Trends in different contraception methods among women attending the Melbourne Sexual Health Centre from 2011 to 2020.

OBJECTIVES: The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN: Repeated cross-sectional study. METHODS: Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS: A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS: Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.

Gallstones in pregnancy.

Gallstone disease is the most common gastrointestinal disease in developed countries and is present in up to 15% of the population. Owing to the increased risk factors for gallstones in pregnancy, it is the second most common non-obstetric emergency, affecting up to 12% of pregnant women with a risk of recurrence. Up to 3% of pregnant women in America require a cholecystectomy in the first year after delivery. Gallstone disease has a high risk of developing associated complications, and maternal mortality can be up to 37% if the patient develops gallstone pancreatitis. Endoscopic retrograde cholangiopancreatography and cholecystectomy can be performed safely in the second trimester when benefits outweigh the risks. However, if the patient is able to be managed conservatively, then a cholecystectomy should be performed in the postnatal period to avoid further recurrences and complications. Despite this, there is currently no national UK guidance on how to manage gallstones and related diseases during pregnancy.

Chlamydia testing and notification in Australia: more money, more tests.

BACKGROUND: To examine the associations between chlamydia testing and notification and age, sex, socioeconomic status and access to services for area of residence for the Australian state of Victoria in 2004. METHODS: Data on 71 295 tests and 7006 notifications for chlamydia were obtained by age, gender and area of residence. Each area of residence was assigned to a population-weighted quartile of socioeconomic advantage and was scored for access to services. Generalised linear modelling was used to analyse relationships between the variables. RESULTS: The odds of being tested for and notified with chlamydia increased by 27% (odds ratio (OR) 1.27, 95% CI 1.26 to 1.27) and 10% (OR 1.10, 95% CI 1.08 to 1.13), respectively, and the odds of a test being positive decreased by 13% (OR 0.87, CI 0.85 to 0.89) for each quartile increase in socioeconomic advantage, when adjusted for access to services. The highest proportion of any subgroup population tested was 7.8% in women aged 20-24 years living in the most advantaged quartile. Men and women over 25 years in advantaged areas receive more testing than men and women aged 20-24 years in disadvantaged areas. CONCLUSION: Access to chlamydia testing is inequitable and favours more advantaged areas. Testing in the age groups at most risk, women aged between 20 and 24 years, was low even in those living in the most advantaged quartile. If Australia is to implement a chlamydia screening programme, education should emphasise the appropriate age group to screen.

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia.

INTRODUCTION: In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS: Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS: Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION: Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.

The female condom.

BACKGROUND: The female condom has been available in numerous countries for some years. It was launched in Australia on March 8th, 2000 and is an important addition to the range of barrier contraceptives. OBJECTIVE: This article aims to provide an overview of the female condom to enable GPs and nurse practitioners to advise clients and provide information about its use. DISCUSSION: The female condom is an effective form of contraception. When used correctly it has a failure rate of about 5%, which compares favourably with other forms of barrier contraception. It is important that users are instructed on insertion, in particular the need to guide the penis into the condom. Evidence shows that it reduces the incidence of sexually transmitted infections. There may also be additional benefit in reducing wart virus and herpes transmission, as there is greater protection to the vulva and the base of the penis, when compared with the male condom. The female condom has high user acceptability, and offers advantages in terms of sensitivity and also ease of use by men with erectile dysfunction. It is the only barrier protection under a woman's control, giving protection to the vagina and vulva as well as the cervix.

Severe H1N1 virus in pregnancy requiring extracorporeal membrane oxygenation and lobectomy.

Prompt diagnosis and treatment of H1N1 is crucial during pregnancy to prevent major morbidity and mortality as the virus poses an increased risk of severe illness in pregnant women. Currently, there is limited obstetric literature concerning pregnancy and the pandemic swine flu outbreak in the UK. Although there was a concerted effort to stockpile the HIN1 virus vaccinations, critical care adult extracorporeal membrane oxygenation is only available in one centre in the UK.

Chiropractic education: a student survey.

This study surveyed 1296 chiropractic students, 724 (55.9%) of who were in their first term, and 569 (43.9%) who were beginning their second academic year (third term/fourth quarter). From the available students in 12 of the colleges participating in this study, 73.2% responded to the three-page questionnaire. Questions included the extent and specialization of previous education, population demographics, the application process, justification for separate health care professions, attitudes concerning the integration of chiropractic principles into the curriculum, the efficacy of chiropractic adjustments, and exposure to chiropractic prior to entering chiropractic college. Results showed that chiropractic students represent individuals from all walks of life, most of whom selected chiropractic as a first choice. They clearly distinguish between chiropractic physicians and medical doctors and are overwhelmingly convinced that the chiropractic adjustment is effective, especially if they had themselves received chiropractic care. Most entered chiropractic college with a nonchiropractic family background.

Cloning and characterization of recA genes froM Proteus vulgaris, Erwinia carotovora, Shigella flexneri, and Escherichia coli B/r.

The recA genes of Proteus vulgaris, Erwinia carotovora, Shigella flexneri and Escherichia coli B/r have been isolated and introduced into Escherichia coli K-12. All the heterologous genes restore resistance to killing by UV irradiation and the mutagen 4-nitroquinoline-1-oxide in RecA- E. coli K-12 hosts. Recombination proficiency is also restored as measured by formation of Lac+ recombinants from duplicated mutant lacZ genes and the ability to propagate phage lambda derivatives requiring host recombination functions for growth (Fec-). The cloned heterologous genes increase the spontaneous induction of lambda prophage in lysogens of a recA strain. Addition of mitomycin C stimulates phage production in cells carrying the E. coli B/r and S. flexneri recA genes, but little or no stimulation is seen in cells carrying the E. carotovora and P. vulgaris recA genes. After treatment with nalidixic acid, the heterologous RecA proteins are synthesized at elevated levels, a result consistent with their regulation by the E. coli K-12 LexA repressor. Southern hybridization and preliminary restriction analysis indicate divergence among the coding sequences, but antibodies prepared against the E. coli K-12 RecA protein cross-react with the heterologous enzymes, indicating structural conservation among these proteins.

Osteopathic vs. chiropractic education: a student perspective.

This study compares nationwide survey results from 506 second year students of 11 osteopathic schools and 881 students from the first and second academic year (third term/fourth quarter) of eight chiropractic colleges. Each student was given a questionnaire regarding his/her perspective on the education he/she was receiving. Both populations were questioned about whether or not they came from an osteopathic/chiropractic family, their application process, the efficacy of osteopathic manipulative therapy (OMT)/chiropractic adjustments, their first year attitude concerning the efficacy of OMT/chiropractic adjustments, the integration of osteopathic/chiropractic principles into the curriculum and the justification for separate health care professions. Osteopathic and chiropractic students entered their respective professions from nonosteopathic/non-chiropractic families. Although both populations selected their profession as a first and primary choice, chiropractic students were more substantially represented. Upon entering their program, osteopathic students were not convinced, but had an open mind concerning the effectiveness of osteopathic manipulative therapy (OMT), and were divided as to whether there is enough of a distinction between DOs and MDs to justify separate professions. Chiropractic students, on the other hand, entered their program convinced that chiropractic adjustments are effective, and saw a clear distinction between the roles of chiropractic physicians and medical doctors.