Specialist follow-up contraceptive support after abortion-Impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial.

OBJECTIVES: To assess the impact of specialist contraceptive support after abortion on effective contraceptive use at six months and subsequent abortions within two years. METHODS: Multicentre randomised controlled trial among women undergoing induced abortion in three London boroughs. Allocation was through electronically concealed stratified randomisation by centre, blinding clinicians and participants to arm allocation until interventions. Control group received standard care, comprising advice to follow up with their general practitioner or contraceptive clinic as needed. Intervention group additionally received specialist contraceptive support via telephone or face-to-face consultation at 2-4 weeks and 3 months post-abortion. Primary outcome was rate of effective contraceptive use at six months post-abortion. Secondary outcomes were subsequent abortions within two years. RESULTS: 569 women were recruited between October 2011 and February 2013, randomised to intervention (282) and control (287) groups; 290 (142 intervention, 148 control) were available for primary outcome analysis. Intention-to-treat analysis showed no significant difference between the two groups in effective contraceptive use after abortion (62%, vs 54%, p = 0·172), long-acting contraceptive use (42% versus 32%, p = 0·084), and subsequent abortion (similar rates, at 1 year: 10%, p = 0·895, between 1-2 years: 6%, p = 0·944). Per-protocol analysis showed those who received the complete intervention package were significantly more likely to use effective contraception (67% versus 54%, p = 0·048), in particular long-acting contraception (49% versus 32%, p = 0·010) and showed a non-significant reduction in subsequent abortions within 2 years (at 1 year: 5% versus 10%, p = 0·098; and between 1-2 years: 3% versus 6%, p = 0·164, respectively). CONCLUSIONS: Structured specialist support post-abortion did not result in significant use of effective contraception at six months or reduction in subsequent abortions within two years. Participants engaging with the intervention showed positive effect on effective contraception at six months post-abortion. The potential benefit of such intervention may become evident through further studies with increased patient participation.

Cysticercosis with an Orbital Tropism in Twins.

Two fraternal twin sisters developed cysticercosis localizing to the right lateral orbit over the same period after a presumed common-source exposure in China. This case demonstrates that cysticercosis can be related to travel. Similar temporal and spatial occurrences of these infections suggest a genetic tropism of the infecting organism in these twins.

Microarray analysis of murine retinal light damage reveals changes in iron regulatory, complement, and antioxidant genes in the neurosensory retina and isolated RPE.

PURPOSE: The purpose of this study was to investigate light damage-induced transcript changes within neurosensory retina (NSR) and isolated retinal pigment epithelium (RPE). Similar studies have been conducted previously, but were usually limited to the NSR and only a portion of the transcriptome. Herein most of the transcriptome, not just in the NSR but also in isolated RPE, was queried. METHODS: Mice were exposed to 10,000 lux cool white fluorescent light for 18 hours and euthanized 4 hours after photic injury. NSR and isolated RPE were collected, and RNA was isolated. DNA microarray hybridization was conducted as described in the Affymetrix GeneChip Expression Analysis Technical Manual. Microarray analysis was performed using probe intensity data derived from the Mouse Gene 1.0 ST Array. For the genes of interest, confirmation of gene expression was done using quantitative real-time PCR. Immunofluorescence assessed protein levels and localization. RESULTS: Numerous iron regulatory genes were significantly changed in the light-exposed NSR and RPE. Several of these gene expression changes favored an iron-overloaded state. For example, the transferrin receptor was upregulated in both light-exposed NSR and RPE. Consistent with this, there was stronger transferrin receptor immunoreactivity in the light-exposed retinas. Significant changes in gene expression following light damage were also observed in oxidative stress and complement system genes. CONCLUSIONS: The concept of a photooxidative stress-induced vicious cycle of increased iron uptake leading to further oxidative stress was introduced.

'Do it yourself' sexual health care: the user experience.

OBJECTIVES: To describe client experience of self-management within a busy walk-in, sexual health service. Self-management in this context is self-registration and take-home pregnancy tests, chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) tests, or condoms dispensed from a free vending machine. METHODS: Twenty-four in-depth, semi-structured interviews with users; 19 structured written reports from mystery shoppers paid to visit the service and report their experience; demographic details of those using the self-management option from the clinic database and 40 h of recorded observation in the clinic waiting room. RESULTS: Between 2 September 2008 and 1 September 2009, 18 657 people had 28 545 attendances at the service. Of these, 1845 (6.5%) attendances were self-managed by 1555 individuals (8.3% of all clients). Of those who self-managed, 646 (35%) obtained a chlamydia and gonorrhoea test only, 597 (32%) obtained condoms only and 488 (27%) obtained a pregnancy test only. Users valued the opportunity to self-manage because of the reduced waiting times, autonomy and privacy that such a service offers. Some prefer the additional support offered within a clinical consultation. Users made personalised decisions about self-management based on time pressure, need for additional services and preferred source of support. Users often required help and advice from client support workers to complete the self-management process. This created problems with confidentiality. CONCLUSIONS: Self-management is an acceptable option within sexual health services if informal support is available. Self-management options in clinical services could mean that 8% of clients at 6% of visits do not need to see a clinician, thus freeing up clinical capacity.

Decision making and referral prior to abortion: a qualitative study of women's experiences.

BACKGROUND: Despite abortion being one of the most common gynaecological procedures performed in the UK, significant regional variation exists in access to services. OBJECTIVE: This study explores women's experience of referral for abortion in three inner London boroughs to determine if services met their expectations. METHOD: In-depth interviews conducted with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy. The data were subjected to qualitative analysis. RESULTS: Most women had made a decision to proceed with abortion before approaching the health service, and expected non-judgmental support, information and prompt referral. We found variations in the extent to which these expectations were met. Delays in referral occurred when health professionals either required women to have more thinking time, referred them elsewhere for pregnancy testing or avoided discussing abortion. This was further compounded by difficulties in making appointments via the centralised telephone booking service. The brief counselling session offered to most women by the abortion providers, although helpful to some women, was viewed as unnecessary and intrusive by others. CONCLUSIONS: Most women seeking an abortion prefer not to discuss their decision but expect information and prompt referral. Delays in referral cause distress and later abortions and should be avoided. High-quality counselling should be targeted at those in need.

Peri-abortion contraception: a qualitative study of users' experiences.

BACKGROUND: Contraceptive counselling is an essential element of induced abortion services but concerns remain about its effectiveness. OBJECTIVE: The issues that influence peri-abortion contraception were explored as part of a study on the experiences of women undergoing induced abortion. METHOD: In-depth interviews with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy, with qualitative analysis of data. RESULTS: Contraceptive risk-taking was high both before and after abortion. After abortion, only a few women had changed either to using some method, or moving to more reliable methods. Health professionals had not explored the issues around contraception with sufficient clarity or detail to be effective. Discussion of contraception was often deferred to the post-abortion follow-up visit, which only 12 respondents had attended at the time of interview. CONCLUSIONS: The effectiveness of peri-abortion contraception counselling was disappointing. We suggest that a family planning-trained outreach nurse attached to abortion providers with specific responsibility for contraception could improve uptake post-abortion.