Natural conception rates in subfertile couples following fertility awareness training.

PURPOSE: To analyze cumulative pregnancy rates of subfertile couples after fertility awareness training. METHODS: A prospective observational cohort study followed 187 subfertile women, who had received training in self-observation of the fertile phase of the menstrual cycle with the Sensiplan method, for 8 months. The women, aged 21-47 years, had attempted to become pregnant for 3.5 years on average (range 1-8 years) before study entry. Amenorrhea, known tubal occlusion and severe male factor had been excluded. An additional seven women, who had initially been recruited, became pregnant during the cycle immediately prior to Sensiplan training: this is taken to be the spontaneous pregnancy rate per cycle in the cohort in the absence of fertility awareness training. RESULTS: The cumulative pregnancy rate of subfertile couples after fertility awareness training was 38% (95% CI 27-49%; 58 pregnancies) after eight observation months, which is significantly higher than the estimated basic pregnancy rate of 21.6% in untrained couples in the same cohort. For couples who had been seeking to become pregnant for 1-2 years, the pregnancy rate increased to 56% after 8 months. A female age above 35 (cumulative pregnancy rate 25%, p = 0.06), couples who had attempted to become pregnant for more than 2 years (cumulative pregnancy rate 17%, p < 0.01), all significantly reduce the chances of conceiving naturally at some point. CONCLUSIONS: Training women to identify their fertile window in the menstrual cycle seems to be a reasonable first-line therapy in the management of subfertility.

Bayesian-based diagnostic decision-support for pediatrics.

The goal of this project was to develop a Pediatric Decision Support system (PDS) that allows a resident physician to define a patient case based on symptoms (diagnostic signs and test results) and generates a list of possible diagnoses based on the World Health Organization's International Classification of Diseases (ICD10). The intent is to improve the diagnostic approach taken by resident physicians and eventually become a training tool in medical education programs.

The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study.

BACKGROUND: The efficacy of fertility awareness based (FAB) methods of family planning is critically reviewed. The objective was to investigate the efficacy and the acceptability of the symptothermal method (STM), an FAB method that uses two indicators of fertility, temperature and cervical secretions observation. This paper will recommend a more suitable approach to measure the efficacy. METHODS: Since 1985, an ongoing prospective observational longitudinal cohort study has been conducted in Germany. Women are asked to submit their menstrual cycle charts that record daily basal body temperature, cervical secretion observations and sexual behaviour. A cohort of 900 women contributed 17,638 cycles that met the inclusion criteria for the effectiveness study. The overall rates of unintended pregnancies and dropout rates have been estimated with survival curves according to the Kaplan-Meier method. In order to estimate the true method effectiveness, the pregnancy rates have been calculated in relation to sexual behaviour using the 'perfect/imperfect-use' model of Trussell and Grummer-Strawn. RESULTS: After 13 cycles, 1.8 per 100 women of the cohort experienced an unintended pregnancy; 9.2 per 100 women dropped out because of dissatisfaction with the method; the pregnancy rate was 0.6 per 100 women and per 13 cycles when there was no unprotected intercourse in the fertile time. CONCLUSIONS: The STM is a highly effective family planning method, provided the appropriate guidelines are consistently adhered to.

Reproductive health awareness: an important dimension to be integrated into existing sexual and reproductive health programs.

The ultimate goal of any sexual and reproductive health program is to ensure cost effectiveness, quality and sustainability. Reproductive health awareness is an educational approach which is both relevant and sensitive to many communities' existing sexual and reproductive health needs and concerns. When working with community groups, a participatory approach that includes reproductive health awareness concepts is a simple non-threatening way for programs to quickly expand beyond pure information giving and explore what reproductive health means to people. Although many community sexual and reproductive health programs do not the term reproductive health awareness, they use techniques similar to the reproductive health awareness education approach, when facilitating discussions about sexual or reproductive health. If reproductive health awareness is identified and included as one of the dimensions of future sexual and reproductive health programs, this will hopefully strengthen the program's overall quality and effectiveness.

Fertility awareness and natural family planning.

Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the sub-fertility investigations. (2) The information is also useful when helping couples to understand how each method of family planning works--how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective observations of the alterations in cervical mucus and the basal body temperature rise are accurate indicators of the fertile phase. Research on the chances of conception on each day of the menstrual cycle, using hormonal assays to estimate the time of ovulation, was carried out in 1994 by Weinberg and Wilcox. Their results showed that the timing of sexual intercourse, in relation to ovulation, strongly influences the chance of conception. Conception only occurred during a 6-day interval that ended on the estimated day of ovulation. The chances of conception fell to zero 24 hours after ovulation. Several different methods of natural family planning are taught; some methods depend on only using one of the indicators of fertility, others are based on two or more indicators. The main indicators of fertility are: observing the cervical mucus, recording the basal body temperature, palpating the cervix and a calculation based on the cycle length. Research studies performed using a combination of the indicators of fertility show that the failure rate using a combination is less than most of the studies which use a single indicator. In each case the method failure is far lower than the user failure. (ABSTRACT TRUNCATED)

Fertility awareness and natural family planning. Opinion.

PIP: Withdrawal, barrier method use, and sexual abstinence are fertility awareness-based family planning methods. They depend on a woman being able to identify the fertile period during each menstrual cycle. Identification of potentially fertile days allows couples to time intercourse either to avoid or to achieve pregnancy. A basic understanding about fertility puts couples in a better position to understand how any family planning method works and to choose the best method for their circumstances. For example, use of a barrier method or withdrawal requires a couple to clearly understand the importance of using the method consistently and correctly during the fertile period. Fertility awareness also helps couples know that most family planning methods do not affect their longterm fertility. Familiarity with fertility signs allows a woman to detect a change in her usual patterns and to seek health care at an early stage of a developing health problem. Use of natural family planning methods can be very important in areas where contraceptives are costly or their supply is unreliable. Most family planning programs do not provide fertility awareness education. Some studies indicate that combining fertility awareness with the use of barrier methods or withdrawal during the fertile period is an acceptable option to using barriers or withdrawal all the time. To identify the fertile period, women need to observe cervical secretions, to monitor basal body temperature, to use calendar calculations based upon cycle length, or to use a combination of these indicators. Development of new ways to improve fertility awareness include new rules that are better able to detect the fertile period and are easier to use and a home test kit tracking cycle length and hormone metabolites in urine. The University of Oxford in the UK is conducting a clinical trial examining the impact of fertility awareness education among condom users. It specifically aims to determine whether fertility awareness education improves the consistent use of condoms during the fertile period.^ieng

Design of an adolescent activity room.

To meet the recreational and developmental needs of hospitalized adolescents, an activity room was designed with adolescents as members of the design team. The design process and materials developed are described. An evaluation process for the environment and program is also presented.

Need and demand for parenting programmes in general practice.

AIMS: To establish the prevalence of behaviour problems and the level of interest in parenting programmes in a population sample of parents of children aged 2-8 years, and to assess to what extent they are associated with socioeconomic factors. METHODS: Postal survey of parents of children aged 2-8 years registered with three general practitioner surgeries; 70% response rate. RESULTS: One fifth of parents from this population sample were experiencing difficulties with their children's behaviour. While behaviour problems were more prevalent in the manual social classes, "need" was high across all social groups. Just under a fifth of parents reported prior attendance at a parenting programme and 58% expressed interest in attending in the future. Interest in attending a parenting programme was not class related, but was predicted by the age of the eldest child and the existence of behaviour problems. CONCLUSION: Behaviour problems are an important public health issue. Findings support the use of a non-selective approach to the provision of parenting programmes in the UK.

Improving mental health through parenting programmes: block randomised controlled trial.

AIMS: To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population. METHODS: Parents of children aged 2-8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin's Parenting Stress Index, and Rosenberg's Self Esteem Scale to measure parents' mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up. RESULTS: The intervention was more effective at improving some aspects of the children's mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range. CONCLUSION: This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.

Impact of a general practice based group parenting programme: quantitative and qualitative results from a controlled trial at 12 months.

AIMS: To test the effectiveness at one year of the Webster Stratton Parents and Children Series group parenting programme in a population sample of parents. METHODS: In a multicentre block randomised controlled trial, parents of children aged 2-8 years in 116 families who scored in the upper 50% on a validated behaviour inventory, took part in Webster-Stratton's 10 week parenting programme led by trained and supervised health visitors. The following outcome measures were used: Eyberg Child Behaviour Inventory, Goodman Strengths and Difficulties Questionnaire, General Health Questionnaire, Parenting Stress Index, Rosenberg Self Esteem Scale. RESULTS: The intervention significantly reduced child behaviour problems and improved mental health at immediate and 6 month follow ups. One year differences between control and intervention groups were not significant. Qualitative results suggest that these findings might be attributable in part to either Hawthorne effects or contamination of control group. At interview parents described ways in which the programme had improved their mental health. They reported gains in confidence and feeling less stressed. Some also reported beneficial changes in their own and their children's behaviour and improved relationships with their children. Some spoke of a need for further sessions to support the behaviour changes they had managed to make, and some the desire for attendance by both parents. CONCLUSIONS: Parenting programmes have the potential to promote mental health and reduce social inequalities, but further work is needed to improve long term effectiveness.