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International

US Judge orders FDA to make Morning-After Pill available over the counter for all

9 Apr, 13 | by shellraine, e-Media Editor

 Judge Strikes Down Age Limits on Morning-After Pill

Plan B

A federal judge has ruled that the Unites States government must make the most common morning-after pill available over the counter for all ages, instead of requiring a prescription for girls 16 and under. The New York Times reported that the decision, on a fraught and politically controversial subject, comes after a decade-long fight over who should have access to the pill and under what circumstances, and it counteracts an unprecedented move by the Obama administration’s Health and Human Services secretary who in 2011 overruled a recommendation by the Food and Drug Administration to make the pill available for all ages without a prescription.

April Journal – 20th Anniversary of the FSRH

9 Apr, 13 | by shellraine, e-Media Editor

Hightlights from this edition include:

The FSRH’s 20th anniversary

It is 20 years since the establishment of the Faculty of Sexual and Reproductive Healthcare (FSRH). In celebrating its anniversary there is much to be proud of, and indeed Community Sexual and Reproductive Health is now a specialty in its own right. Readers should find the story of the birth and rise of the specialty interesting and some will be reminded of ‘old times’, while looking ahead to a bright future. See page 78

Does HRT cause breast cancer? Part 5

Shapiro and colleagues conclude the interesting and enlightening series of articles looking at the evidence around hormone replacement therapy (HRT) and breast cancer risk (page 80). The final part examines the evidence for there being a declining trend in breast cancer incidence as HRT use reduced. Although the two are widely held to be related, they conclude that it is not possible to say either way. In the accompanying
Commentary (page 72), Nick Panay reviews the whole series of five articles and reminds us that optimising the lives of millions of women going through the menopause should be our priority. See pages 72 and 80

COCs and the risk of VTE, ATE and cardiovascular death

Syd Shapiro provides another of his incisive reviews of the latest database study of the combined pill and venous (VTE) and arterial (ATE) thromboembolism risk. Unsurprisingly, he finds many of the same problems as in the other studies, and asks the question why do these studies keep being done badly when the methodological flaws have been so well established? See page 89

“Anything for the weekend – and beyond, madam?” Community pharmacies increase OC uptake

Parsons et al.‘s evaluation of a community pharmacy delivered oral contraceptive (OC) service in South-East London is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Specially trained pharmacists provided OCs under a patient group direction (PGD), and subsequent evaluation showed that these pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need.  See page 97

There’s a tale in this sting – The policing of abortion services in England

What was the background to last year’s Care Quality Commission inspections of all English abortion services? Why were medical and nursing colleagues reported to their regulatory Councils and why is a Metropolitan Police investigation still ongoing? Sam Rowlands’ commentary provides a fascinating and detailed account of the regulatory framework of abortion services in England and the unexpected consequences of a national newspaper’s ‘sting’ operation on certain clinics in February 2012. It suggests that the regulation of abortion goes further than the Law requires and that this is now out of step with progress in abortion practice, leading to unnecessary restriction for women with unwanted pregnancies in accessing the support they need. See page 121

Role of ambulatory hysteroscopy in reproduction

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review aims to summarise the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation. See page 127

LAM: why ignore this useful option?

In this interesting personal view article, the authors explore and elaborate on the reasons why health care providers and the public are hesitant in recommending/adopting the lactational amenorrhoea method (LAM), a valuable short-term postnatal contraceptive option. These include ignorance about the LAM criteria for correct use, mistrust of the method’s effectiveness despite a strong evidence base, inconsistencies in the advice given to breastfeeding women in the UK by health practitioners and public bodies (e.g. the National Health Service, Royal College of Obstetricians and Gynaecologists), and lack of awareness about potential benefits. See page 136

Internet: good or bad?

2013 marks the 30th anniversary of the Internet. Our Consumer Correspondent looks at whether this technological miracle is a ‘good idea’ for the health profession. See page 139

New subcutaneous DMPA injection

Sharon Cameron discusses the new subcutaneous injection of depo-medroxyprogesterone acetate (DMPA), Sayana® Press, which is soon to be released onto the market in the UK. It seems to be very similar to the intramuscular DMPA, but can be self-administered. Unfortunately, this advantage is not being utilised, as this contraceptive method is not yet licensed for self-administration in the UK. See page 75

Psychosocial factors affect semen quality

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. See page 102

The ‘Woman’s Condom’ – will the Chinese go for it?

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of multipurpose prevention technologies, including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman’s Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. See page 111

Sexual health improvement framework, comments and other News

22 Mar, 13 | by shellraine, e-Media Editor

A Framework for Sexual Health Improvement in England’ sets out the government’s ambitions for improving sexual health.

Designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. This includes the need for:

  • a fall in the number of unwanted pregnancies
  •  greater efforts to prevent STIs and HIV
  •  an increase in the number of people in high-risk groups being tested for HIV
  • building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex
  • making sure that all people have rapid and easy access to appropriate sexual health services
  • offering counselling to all women who request an abortion so they can discuss the options and choices available with a trained counsellor

Responses to ‘Framework for Sexual Health Improvement’.

 The Sex Education Forum, based at leading children’s charity The National Children’s Bureau, welcomed the publication of the government’s strategy for improving sexual health and its focus on preventative measures, such as good quality sex and relationships education (SRE). However, more needs to be done to ensure all schools step up to the mark, in providing the information, support and advice that children want and need.

FPA welcomes the Government’s long-overdue publication of its Framework for Sexual Health Improvement in England document, which finally provides guidance to local government to help ensure that the nation’s sexual health improves.

Although we support the Government’s formal endorsement of the need to improve areas of sexual health like sexually transmitted infection (STI) and teenage pregnancy rates, we are acutely aware that there is absolutely no guarantee that local councils will actually act on this guidance.

We know from our Unprotected Nation report, released in January, that if the situation worsens, and local government chooses not to invest in sexual health services, the additional cost to the economy is likely to be over £135 billion over the next few years.

Brook

Responding to the publication of A Framework for Sexual Health Improvement in England Simon Blake OBE, Brook’s Chief Executive, said:

“We are pleased that the Framework for Sexual health has been published just in time for the move to local authorities and that there are clear aspirations for the improvement of young people’s sexual health, in particular that all young people have access to confidential services and support.

“We are also pleased to see the ambition that all children and young people should receive good quality Sex and Relationships Education (SRE) at school which we know is vital in preventing abuse and exploitation and promoting positive relationships. However, this ambition will never be realised whilst the Department for Education fails to ensure that every school is required to deliver a comprehensive programme of SRE.

“As we move towards 1st April we look forward to working local authorities to realise these ambitions and improve young people’s lives.”

FAMILY PLANNING 2020 names Director of the global partnership

The Family Planning 2020 (FP2020) Reference Group announced that long time global advocate for family planning and reproductive health Valerie DeFillipo has been named Director of the global partnership. FP2020 builds on the partnerships launched at the London Summit on Family Planning. It will sustain the momentum from London and ensure all partners are working together to achieve and support the goals and commitments announced at the Summit.

 

Depo-Provera does not increase fracture risk.

27 Feb, 13 | by shellraine, e-Media Editor

Results from a new study published in the March issue of Obstetrics and Gynaecology demonstrate that the use of depot medroxyprogesterone acetate (DMPA) does not appear to increase fracture risk. Whilst the use of DMPA reduces serum oestrogen levels and is associated with significant loss of bone mineral density (BMD), this study shows that it does not appear to have an effect on fracture risk.  In addition although DMPA users had higher fracture risk than non-users, the risk did not increase after starting DMPA but was similar to before it was initiated.

The retrospective cohort study by Lanza et al1 of 312,395 women, who had had 11,822 fractures, was designed to assess the extent to which DMPA increases fracture risk. Using data from the General Practice Research Database, the study compared fracture incidence in DMPA users with women using non-DMPA hormonal contraceptives. It also investigated fracture incidence before and after initiation of contraceptive use. The study reported that before contraceptive use started, DMPA users had a higher fracture risk than non-users (incidence rate ratio [IRR] 1.28; 95% confidence interval [CI] 1.07-1.73). After use began, crude fracture incidence was 9.1/1000 person-years for DMPA users and 7.3 for non-users (crude IRR 1.23; 95% CI 1.16-1.30). Fracture risk in DMPA users did not increase after starting DMPA  (IRR after/before 1.08; 95% CI 0.92-1.26). Fracture incidence was 9.4/1000 person years in low exposure DMPA users, and 7.8/1000 in high-exposure DMPA users. DMPA users had a higher fracture risk than non-users at the start of contraceptive use, with no discernable induction period.

Commenting on the results Professor Anna Glasier, Honorary Professor of the University of Edinburgh and the London School of Hygiene and Tropical Medicine, said “This study confirms what others have shown, that women who use Depo-Provera® appear to have a modest increase in fracture risk compared with women using other contraceptive methods. Importantly however, in this UK population the increased risk of fracture preceded the start of Depo-Provera®. The difference in fracture risk was mainly in fractures associated with trauma rather than those typical of osteoporosis. Further research is indicated to explore behavioural differences among populations of women choosing to use different contraceptive methods.”

1. Lanza L. et al. Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture. Obs and Gynae. 2013; 121(3):593–600.

Journal Online First

13 Feb, 13 | by shellraine, e-Media Editor

The following Online Firsts have been published

Does a full bladder assist insertion of intrauterine contraception?: a randomised trial (Cameron, Glasier, Cooper,  Johnstone)

Cameron and colleagues set out to answer a simple question: does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful.

Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives (Briggs, Praet, Humphreys, Zhao)

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHC). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had Category 3 or 4 risk factors, particularly BMI ≥35. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower risk alternatives.

Understanding barriers to sexual health service access among substance-misusing women on the South East coast of England (Edelman, Patel, Glasper, Bogen-Johnston)

This interesting article explores why substance-abusing women have problems accessing SRH services in Hastings, UK. Drug use, low self-esteem and previous traumatic experiences all combine prevent women accessing help. This is a qualitative interview study and provides important insights into the care of these women; there are no easy answers but the authors have provided some suggestions as to how practitioners may make the service more accessible.

Coping after recurrent miscarriage: uncertainty and bracing for the worst (Ockhuijsen, Boivin, van den Hoogen, Macklon)

Pregnancy loss is a significant trauma for women, the more so if repeated.  In their study, Ockhuijsen and her colleagues investigated the ways in which women coped in the time after single and recurrent miscarriages and in the difficult period soon after conception while waiting for ongoing pregnancy to be confirmed. They found that coping strategies differed between the two groups of women and they investigated the use of a simple psychological support tool, the Positive Reappraisal Coping Intervention, that may be of help, particularly to those with greater concern for the future following recurrent miscarriage.

The role of ambulatory hysteroscopy in reproduction (Robinson, Cooper, Clark)

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review summarises the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation.

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK (Akintomide, Sewell, Stephenson)

What to do now? How women with breast cancer make fertility preservation decisions (Snyder, Tate)

A service-based approach to nurse training in sexual and reproductive health care (Shawe, Cox, Penny, White, Wilkinson)

Increasing male participation in the uptake of vasectomy services (Singh, Mishra, Alam, Pandey)

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia
(Abdala, Hansen, Toussova, Krasnoselskikh, Verevochkin, Kozlov, Heimer)

Plus Organisation Factfiles on Tommys and the College of Sexual and Relationship Therapists (COSRT) by Susan Quilliam and a letter to the editor “Learning from Romanian women’s struggle to manage their fertility” by Ann Furedi following the article in the January Journal

 

SRH News

28 Jan, 13 | by shellraine, e-Media Editor

Education for Choice hightlights misleading pregnancy counselling

Education for Choice support young people’s right to informed choice on abortion. They report that Feminist Action Cambridge held a demo in Cambridge city centre to raise awareness of local ‘crisis pregnancy centres’ which they feel are ‘using emotionally manipulative techniques’ and misinformation ‘in order to increase the guilt women might feel at having an abortion.’ They sent mystery shoppers to three counselling centres in Cambridgeshire and found that, at each one, women were being given some kind of false information about abortion and/or subjected to ‘counselling’ which was biased and often based on personal anecdotes.

New NICE Clinical Guideline: Ectopic pregnancy and miscarriage

This clinical guideline offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy and is available from NICE at: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=14000

The Morning After: A Cross Party Inquiry into Unplanned Pregnancy

2020Health.Org report that “Over half of unplanned pregnancies happen because people are not using sufficient contraception, according to a survey by a Cross-Party Parliamentary Inquiry.

Th inquiry, supported by 2020health, into unwanted pregnancies, highlights three main findings:
1.That a large proportion of unwanted pregnancies are happening because people are not using sufficient contraception;
2. That there is inadequate Sex and Relationship Education in schools; and
3. That there is a lack of access to contraception for over 25s.

http://www.2020health.org/2020health/Press/latest-news/Unplanned-Pregnancy-Report.html

 

ICEC

ICEC has relaunched its website with easily accessible information on all aspects of emergency contraception worldwide. The map of registration status of EC pills is particularly interesting as is the status and availability database

 

New IUS launched

Skyla, has gained FDA approval and is due to be launched in the USA next month – the first new device to come to market in 12 years.  Skyla contains 13.5 mg of Levonorgestrel and differs from Mirena in that it prevents pregnancy for 3 years rather than 5 and appears to be aimed at younger women who have not had children.

 

Capture

MEDFASH eBulletin

Read all the latest SRH news here

 

 

 

The remarkable story of Romanian women’s struggle to manage their fertility

17 Jan, 13 | by shellraine, e-Media Editor

 

As mentioned in the previous blog this remarkable story (Editor’s choice in this month’s Journal) documents what can happen when access to abortion is restricted. I include here the graph, from the paper, which shows this so well.

 

http://jfprhc.bmj.com/content/39/1/2/F1.large.jpg

Anne Furedi, Chief Executive of BPAS, writes, in response to the article,

The commentary by Horga et al.[1] on the consequences of Ceausescu’s attempt to ban abortion in Romania is a stark reminder of what happens when women are prevented from accessing safe and legal means to end problem pregnancies. continue at:http://jfprhc.bmj.com/letters

 

Some ‘Online Firsts’ and News

18 Dec, 12 | by shellraine, e-Media Editor

The following papers have been published at http://jfprhc.bmj.com/content/early/recent

The financial costs to patients of diagnosing and excluding ectopic pregnancy (Unger et al)

In their article, Unger and his colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This paper describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. from David Horwell, Advisory Editor

Despite the best intentions: a reflection on low client numbers for a pilot telemedicine sexual health service (Garrett & Kirkman)

This “Better Way of Working” article describes the outcome of a pilot of a telemedicine sexual health service for rural youth in Victoria, Australia. Despite expecting high client numbers, few used the service. This article explores the reasons for the disappointing usage, and concludes that clinicians’ expertise and passion for improving access to health care may not be enough to guarantee successful design and implementation of the most appropriate service. from Gillian RobinsonAssociate Editor

Uptake and continuation rates of the intrauterine system in a university student general practice population in the UK (Armitage et al)

This is a very simple real-life observational study of a cohort of young nulliparous women in a university-based general practice choosing and continuing with LARCs as their first line method of contraception. This paper compels the reader to offer this ‘fit and forget’ method of contraceptive to our younger population, of course along with all other forms of contraception, as a matter of routine. from Scott Wilkes, Associate Editor

Removal of a fractured Nexplanon® (Elliman)

In a letter to the editor Alyson Elliman describes removal of a partially fractured, curved implant with no obvious cause and asks if other clinicians have observed anything similar.

NICE Good Practice Guidance: Patient Group Directions is now under development.

This guidance is now in development and due to be published in April 2013

Stakeholder registration is now open.  To register your organisation as a stakeholder* send registration details (name of contact, name of organisation, email address) to pgd@nice.org.uk using the subject heading Patient group directions GPG stakeholder registration 2012/13

*for the purposes of this guidance stakeholders are:

  • national patient and carer organisations that directly or indirectly represent the interests of people whose care is covered by the guidance
  • national organisations that represent the healthcare professionals who provide the services described in the guidance
  • companies that manufacture the medicines or devices used in the area covered by the guidance and whose interests may be significantly affected by the guidance
  • providers and commissioners of health services in England, Wales and Northern Ireland
  • statutory organisations including the Department of Health, the Welsh Assembly Government, NHS Quality Improvement Scotland, the Healthcare Commission and the National Patient Safety Agency
  • research organisations that have done nationally recognised research in the area

See http://www.nice.org.uk/mpc/goodpracticeguidance/PatientGroupDirections.jsp for further information.

Philippine Government finally passes Reproductive Health Bill after 14 years.

This is a huge victory in the Philippines for access to maternal health services, family planning, and sex education. The reproductive health bill gives the national government the mandate to make reproductive health services accessible to poor families through information and education and the provision of free contraceptives.

 

 

World AIDS Day 2012 – News

30 Nov, 12 | by shellraine, e-Media Editor

“Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination” is the theme of World AIDS Day 2012 on 1 December. Life-saving antiretrovirals have reduced new HIV infections and deaths. The 2015 target of 15 million HIV-infected people on antiretroviral medicines worldwide looks more achievable now than ever before.

 

World AIDS Day – BMJ special promotion 

The BMJ Group is putting together a special promotional webpage for World AIDS Day on 1st December that will offer a week’s free access to all relevant content published by our full range of journals. Please click here for access

New resources for young people living with HIV 

To mark World AIDS day on the 1st of December, the Children and Young People HIV Network, based at leading children’s charity the National Children’s Bureau, is sending a message of support to young people with HIV by launching a range of materials to support them in managing life with the condition.

The ‘Your Life’ leaflets and the ‘Studying with HIV’ guidance and LifeLinks resources are all available from www.ncb.org.uk/hiv

More than Half of those with HIV in the UK are Overweight:  The Surprising Issues Facing Those Living with HIV

The British Dietetic Association (BDA) will once again be supporting World Aids Day on 1st December. Early data from the BDA’s DHIVA specialist group audit suggests that more than half of people living with HIV in the UK are overweight or obese, with only about one-in-nine being underweight.

In fact by far the most common issues facing HIV dietitians in the outpatient clinic these days are dyslipidaemia, hypertension, diabetes and osteoporosis, with over 75% of HIV patients Vitamin D deficient. Dealing with these issues is not as straightforward as it might seem, with HIV-specific barriers to lifestyle change emerging.

Members report common themes from their patients, including a fear that deliberate weight loss might lead to others guessing their HIV status (“why are you getting thin – you don’t have AIDS do you?”), and a feeling that being overweight is safer (“I remember how ill and thin I was before starting ARVs and I don’t want to go back there again”). from Alastair Duncan, Chairman of the BDA’s DHIVA (Dietitians in HIV/Aids) specialist group.

 

UNITAID welcomed the good news this World AIDS Day that the number of children newly infected with HIV continues to decline but urges the international community to step up efforts for those children already living with the disease. more from the website

    2012 UNAIDS World AIDS Day Report

 

 

HPV, HIV & UK Sexual Health Awards

2 Nov, 12 | by shellraine, e-Media Editor

Australia Adopts Herd-Immunity Approach in Fight Against HPV

On July 12, 2012, Australia took a stand to become the first country to provide coverage of the Gardasil® vaccine to boys between the ages of 12 and 13, through a National Immunization Program-sponsored school-based initiative. In her press release, the minister of health, Tanya Plibersek, stated that the government-sponsored initiative was targeted to synergize with the current immunization program in girls to decrease the incidence of human papillomavirus (HPV) infection in the Australian population.

Girls don’t see HPV vaccine as green light for sex

A study by Bednarczyk et al in Atlanta and published in Pediatrics has concluded that HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.

Nurses in Zimbabwe to prescribe HIV drug

Faced with the ambitious target of reaching 85 percent of people in need of HIV treatment by the end of 2012, the Zimbabwean government has announced that nurses will be trained to prescribe and manage antiretroviral (ARV) drug treatment. Experts welcomed the move but warned that nurses would have to be adequately prepared and supported to take on the additional duties. Previously, nurses were allowed only to administer the drugs after a doctor had prescribed them. Now, changes made in the job descriptions of nurses by the Nurses’ Council of Zimbabwe will see them prescribing the medication. Report from HIV/AIDS/Zimbabwe (HAZ)

UK Sexual Health Awards 2013

Nominations are invited in the following catergories:

  • Sexual health professional of the year.
  • JLS young person of the year.
  • Adult sexual health service/project of the year.
  • Pamela Sheridan young people’s sexual health service/project of the year.
  • Rosemary Goodchild Award for excellence in sexual health journal.
  • Sexual health media campaign/storyline of the year.
  • Durex community pharmacy award.

More information and nomination forms from fpa/Brook

Latest from JFPRHC

Latest from JFPRHC