A comparative study of peer-led and adult-led school sex education.

There are, and have been, many school-based sex education projects in this country which have used peer leaders (students delivering an educational programme who are of similar, or slightly older, age than the students receiving the programme). Rigorous evaluation of the methodology remains scant. This paper describes a comparative investigation of peer-led and adult-led sex education in National Curriculum Year 9 (aged 13/14 years). The results from this study suggest that peer leaders appear to be more effective in establishing conservative norms and attitudes related to sexual behaviour than the adults. Peer leaders were less effective than adults in imparting factual information and getting students involved in classroom activities. These findings suggest that both adult-led and peer-led methods may have a place in effective sex education--the challenge being to determine which areas are best dealt with by whom.

Objective measures of dysphagia complexity in children related to suckle feeding histories, gestational ages, and classification of their cerebral palsy.

Data collected during the routine assessment of 117 dysphagic children with cerebral palsy have been related to both suckle feeding histories and gestational ages and to the classification of cerebral palsy. In addition, a concurrent survey involving 281 children with cerebral palsy in special schools was undertaken which revealed that the sample of referred children appeared to be a true representation of a wider population of dysphagic children with cerebral palsy. A Feeding Difficulty Symptom Score (FDSS) describes the severity of swallowing symptoms reported. A numerical Dysphagia Complexity Index (DCI) quantifies numerically the neurological complexity of the swallowing difficulty. The FDSS correlates closely with the DCI. Twenty-seven percent of mothers of the children who were referred for advice on their present swallowing difficulties stated that they recalled no suckle feeding problems. However, there was no difference in the severity of present swallowing difficulties between those infants who suckle fed well and those who experienced severe difficulties. Those referred children with cerebral palsy born at term exhibited more complex later swallowing problems and were more likely to be classified as athetoid than those born preterm.

Non-invasive technique for assessment and management planning of oral-pharyngeal dysphagia in children with cerebral palsy.

The non-invasive Exeter Dysphagia Assessment Technique (EDAT) was evaluated as a method of assessing the aetiology of dysphagia in children with cerebral palsy (CP). Data were collected from a group of 20 typically developing children (nine girls, 11 boys; age range 7 to 14 years) for comparison with 125 dysphagic children with CP (81 boys, 44 girls; age range 1 to 18 years). The swallowing mechanism has been separated into physiological phases: anticipatory, delivery, oral transit, and oral-pharyngeal. Normal or abnormal function in each phase was recorded and the common causes of any impaired phase were considered, starting with generalized possibilities before focusing on specific parts of swallowing physiology. Data from 125 dysphagic children with CP show marked differences from the data for the typically developing children. Interpreting individual results was valuable in assisting the assessment team to formulate management strategies; two examples are presented. The technique appears to provide a cost-effective, non-invasive, and valuable clinical tool.

Teenagers' views on general practice consultations and other medical advice. The Adolescent Working Group, RCGP.

BACKGROUND: The provision of health services for teenagers is of current interest in relation to primary care. OBJECTIVES: The main objective of the study was to look at satisfaction with the teenager's last consultation and any reasons for dissatisfaction. A further objective was to look at common teenage health concerns to identify how many teenagers had been concerned about them, where they sought advice, and to look at ratings of this advice. METHOD: Questionnaires were completed as part of a continuing evaluation of a novel sex education programme in 38 schools in 1997 and provided the data. The particular items reported in this study were related to satisfaction with the last GP consultation and reasons for dissatisfaction, health concerns and who (if anybody) was approached to address these concerns, and comments on services used. 5152 teenagers (51.8% male and 47.8% female) completed the questionnaires in a school lesson under conditions of complete confidentiality. RESULTS: Over 86% of adolescents were apparently satisfied with their last consultation with a GP, although several possible reasons were identified for any dissatisfaction. Health concerns were identified and sources of help were considered and compared; no obvious levels of relative dissatisfaction with services were noted. A large number of teenagers identified apparent concerns but did not seek help for these concerns. CONCLUSIONS: Adolescents are largely satisfied with the services available in primary care. A number of teenagers do not seek help for their own individual concerns. Encouraging teenagers to attend when they perceive a health problem may help provide a more sensitive primary care service.

Peer-led and adult-led school health education: a critical review of available comparative research.

Peer-led health education in school is widely used. Advocates suggest it is an effective method based on the belief that information, particularly sensitive information, is more easily shared between people of a similar age. Critics suggest that this is a method not based on sound theory or evidence of effectiveness. This review evaluates school-based health education programmes which have set out to compare the effects of peers or adults delivering the same material. The identified studies indicated that peer leaders were at least as, or more, effective than adults. Although this suggests that peer-led programmes can be effective, methodological difficulties and analytical problems indicate that this is not an easy area to investigate, and research so far has not provided a definitive answer.

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study.

The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term 'need'. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.

Deglutition apnoea as indicator of maturation of suckle feeding in bottle-fed preterm infants.

The maturation of deglutition apnoea time was investigated in 42 bottle-fed preterm infants, 28 to 37 weeks gestation, and in 29 normal term infants as a comparison group. Deglutition apnoea times reduced as infants matured, as did the number and length of episodes of multiple-swallow deglutition apnoea. The maturation appears related to developmental age (gestation) rather than feeding experience (postnatal age). Prolonged (> 4 seconds) episodes of deglutition apnoea remained significantly more frequent in preterm infants reaching term postconceptual age compared to term infants. However, multiple-swallow deglutition apnoeas also occurred in the term comparison group, showing that maturation of this aspect is not complete at term gestation. The establishment of normal data for maturation should be valuable in assessing infants with feeding difficulties as well as for evaluation of neurological maturity and functioning of ventilatory control during feeding.

Is venepuncture in neonatal research ethical?

AIM: To determine whether venepuncture accords with the accepted (BPA) criteria of not causing more than minimal physical or psychological distress during non-therapeutic research. METHODS: Ninety two venepunctures were carried out in 69 neonates between days 6 and 10 of life, and in some cases, on day 28. Parents were fully informed of the need for the procedure and allowed to attend while it was performed. Ninety parents and 87 doctors completed questionnaires to assess the levels of perceived parental and child distress and anxiety before and after the procedure. RESULTS: Only three parents were very upset, and 47% reported the test as being better than they expected, compared with 10% who thought it worse than expected. Seven babies were recorded as being very upset. Doctors tended to underestimate the degree of anxiety before the procedure and the level of distress afterwards. CONCLUSIONS: Venepuncture in neonates seems to be acceptable to most parents and is associated with a favourable risk: benefit ratio using semiquantitative assessment of risk and benefit.

Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group.

BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.

School sex education: an experimental programme with educational and medical benefit.

OBJECTIVES: To develop and teach a school sex education programme that will lead to a decrease in sexual activity. DESIGN: A matched internal and external control experiment, comparing control populations which received their own sex education programmes with populations which received a novel sex education intervention that included medical and peer led teaching. SETTING: Comprehensive secondary schools; control and intervention populations within Devon, and distant controls from rural, semiurban, and urban areas of England excluding major conurbations. SUBJECTS: Schoolchildren were taught from age 12 to 16; three successive cohorts of students were evaluated in school year 11 (mean age 16.0). MAIN OUTCOME MEASURES: Questionnaire conducted under "examination conditions" and invigilated by the research team and other trained medical staff. RESULTS: In the intervention population, progressive increase in knowledge related to contraception, sexually transmitted diseases, and prevalence of sexual activity (chi 2 (trend) P < 0.001 for all three series); relative increase between intervention and control populations in knowledge, relative decrease in attitudes suggesting that sexual intercourse is of itself beneficial to teenagers and their relationships, relative decrease in sexual activity, and relative increase in approval of their "sex education" (relative risk > 1.00 with 95% confidence limits not including 1.00 for all series and for comparisons with both control populations); odds ratio (control v programme) for sexual activity of 1.45, controlling for sociodemographic variables. CONCLUSION: School sex education that includes specific targeted methods with the direct use of medical staff and peers can produce behavioural changes that lead to health benefit.