guidance on family counseling. The goal is to study and examine the knowledge and attitudes of University level students about the matter. This work has been down in cooperation with Finnish Student Health Service. Our study is qualitative and the data were gathered through two group interviews. In those two Interviews we dealt with pre-defined themes. The first group consisted of women and the other of men. The data analysis was done by contents analysis. The results of our study show that students postpone foundation of family because of the economic situation, or in order to spend a free youth, or they just simply want to graduate before or to achieve first a certain level in their careers. On the other hand, some of men are not aware of women’s fertility age, which can also be a reason that causes men to have children later. Moreover, women were more open to the idea of having a baby while studying. Both female, but especially male students were willing to hear more about reproduction and matters concerning reproduction. Further approaches to the subject could be to examine the Student Health Service’s doctors’ and public health nurses’ views on the current subject. Our development mission was an article in magazine Terveydenhoitaja, on which we try to expand the view of reproductive health

"We can still live a positive life" : The experience and impact of community support for people living with HIV

Non peer reviewe

‘We view that as contraceptive failure’: Containing the ‘multiplicity’ of contraception and abortion within Scottish reproductive healthcare

AbstractWithin contemporary Scottish policy guidance, abortion is routinely configured as evidence of a resolvable problem with the healthcare provision of contraception. This article draws on 42 semi-structured interviews with Scottish health professionals conducted during 2007–2008, in order to explore how, and in what form, realities of contraception/abortion are sustained within abortion practice. In addition to providing empirical insights concerning this sociologically neglected aspect of reproductive healthcare, it demonstrates how a novel conceptual approach could be used to develop existing social scientific analyses of the provision of techniques of fertility prevention. Science and Technology Studies (STS) has highlighted the importance of studying the complex socio-material practices through which realities are enacted (or ‘performed’). Mobilising this insight, my analysis illustrates the complex socio-material work required to enact abortion as evidence of a ‘problem’ with contraception that is resolvable within the healthcare consultation. This work, I argue, renders visible the ontologically ‘multiple’ (Mol, 2002) nature of contraception/abortion, with important implications for both social science and policy approaches to these techniques of fertility prevention