Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics.

OBJECTIVES: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT's potential to identify young people in need of special care and monitoring. METHODS: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors' responses to SEXIT were analysed. RESULTS: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15-24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. CONCLUSIONS: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors.

Inferring individual sexual action dispositions from egocentric network data on dyadic sexual outcomes.

In this paper we present a family of models that allows us to estimate egos' unobserved action dispositions from a joint behavioural outcome of a dyadic social interaction process of both egos' and alters' action dispositions. The method is put to test on a data set containing two different types of dyadic activities of high relevance for the spread of sexually transmitted infections (STI), condom use and anal sex. The data consists of individuals older than 15 years old who visited one of the nine youth clinics in the Vastra Gotaland region of Sweden between February 2010 and March 2011 for STI testing. This is hence a group of special interest for STI interventions. We cannot find any difference in condom disposition between women and men. Condoms are initially used more often in less risky types of relationships, especially if the partner ends up as a main partner. When studying the disposition towards anal sex we do however find a difference between men and women. Women are more against practising anal sex than men while the majority of men are neutral towards anal sex.

Sexual health interventions for young people in state care: a systematic review.

OBJECTIVES: To describe evaluated sexual health interventions for young people in state care and provide an assessment of the quality of and evidence for these interventions. METHODS: A systematic review of sexual health interventions for young people in state care was conducted. Randomised controlled trials and quasi-experimental designs were eligible, 2051 records were screened, 412 full-text studies retrieved, and 12 publications with low-to-moderate risk of bias included. RESULTS: Due to substantial heterogeneity in study populations, settings, intervention approaches, outcomes and measures, standard summary measures for intervention outcomes was not used. Instead, data were synthesised across studies and presented narratively. CONCLUSION: Without making recommendations, the result suggests that group-based educational interventions in general increase knowledge, attitudes and behaviour compared with standard care. However, these findings need to be further investigated, with a special emphasis on cultural context and the involvement of young people.

Identification and risk assessment of Swedish youth at risk of chlamydia.

AIMS: The aim of the study was to identify youth at high risk of chlamydia including variables related to sexual health and negative experiences of sexuality. METHODS: In late 2009, a questionnaire on sexuality was answered by Swedish youth. The study sample was self-selected from different Internet communities. Data from 6544 sexually active participants, aged 15-24 years, were analyzed in a multivariable logistic regression model. Discriminative power was measured by the area under the receiver operating characteristic curve. RESULTS: In the univariate analysis, self-reported chlamydia was associated with most risk behavior variables, experience of coerced sex, and reimbursement for sex, with slight gender variation. The factors that best predicted self-reported chlamydia among females were number of partners, age, and having been reimbursed for sex. Among males, the number of partners and alcohol consumption were the strongest predictors. Increasing number of partners up to 10 during the past 12 months was the most important predictor for both genders. A skewed distribution of chlamydia was demonstrated, in that 37.6% of cases in females and 38.6% in males were estimated to occur among a tenth of the population. CONCLUSIONS: Testing, prevention, and care for chlamydia should be directed toward those most at risk, as they account for a large proportion of the total number of chlamydia cases. The special needs of the high-risk group need to be acknowledged and chlamydia regarded as a possible marker for risk behavior and negative sexuality experiences.

Condom use: the discrepancy between practice and behavioral expectations.

AIM: The overall aim of this paper is to examine sexually active young people's behavioral expectations of condom use. METHODS: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies. RESULTS: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner. CONCLUSIONS: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants' behavioral expectations of condom use under those conditions.

Influenza work on the regional level in Sweden: an integrated program for vaccination of risk groups, surveillance and pandemic planning which focuses on the role of the health care worker.

The aim of the study was to increase the vaccination rates of influenza among the risk groups in Region Västra Götaland, Sweden. The main interventions performed were education of doctors and nurses, information on the Internet and advice on administrative routines and organisation for the task. There was no campaign towards the risk group and no reimbursement. The vaccination rate increased from 33.6 to 54.6% in the Göteborg area between 1999 and 2004 and from 44.1 to 51.9% in the whole region. Vaccination rates increased with age and chronic disease in the elderly population, among person's 20-64 years of age with chronic disease only 23.8-34.0% were vaccinated. In order to increase the vaccination coverage in persons with chronic disease the program intensified the education of hospital staff. It was then evident that the awareness and knowledge about influenza and vaccination was limited among hospital doctors. The study demonstrates the key role of health care workers in a vaccination program and points at the importance of preparing the personnel for a pandemic situation. Co-ordination of the vaccination program with the surveillance and pandemic planning are effective means of strengthening the preventive work against influenza.

The impact of active intervention on the spread of penicillin-resistant Streptococcus pneumoniae in Swedish day-care centres.

Policies for handling cases of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) in day-care groups vary between different counties in Sweden. The aim of this study was to evaluate the epidemiological effect of excluding PNSP-carriers from children's day-care centres (DCC). We followed the incidence in 14 DCC groups with ongoing PNSP-spread, by repeated group screens until no further cases could be identified. All identified carriers were excluded from DCC attendance in study area A (Skåne region) while they remained in the group in study area B (Göteborg and örebro), according to local policies. The intervention effect was evaluated by comparing the number of additional cases after the baseline screen (start of the intervention period) between the 2 study areas. All PNSP-isolates were characterized by resistance pattern, serotype and pulse-field gel electrophoresis. The relative risk for children in DCCs without active intervention was 6.4 (95% CI: 2.0-20.7). Each prevented case in area A can be estimated to have demanded the exclusion of 2 other children from day care for approximately 4 weeks each. The total cost-benefit outcome of this action has to be seen in the light of the local situation with regard to the population prevalence and the distribution of other risk factors.

[Increasing number of Chlamydia infections--how can we reverse this trend?]. / Klamydiainfektionerna ökar--hur vänder vi trenden?

The incidence of chlamydia in Göteborg, the second largest city in Sweden, increased by 81 percent between 1995 and 2001. The majority (82%) of men and women diagnosed with chlamydia were aged 15-29 years. The incidence of chlamydia was higher among teenagers from areas of lower socio-economic index during the first years of the study but after 1995 there was no difference between low and high socio-economic groups. Chlamydia tests were taken three times more often in women than men. Analysis of original data from the Swedish survey of sexual behaviour 1996 demonstrated a strong correlation between the number of sexual partners and STD. Strategies for preventing the spread of chlamydia should be to a greater extent directed towards men and include better accessibility for men to STD clinics as well as a general improvement in contact tracing. The general public should be informed about the fact that chlamydia infections do not always give symptoms and may lead to infertility. Campaigns about condom use in order to avoid chlamydia, HIV-infection and other STD are needed.