Attitudes of women in Scotland to contraception: a qualitative study to explore the acceptability of long-acting methods.

Background And Methodology: Long-acting reversible contraception (LARC) (i.e. injections, implants and intrauterine methods) has the potential to reduce unintended pregnancies but in the UK these methods are under-used.

Effect of depot medroxyprogesterone acetate on bone density in a Scottish industrial city.

Objective: To determine if long-term users of depot medroxyprogesterone acetate injectable contraception (DMPA) were more likely than their peers to have low bone density.

Design: Cross-sectional observational study.

Setting: The Domiciliary Family Planning Service, Glasgow, Scotland.

Low literacy: a hidden problem in family planning clinics.

Objectives: Low literacy is highly prevalent among UK adults. This study assessed functional health literacy among family planning clinic clients and whether this was associated with sexual health knowledge and behaviours. It also assessed the readability of patient leaflets.

Risk of pregnancy and external validity in clinical trials of emergency contraception.

Objectives: To compare women who enroll in emergency contraception (EC) trials to those who decline and to understand why eligible women decline to participate.

Methods: Data were collected from all women seeking EC (n = 5,787) at three clinics in the USA and UK during a period of nearly 1 year (from September 1997 to August 1998). The main outcome measures were pregnancy risk calculated by adjusted cycle day of ovulation.

Recording what happens in the under-16 consultation.

Background: Clinical staff offering sexual health services to young people need to balance the rights of the young person to confidentiality and good quality advice with the need to protect their wider interests. The needs of young clients may be complex and raise ethical and medico-legal questions for the staff involved in their care.

Methods: In our large, integrated sexual health service, a 'recording form' was introduced to prompt staff to record data systematically pertinent to consultations in clients under 16 years of age, to understand what kind of presentations dominate in these consultations, and to establish how common child protection concerns are.

What do clients of a young people's sexual health service recall about their sex education programme at school?

Objectives: To assess young people's recall of school-based sexual health education.

Methods: Clients attending The Place, an open-access sexual health service for young people, were asked to recall whether they had received teaching on key areas of sex education outlined in the Scottish Executive's draft Sexual Health and Relationship Strategy and Greater Glasgow NHS Board's guidelines for sex education in schools.Their responses were analyzed by age, sex, and type of school attended.

Uterine balloon therapy for menorrhagia: a feasibility study of its use in the community setting.

Objectives: To determine whether uterine balloon therapy (UBT) for menorrhagia can be performed safely in the community setting, obviating the need for hospital admission or general anaesthesia.

Design: Prospective case studies of 20 women undergoing Thermachoice endometrial ablation for menorrhagia.

Setting: Glasgow Centre for Family Planning and Reproductive Health Care, Greater Glasgow Primary Care NHS Trust, Glasgow, UK.

Use of a staff administered structured questionnaire to identify relevant life-style issues and social-health determinants in a sexual and reproductive health service.

Objective: To evaluate a staff-administered questionnaire to identify life-style issues and social-health determinants.

Design: Structured questionnaire administered by a health professional after dealing with the primary reason for attendance.

Setting: Community-based UK sexual and reproductive health service.

A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings.

Objective: To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings.

Methods: The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge.

A comparative study on the effects of a contraceptive vaginal ring NuvaRing and an oral contraceptive on carbohydrate metabolism and adrenal and thyroid function.

Objectives: To compare carbohydrate metabolism, adrenal and thyroid function during use of a combined contraceptive vaginal ring (NuvaRing, NV Organon, Oss, The Netherlands) with those of a combined oral contraceptive.

Methods: Healthy women aged 18-40 years used either the vaginal ring, delivering 15 microg ethinylestradiol and 120 microg of etonogestrel per day, or a combined oral contraceptive containing 30 microg ethinylestradiol and 150 microg levonorgestrel, for six cycles. Each cycle comprised 3 weeks of use of the ring or the pill followed by 1 ring- or pill-free week.

Client perspectives on sexual health service provision.

Development of integrated genitourinary medicine (GUM) and family planning (FP) services must take into account the views and requirements of service users. As we strive to modernize sexual health services, various changes are being introduced, such as a policy of no microscopy for selected patients attending GUM clinics. In order to determine the views of our clients prior to implementation of change, we performed a qualitative study in our UK centre, which houses both FP and GUM.

Effect of hormonal emergency contraception on bleeding patterns.

Spotting following the use of emergency contraception is not unusual, nor is anxiety in women waiting to see if the treatment has worked. It is not known whether such spotting should bring worry or relief. We, therefore, wished to see if there was any correlation between bleeding pattern and treatment outcome.

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services.

Objective: To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services.

Methods: Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data.

Results: The integration of the three services led to a reduction in stigma associated with attending sexual health services.

Modifying the Yuzpe regimen of emergency contraception: a multicenter randomized controlled trial.

Objective: Emergency contraceptives can prevent unintended pregnancy after unprotected intercourse. The best-studied regimen ("Yuzpe") consists of ordinary combined oral contraceptives containing levonorgestrel and ethinyl estradiol. Women traditionally take one dose within 72 hours after unprotected intercourse, and a second dose 12 hours later.

Estimating the effectiveness of emergency contraceptive pills.

Objective: We use new estimates of conception probabilities by cycle day of intercourse, where cycle day is measured with day 1 being the first day of bleeding in a cycle, to propose a new approach for estimating the effectiveness of emergency contraceptive pills (ECPs). We use this new approach to examine the absolute effectiveness and the cost-effectiveness of ECPs and whether ECPs are more effective the sooner after unprotected intercourse they are initiated.

Methods: Using the new set of conception probabilities, we employ data from two recent clinical trials of ECPs, one from the Population Council and the other from the World Health Organization (WHO), to examine the effectiveness of the combined ECP regimen.

The Sandyford Initiative: creating added value to health and health care.

The Sandyford Initiative in Glasgow brings together Family Planning, Genitourinary Medicine and the Centre for Women's Health in a new partnership which aims to provide integrated health and social care in a manner which reflects a social model of health. The Steve Retson Project for Gay Men's Sexual Health is also situated within the Sandyford, providing clinical services within the context of a social model of health. The Initiative is managed by the Greater Glasgow Primary Care NHS Trust but has been developed as a result of joint working between three main services, Greater Glasgow Health Board, Glasgow City Council and a number of voluntary organisations.

Evaluation of a young person's sexual health service in a commercial setting.

Objective: To determine the acceptability and accessibility of a sexual health service for young people in a city centre pharmacy.

Design: Prospective qualitative survey of clients attending a new sexual health service, including client characteristics and semi-structured interviews.

Participants: Clients attending the service between January and May 1999.

Public and private collaboration in establishing a young person's sexual health clinic in a commercial setting.

Objective: To define the key factors and constraints in public-private sector collaboration in establishing and delivering a young person's sexual health clinic within an existing commercial establishment.

Consultation, Planning And Implementation Phases: Consultations were held between the Health Promotion Department, family planning and commercial outlets, resulting in the establishment of the UK's first sexual health service within commercial premises. Once the clinic had been operational for 6 months, a single researcher carried out semi-structured interviews with 13 staff representing all levels within the partner organisations.

Assessment of compliance with a weekly contraceptive patch (Ortho Evra/Evra) among North American women.

Objective: To determine compliance with the contraceptive patch (Ortho Evra/Evra) overall and by age among women in North America and to compare rates of perfect use with those of an established oral contraceptive.

Design: Data were pooled for three contraceptive studies in which women participated for up to 13 cycles; the subset of centers in North America was used in this analysis.

Setting: 76 North American centers.

Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening.

Objectives: To investigate the psychosocial impact for women of a diagnosis of Chlamydia trachomatis and discuss the implications for the proposed UK chlamydia screening programme.

Design: Qualitative study with semistructured interviews. Interview transcripts analysed to identify recurrent themes.

Outcomes in action: how relevant to clinical practice are health outcome measures such as the rate of unintended pregnancies in young teenagers?

Scientific evidence shows that correct contraceptive use will prevent unintended pregnancy and the provision of contraceptives is recognized as a cost-effective intervention. This could encourage health authorities to keep investing more resources in family planning until the target rate of unintended pregnancies is reached, but if this was the only approach taken, the target rate never would be reached. Clinicians and their public health colleagues need to examine their practice in the light of all available evidence.