You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Jaydess

6 Apr, 14 | by shaworth

Intrauterine systems delivering progesterone to the endometrium have been in use in the UK for some time. Most of us will be familiar with Mirena (Bayer), a system containing 52 mg levonorgestrel which can be used for five years. This month, a new intrauterine system was launched: Jaydess®, also produced by Bayer.

Jaydess® measures 28x30x1.55mm, and contains 13.5 mg of levonestrogel. Unlike its predecessor, it is licensed only for contraceptive use at the moment, and needs to be replaced after three years of use; however, it has a narrower insertion tube (3.80mm vs 4.75mm) and a slightly smaller frame, which may be of value in women with a stenosed cervix, or in nulliparous women. In comparison, a Pipelle is 3.1mm in outside diameter. In Bayer’s phase II, single blinded trials, slightly less cervical dilatation was needed for the Jaydess insertion and more women reported no pain on insertion in comparison with Mirena.

For those wishing further information, the product characteristics can be found at the MHRA  webpage.

 

European Society of Contraception Expert Group and Committee Vacancies

4 Apr, 14 | by shellraine, e-Media Editor

If you are interested in taking a more active part in the European Society of Contraception and Reproductive Health, then why not apply for one of these groups or committees?
http://www.escrh.eu/call_for_applications_committees_and_groups

Expert groups are groups of internationally recognized experts in different fields of contraception and reproductive health. Currently established groups:

  • Expert Group on Sexual and reproductive health and education
  • Expert Group on STI
  • Expert Group on Abortion
  • Expert Group on Hormonal contraception
  • Expert Group on Non-hormonal methods of contraception

NOTE:  you must have paid your 2014 subscription before you apply.
Closing date to apply:  1 May 2014

Jo’s Cervical Cancer Trust-new information, surveys and an online app

4 Apr, 14 | by shellraine, e-Media Editor

1.     Surveys: – Costs of cervical cancer and Sex & intimacy after cervical cancer treatment

In an effort to increase cervical screening uptake and reduce cervical cancer incidence Jo’s Cervical Cancer Trust is working to explore the impact that having cervical cancer can have on peoples’ income and wider financial situation, including additional spending, and producing information about sex and intimacy after treatment for cervical cancer.

They are looking for women who have been through a cervical cancer diagnosis to take part in 2 surveys; on the financial impact of cervical cancer; and about long term side effects related to sexuality and sexual function after treatment.

More information can be found on the website: http://www.jostrust.org.uk/support/research/cost-cervical-cancer-survey

2.    New online app created to raise awareness of cervical screening – Put Yourself In The Picture

Annually one in five UK women do not take up their cervical screening invitation and uptake is now on the decline. The Put Yourself In The Picture app aims to get people talking about cervical cancer and encourage women to pledge to attend a cervical screening which could save their life.

Find out more: http://www.jostrust.org.uk/selfie

3.    New information online and printed

 Four new miniature additions to information publications.

These mini fact sheets provide information on: human papillomavirus (HPV), cervical screening, abnormal cervical screening results, and being diagnosed with cervical cancer.

They complement the original mini on cervical cancer – the facts. They are credit card sized and ideal for women to pick up discretely to read when they’re ready.

New Guidance For Young People At Risk

3 Apr, 14 | by shaworth

A joint document designed to help healthcare professionals identify young children who may be at risk of sexual exploitation has been launched today. The project, Spotting The Signs, was funded by the Department of Health and produced by BASHH (the lead professional representative body for those managing STIs and HIV in the UK) and Brook (a charity which provides sexual health services for young people) . The document is a pro-forma, aimed at those working in sexual health services and is designed to be used within existing social and sexual health history frameworks, supporting professionals to engage young people in conversations about their risk of sexual exploitations.

Based on current research and evidence, the document assists professionals in indentifying circumstances and behaviours which be concerning, and reminds us about the dangers of assumptions based on the stereotypes we hold of certain social groups and cultures. The project was developed through consultations with young people.

The proforma was written by Dr Karen Rogstad of BASHH and Georgia Johnston of Brook. Dr Karen Rogstad is a  Consultant in HIV and Sexual Health at Sheffield Teaching Hospitals NHS Foundation Trust, and previously chair of the BASHH Adolescent Special Interest Group “This is the first national proforma to be developed which covers all sexual health providers working with young people, and that has been developed with young people’s input. It is particularly valuable because of the range of services that have evaluated it, including General Practice, and its endorsement by a wide range of organisations.  I hope it will help in identifying those young people who are being exploited as well as those who may be at risk in the future.”

Spotting the Signs is available to download from Brook and BASHH’s websites. It can be used alongside existing Brook guidance documents such as the traffic light toolkit which helps identify behaviours which may be cause for concern.

 


30 Mar, 14 | by shaworth

For those of you following the increasing restrictions on abortion providers and access to abortion in the US, the ongoing events in Texas will not come as much of a surprise. Abortion is a highly politicised issue in the United States, and perhaps nowhere more so than Texas, which has been the location of many abortion-related flashpoints in the last fifty years.

Abortion was legalised in the US in 1973, after the case of Roe vs Wade. Jane Roe was the pseudonym of Norma McCorvey, a Texas resident, who challenged the court for her legal right to terminate her pregnancy. The supreme court of the US voted that this was a private matter for the women seeking abortion, and as such was protected under the 14th amendment of the US constitution, which decrees the right to personal liberty.

After Roe vs Wade, individual states have brought in their own legislation to restrict access to abortion, in some ways reflecting the devolved differences in accessing abortion in the United Kingdom.

In Texas, abortion and politics related to abortion have flared up again recently, as the state government attempts to bring in laws that restrict the workings of clinicians and centres that provide abortions, despite opposition from ACOG and AMA. The restrictions include insistence that the physicians must have admitting privileges to a hospital, and restricts where medication for medical termination of pregnancy can be prescribed.

For pro-choice campaigners, these restrictions appear to be attempts to restrict and criminalise abortion through over-regulation. A third of centres providing termination of pregnancy services will close under the new laws, meaning that some Texas residents will need to travel hundreds of miles in order to procure an abortion.

Not all Texans are in favour of these measures and in June of last year, Senator Wendy Davis undertook an eleven hour filibuster to delay passage of the bill restricting access to abortion. Ultimately, this was unsuccessful; although it appears that Davis will now run for governor in the next election, and it’s likely that this will keep abortion related issues at the frontline of Texan, and American, politics for some time.

In the UK, we can think ourselves lucky that we live in a country with healthcare that’s free at point of access and comparatively liberal access to termination of pregnancy services; however, there is still huge disparity in access to termination of pregnancy in the UK, with abortion in Northern Ireland remaining highly restricted. We in mainland UK might consider our healthcare system to be superior to that of the US, but when we consider that a woman in Texas has more freedom to choose an abortion than her counterpart in Belfast, perhaps we are on very shaky ground indeed.

 

BPAS: Call for Mandatory Fortification of Flour

20 Mar, 14 | by shaworth

The British Pregnancy Advisory Service (BPAS) released a statement yesterday advising that flour in the UK should be fortified with folic acid as a public health measure to reduce the incidence of neural tube defects, such as spina bifida, in developing pregnancies.

 

The UK has one of the highest rates of spina bifida in the EU, and the rate has remained static for thirty years. The effects of the condition vary depending on the defect itself. If the neural tube fails to close, it can result in anencephaly, where the skull and brain do not form: a fatal condition. Other variations of the condition can result in lifelong disability.

 

That folate supplementation reduces the incidence of neural tube defects, but in order to be effective, folate supplementation must be initiated before a women realises that pregnancy has occurred, as the critical period for neural tube defects occurs in the first two weeks, before a missed period occurs. Seven years ago, the Scientific Advisory Committee for nutrition endorsed mandatory flour fortification with folic acid, and this was approved by the chief medical officers. Countries which have already introduced this measure, such as Canada, have already seen a fall in the incidence of neural tube defects.

 

BPAS is a charity that advocates reproductive choice, aiming to reduce the incidence of unwanted pregnancy with the use of contraception and offer the choice to end them with abortion. They treat more than 60,000 men and women each year. Ann Furedi, chief executive of the BPAS, said:

 

“Unplanned pregnancy‘s a fact of life and often a wonderful and welcome surprise, but it‘s unrealistic to expect women to be taking folic acid supplements on the basis that they might conceive. The fortification of flour with folic acid‘s a straightforward public health intervention which could spare hundreds of women every year from the painful decision to end a wanted pregnancy after a diagnosis of a neural tube defect.

 

“Many politicians problematize abortion but show little interest in addressing some of the issues which result in a woman needing to end a pregnancy. Whatever our differences on abortion, we should all be able to unite behind a simple measure with huge benefits. We call on the UK‘s health ministers to make the necessary changes to protect the health of pregnant women and their babies and we urge them to do this as a matter of urgency.”

 

In the meantime, healthcare professionals involved in the provision of family planning and sexual health should be aware of the recommendation for 400mcg of folic acid to be taken preconceptually in low risk women who wish to become pregnant, and that high risk women: women with diabetes, women with a neural tube defect themselves or with a previous affected pregnancy, women with coeliac disease, women with a BMI greater than 35 and women taking folate antagonist drugs such as sodium valproate, should taken 5mg of folic acid whilst attempting to conceive.

 

Vacancy: Editor-In-Chief

17 Mar, 14 | by shaworth

Since the passing of Anne Szarewski, the Journal has been stewarded by David Horwell temporarily. We are now seeking to appoint a permanent Editor In Chief.

The full job advert can be found on the FSRH pages, along with the role of the Editor In Chief.

The closing date for applications is the 2nd of May 2014.

Commission On Sex In Prison

2 Mar, 14 | by shaworth

The Howard League For Penal Reform is a charity dedicated to improving prisons, the justice system and crime prevention. As part of their work, they commission research into aspects of life in the prison system and one of their ongoing concerns is the Commission on Sex in Prison which is the first large scale review of sex in prisons in England and Wales.

As prisons are deemed public places, sex in prison is technically unlawful, but previous research suggests that sexual activities are undertaken in the prison environment. There is little evidence on how to best manage the sexual health needs of prisoners, or how relationships developed in prisons should be managed within the prison system.

So far, two interim reports from the Commission have been produced. In 2013 they released their first report on Consensual Sex Amongst Men In Prison and in the last week, have released their first report on women prisoners entitled Women In Prison: Coercive and Consensual Sex. Further reports on coercive sex in prison and healthy sexual development in prison are planned in the future.

The report makes valuable reading. According to the Howard Leagues own statistics, this week in the UK there are 85,469 people in prisons and young offender institutions in England and Wales. This is made up of 81,521 male prisoners and 3,948 female prisoners. 1,229 children are currently in custody, with the split on gender being highly skewed towards the male population, with only 65 girls in this population. Although only 0.002% of the adult population is in prison custody, this population changes over time, with offenders being released after serving their sentence. It is probable that medical professionals will provide healthcare for not just those in prison, who access secondary care through the NHS, but also those who have been released or currently progressing through the justice system. It is therefore important that care providers are familiar with the special needs of prisoners and a detailed report on sexual behaviour in prison is valuable to us.

The most recent report makes harrowing reading in places, detailing the high levels of sexual abuse experienced by women offenders prior to detention, and the risk of sexual assault for those remanded in custody from the prison population, including the specific risk of assault from other prisoners to locate drugs concealed internally, and evidence for coercive sexual activities between staff and prisoners. The report highlights that the sexual health needs of women and men are different, and that specific guidance on relationships between women in prison for staff is required.

The final findings of the report will not be revealed for some time yet, and hopefully will go some way to assisting us professionals in providing better care for this particular group.

NICE PGD good practice guidance implementation tools

29 Jan, 14 | by shellraine, e-Media Editor

NICE has published competency frameworks to support the implementation of patient group directions NICE good practice guidance. The competency frameworks have been produced as developmental tools to support individual people and organisations and may help to:

  • identify training and competency needs
  • develop educational materials
  • establish a comprehensive and appropriate training programme
  • facilitate continuing professional development
  • inform the development of organisational systems and processes.

Three competency frameworks have been produced:

The competency frameworks are available to download under ‘Implementation tools and resources’ on the patient group directions guidance page:  http://www.nice.org.uk/mpc/goodpracticeguidance/GPG2.jsp.

The competency frameworks have been developed to support individuals and organisations commissioning or providing NHS services. They may also be relevant to individual health professionals and organisations delivering non-NHS healthcare services.

In The News: The Risks of ISP Filtering for Young People

19 Jan, 14 | by shaworth

The idea of how to police the internet has always been a complex one, and striking a balance between protecting those who use it, in particular those who are not yet adults, remains something that we have not achieved. The idea of restricting what ISP (Internet Service Provider) subscribers can be allowed to access has been debated as long ago as the turn of the century, and over the last fifteen years we’ve watched our legal system frantically try to modernise to keep up.

Most recently, the Prime Minister David Cameron announced plans to make filters blocking adult material to be the default experience for ISP subscribers. Predictably, this has not gone as planned, and in December there was widespread media coverage of mistakenly blocked websites restricting the subscribers access to sex education, and the websites of several LGBT organisations. Oddly enough, this was an improvement from the prior attempt to turn on the filters which blocked access to Childline, and suicide prevention websites.

Many healthcare professionals will have experience of filtering and blocking, and some of you may well have had the unfortunate experience of phoning your IT service attempting to convince them that you’re not in violation of their policies, but just doing your job. This blogger had the misfortune to be on call one weekend, when the employing trust’s filter reset itself to the full default settings, rendering access to all abortion related content impossible. This was rectified as soon as IT were back in office, but children wishing to access impartial advice about sexual health, seeking help and advice about relationships or worse, those in crisis who need urgent access to information to keep themselves safe, may not have that option.

Latest from JFPRHC

Latest from JFPRHC