bluuebunny/crossref_metadata_2025_split huggingface dataset:
P84 Where do babies come from? A man's understanding of women's health
Authors: Appleby M F , Allen F , Dowsing B , Rich H , Douglass P 
Published: May 2012

BackgroundAs part of a student selected study component, five male fourth year medical students sought to examine young men's knowledge of women's reproductive health. The importance of raising awareness of women's health must not be underestimated. Education of men in basic women's health could result in a significant reduction in unwanted pregnancy, misuse of contraception and domestic violence.Aim(s)/Objective(s)The research question was simple—was our ignorance representative of our peers, and specifically, in which areas was knowledge most lacking?Methods24 questions were chosen for simplicity, guided by the developers' own lack of knowledge. Respondents were male pre-clinical medical students (n=41) aged 18–21, with a smaller but representative female cohort (n=12) to be used for comparison.Results and DiscussionMale respondents' overall mean grade 48.3 % (SD 16.9%) compared poorly to the female respondents' 70.8% (SD 10.9%), significant on between samples t-test (p<0.01). Results for each category are represented in abstract P84 table 1. Male respondents scored poorly on contraceptive awareness. The majority believed A&E to be an appropriate place to access emergency contraception. Not one male was able to name a serious side effect of the COCP. Only 7% of respondents knew the age women should receive their first cervical smear, and less than half knew its purpose. The project was limited by the opportunity sample used - medical students are well educated but unworldly in many other ways and not representative of other men their age. However, this study outlined the key areas where male education needs to be improved in an effort to involve men in women's health and combat inequalities.Abstract P84 Table 1Correct male responses regarding female sexual healthMenstrual cycle60%Contraception47%Cervical Screening27%Menopause64%Anatomy49%
P86 Audit on the management of women with syphilis in the north east of England
Authors: Hew Y , Foster K , Mitchell L , Suchak T , Wholey V , Elawad B , Basta M , Hussey J 
Published: May 2012

BackgroundThe increase in syphilis in women over the last 10 years in the North East and re-emergence of congenital syphilis, as presented at BASHH spring meeting 2011, prompted a review of current management of pregnant women with syphilis.ObjectivesTo identify any risk factors in women being diagnosed with syphilis in the region and to review the current management of pregnant women with syphilis.MethodsA regional audit involving all Genitourinary Urinary Medicine (GUM) departments in the North East was conducted. Case notes of all women diagnosed with syphilis from 2006 to 2010 were obtained to identify risk factors in the women and to review the management, communication, follow-up and outcome of pregnant women with syphilis. Standards were set against current BASHH guidelines on syphilis management and local standards.ResultsA total of 98 women were diagnosed with syphilis over the 5 years. 61% of all women were White British. 42/98 women were pregnant. 27% of non-pregnant women had infectious syphilis compared to 42% of pregnant women. 23% had another concurrent sexually transmitted disease. Most women were in a regular relationship with only 17 women reporting a casual partner in the last 3 months. Overall 41%, but only 7% of white British women, had had sex with a man from overseas. There were two cases of confirmed congenital syphilis and five early miscarriages. Documentation of excluded congenital syphilis was poor (only three cases) in GUM records.ConclusionThe high level of infectious syphilis in pregnant women and poorly documented outcomes has informed a multi-disciplinary good practice arrangement to be produced and promoted to improve communication between clinicians, ensure recommended treatment and follow-up. No clear risk factor groups were found to inform repeat testing in later pregnancy. A new enhanced surveillance form is soon to be piloted which includes collecting data on birth outcomes.
P88 Ulipristal acetate (UPA) is affordable as emergency contraception (EC) if used where levonorgestrel (LNG) is unlicensed
Authors: Jones A B , Garcia L Dominguez , Cohen C E , Nwokolo N , Day S L 
Published: May 2012

Background/AimOur three GUM clinics are increasingly offering an integrated family planning (FP) service. We audited against three Faculty of Sexual and Reproductive Health EC standards. UPA is licensed to be given as EC following an extended window period (<120 h) after unprotected sex (UPSI)) compared to LNG (<72 h) but, is prohibitively more expensive (LNG £6.65, UPA £20.35). We estimated the anticipated cost to our service by introducing UPA to the GUM formulary.MethodsElectronic notes review of patients prescribed EC between 1st December 2010 and 1st March 2011.ResultsThe case notes of 163 EC prescriptions were reviewed. The median age was 24 years and 58.9% were Caucasian. The Faculty of Sexual and Reproductive Health standards were not achieved (Aim 100%): discuss future contraception (95%); offer STI screening (90%); offer an intrauterine device (Cu-IUD) (54%). 33% (54/163) of patients received a method of general contraception on the day of EC prescription. Of those that did not: 19% (21/109) booked an FP appointment at which 62% received general contraception and 38% did not attend; 12% (13/109) returned for more EC and at one site 4% (2/49) returned pregnant (not EC failures). 4.3% (7/163) of EC prescriptions were outside the product license for LNG but within license for UPA (UPSI 72–120 h ago or multiple episodes of UPSI within 120 h). Using this as an estimate of UPA service need, this equates to an additional expenditure of £383.60/year though, this is likely an underestimate given LNG may not be routinely offered outside its license and is of uncertain efficacy beyond 72 h.RecommendationsExtended provision of Cu-IUD fittings is required to improve offer/uptake rates of this first line EC method—current availability is limited to 1–3 sessions/wk. In light of high default rates clinicians should consider quick starting/dispensing general contraception when prescribing EC. Further FP integration is planned to facilitate this. UPA seems affordable in GUM.
P89 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty
Authors: Shahmanesh M , Wayal S , Cowan F M 
Published: May 2012

BackgroundFemale sex workers (FSWs) in India remain most vulnerable to contracting HIV immediately after initiation into sex work. We explored the process of initiation to inform interventions.MethodsIn-depth interviews were conducted with sixteen purposively selected FSWs in Goa (December 2004–December 2005). The life narratives were interrogated using grounded theory.ResultsThe narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and how women entered sex work: The ubiquitous mitigating theme that emerged was violence: dysfunctional and violent family life; sexual violence; and violence from intimate male partners. Other underlying vulnerabilities were also manifestations of gender disadvantage: being unwanted; sexual naïveté; early sexual debut; entrapment in loveless marriages; and lack of life skills. Loss of social support through bereavement and abandonment or financial need, were the commonest events that precipitated entry into sex work. The clearest division in the route into sex work was between traditional caste-based sex workers (devadassi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar.ConclusionThe interplay between caste, economy, gender, and violence drives entry into sex work. HIV prevention interventions must work upstream on the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potential vehicles to “deliver” HIV prevention services. Ultimately, the challenge is to ensure that the structural vulnerabilities that prevent effective HIV prevention early after entry into sex work do not also become barriers preventing FSWs from accessing HIV treatment.
P9 Sustainable and embedded opt out HIV testing on an acute medical admissions unit
Authors: Palfreeman A , Mckinnon G 
Published: May 2012

BackgroundOpt out testing for HIV in our hospital's acute medical unit (AMU) had been successfully piloted between August 2009 and September 2010. Our trust was selected a pilot site to implement the 2008 national HIV testing guidelines as an area of high HIV prevalence outside London. (Data from this pilot were presented at BASHH in Gateshead in 2010). However, could opt out testing for HIV on an AMU be sustained beyond the pilot?MethodsHIV testing in the pilot was embedded into the normal working of the AMU, clinical aides did the phlebotomy, medical admission proformas were modified to include HIV testing and consent was obtained by a widely distributed information leaflet. One of the GU consultants attended the AMU to remind doctors to test several times a week. After the pilot finished, the GU consultant stopped attending the ward HIV testing is now part of routine care on the AMU. It is explained at each junior doctors induction which includes a patient video. Electronic blood test requests for AMU automatically include an HIV test as part of the AMU blood bundle set. A CQUIN target that 25% of all admissions are to be tested for HIV has been set by commissioners. Testing has been expanded from the 16–60 age range to the 16–80 age range.ResultsThe rate of HIV testing has risen from 80 a month to 140 a month in 2011 the number of new +ves diagnosed has risen from 10 per year to 25 in 2011ConclusionSustainable opt out testing for HIV on an AMU can be achieved by embedding the testing process in the clinical pathways that already exist upon an AMU. This requires no extra manpower or resources to achieve within an AMU setting. Since the withdrawal of consultant support our average testing rate has gone up. Our model for opt out HIV testing is therefore sustainable, requires little extra resource and should be easy to reproduce in other centres.
P90 Is a 100% antenatal HIV testing possible?
Authors: Tegally D , Doucas T , Green H , Apoola A 
Published: May 2012

BackgroundAntenatal HIV testing in the UK has been a resounding success and is credited with reducing the rate of mother to child HIV transmission.AimsTo explore the characteristics of women who did not have the HIV test at booking, the reasons for declining and adherence to local policy on re-offering tests later in pregnancy. Between April 2010 and April 2011 a review of maternity case notes was carried out.Results6723 women were booked in early pregnancy in the relevant time period and 33 (0.5%) of these women did not have a documented HIV test. Notes were only available for 32 of these women.31/32 (96.8%) of the women were UK born, 27 (84.4%) partners were UK born. 11 (34.4%) women were pregnant for the first time. 13 (40.6%) women had no documentation of a HIV test within a year of booking. There was no documentation of intravenous drug use in any of the women or their partners. 7 (21.9%) women did not have any other blood borne virus testing done and none of these women had a recent documented HIV test either. Only in 8 (25%) women was there documentation of reasons for declining. 5 (12.5%) women were re-offered screening at about 28 weeks gestation in line with local policy with 4 (80%) accepting. 6 of 18 women were offered testing on admission to the labour ward and 2 (33.3%) were tested.DiscussionThe maternity unit has a policy for dealing with women declining HIV testing in pregnancy and achieved a 99.6% acceptance rate. This study shows that there are some problems with documentation of previous testing, risk assessment and consistently re-offering of the screening tests later on in pregnancy. When the test was re-offered later on in pregnancy there was a high acceptance rate emphasising the benefit of this approach. In view of these results further training of midwives with an emphasis on HIV risk assessment and re-offering testing later on in pregnancy will be implemented.
P91 Care of HIV+ women aged 50 and over: can we do better?
Authors: Samuel I , Welch J , Tenant-Flowers M , Poulton M , Taylor C 
Published: May 2012

BackgroundThe prevalence of ageing HIV infected females continues to increase due to greater survival, delayed diagnosis and new infections; management of specific issues in this group becomes more challenging.Aims/ObjectiveTo identify the specific care issues for women at and above 50 years.MethodFemale patients aged 50 and over were identified from a female cohort of 828 and data collected retrospectively from case notes and electronic patient records.Results and DiscussionThe sample consisted of 124 (15% of 828) women, mean age 52 y, range 50–75 y; 83% black ethnicity. 40.3% diagnosed at 50 y or over. CD4 counts, mean 217 cells/μl indicating 71% late diagnoses and 42% with advanced/very advanced HIV. 22.6% of the sample had attended hospital before and missed the opportunities for early diagnosis suggesting wider testing even in elderly. 4.5% women had premature menopause compared to <1% in the general population, 7.1% early menopause, 28% had menopausal symptoms, 10% had HRT. On opportunistic testing of BMD tests, 5/8 women had evidence of osteoporosis/osteopenia. 54% of the whole group had vitamin D deficiency. 38% had abnormal cervical cytology, of which 16.5% were high grade. A high degree of obesity (48%) and other co-morbidities (90%) identified.ConclusionsSpecial care for premature/early menopause including early counselling regarding reproductive options, wider HIV testing regardless of age, screening for osteoporosis, breast and cervical cancer, holistic approach in the management of obesity and other co-morbidities. Consideration needed as to how care is provided for this group within current health care settings.
P94 Prevalence and correlates of sexual violence in female attendees at genitourinary medicine clinics
Authors: White J , Biros N , Holland D 
Published: May 2012

BackgroundSexual violence (SV) is common but under-reported in the UK. Victims of SV may be more likely to attend genitourinary medicine (GUM) clinics but there are no recent urban data.AimsTo determine the prevalence and correlates of SV in female GUM attendees. To assess whether routine enquiry on SV is warranted and to gauge if specific SV resources are needed in GUM.MethodsQuestionnaire-based survey offered to all women attending our two urban walk-in GUM clinics. Participants self-completed anonymised proformas about any experiences of SV using a broad definition of SV. Demographic, clinical and behavioural data were also collected.ResultsAnalysis of the initial 164 surveys showed a median age of 27 (IQR 23–31). Ethnicity was typical of the clinics' populations: 62% UK born; 40% White British, 21% White other, 16% Black British, 8% Black African and 7% Black Caribbean. When asked about a history of SV ever, 17% responded yes; in 36% of these women SV had happened more than once. Median age at the time of SV was 19 years (range 6–40); 22/164 (13%) described the SV as rape/sexual assault and in two women this was in the last year. Only two women described their assailant as a stranger; one confirmed her SV was gang-related. Additional women responded to queries on forced oral sex 5%, forced touching 7%, forced sex without a condom 11%. Of 32 women who told someone it included a health professional in only 28% and the police in 25%. 78% of all participants agreed it was helpful to ask routinely about SV and 87% felt that a SV worker was needed in the clinic; four women indicated that their reason for attending GUM today was SV-related. Qualitative comments were mostly positive and accepting of SV enquiry, though several women expressed negative comments about the difficult emotions it had evoked.ConclusionsWomen attending GUM have a high prevalence of SV. Further study is warranted within GUM settings to establish if routine enquiry and SV service provision should be core business.
P96 Characteristics and sexual health outcomes of sex workers seeking sexual health care in England
Authors: Marsh K , Savage E , Ward H , Wetten S , McGrath L , Hughes G 
Published: May 2012

BackgroundUntil recently the only data on sexual health of sex workers (SWs) were from special studies. We used new STI surveillance data to investigate the characteristics and health outcomes of SWs visiting GUM clinics in England.AimTo assess the sexual health needs of SWs.MethodsProvisional data from the GUM Clinic Activity Dataset (GUMCAD) on consultations by SWs (SHHAPT code SW) were analysed.ResultsReporting began on a rolling basis in 207 GUM clinics during 2011; 2305 SWs were reported from 83 clinics to date. Of these, 1908 were female and 397 male (including 29 MSM). Among female SWs, median age was 29 years, 69% were white and 65% born abroad (migrants). Of the migrants, 35% were from Eastern Europe (60% Romania) and 31% from South America (93% Brazil). The 1908 women made 3131 visits with 63% having a repeat visit within 6 months; 5.4% having chlamydia, 1.2% gonorrhoea, 1.8% genital warts, 1.6% genital herpes, 0.1% syphilis and 0.1% HIV. Migrant SWs were more likely than UK-born women to be seen in London clinics, and less likely to have a sexual health screen (67% vs 83%) or HIV test (67% vs 82%). Migrants were less likely to be diagnosed with chlamydia (4.4% vs 7.3%) or gonorrhoea (1.0% vs 1.5%) but more likely to have genital warts (2.4% vs 1.0%) or genital herpes (1.8% vs 1.3%).ConclusionsOverall STI rates among female SWs are low, particularly among migrants. Lower rates of HIV testing among migrants should be analysed further.
The Staffa Lava Formation: graben-related volcanism, associated sedimentation and landscape character during the early development of the Palaeogene Mull Lava Field, NW Scotland
Authors: Williamson Ian T. , Bell Brian R. 
Published: May 2012

Synopsis
The name ‘Staffa Lava Formation’ is proposed for the early sequence of volcanic and associated sedimentary rocks of the Palaeogene Mull Lava Field in the Inner Hebrides, off western Scotland. The Formation is defined as the sequence between the sub-Palaeogene unconformity and the base of the so-called (Mull) Plateau Lava Formation. Observations across the outcrop reveal that the Staffa Lava Formation is a complex, laterally variable sequence of lava facies, hyaloclastites and other breccias, and various interflow sedimentary rocks; also present are peperites and a single occurrence of silicic ignimbrite. The sedimentary rocks and associated palaeo-surfaces represent significant pauses in the volcanism, enabling us to subdivide the Formation into a number of allostratigraphical units termed ‘genetic sequences’. Each sequence is essentially a couplet comprising a ‘basal’ sedimentary unit and an ‘upper’ volcanic unit. In detail, some sequences comprise more than one, laterally restricted, sub-couplet. There are systematic patterns in both the distribution and thickness of the sedimentary and volcanic lithofacies that make up these units. The individual sequences appear to show a strong structural control of thickness, distribution and lithofacies, which we link to palaeo-topographic effects, especially their position within existing Palaeogene fault-controlled valley systems or active, syn-volcanic graben. The presence and significant role played by contemporaneous drainage systems and topography during the evolution of the Staffa Lava Formation is demonstrated by the number and variety of intercalated sedimentary units and the nature and facies of the volcanic products. The clearest example of the latter is the close association of hyaloclastite breccias and thick, impounded lava flows exhibiting classical two-tiered columnar joint sets. Palaeontological data, most especially palynological analysis, allow further detailed ecological characterization of the sedimentary units and palaeo-surfaces, and the development of a model for the early landscape evolution of the lava field. The taxa associated with the sedimentary sequence at the top of the Formation are typical of the early Eocene and contain floral elements characteristic of Paleocene–Eocene Thermal Maximum sites throughout the NE Atlantic region.
Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Report From the American Heart Association’s
Mission: Lifeline
Authors: Jollis James G. , Granger Christopher B. , Henry Timothy D. , Antman Elliott M. , Berger Peter B. , Moyer Peter H. , Pratt Franklin D. , Rokos Ivan C. , Acuña Anna R. , Roettig Mayme Lou , Jacobs Alice K. 
Published: May 2012

Background—
National guidelines call for participation in systems to rapidly diagnose and treat ST-segment–elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States.

Methods and Results—

A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association
Mission: Lifeline
website.

Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%).

Conclusions—
This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI.