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Background: Evidence-based clinical guidelines on contraceptive use were developed and distributed among all Flemish general practitioners (GPs) in Belgium., Objectives: To evaluate the effectiveness of two strategies for implementing a guideline on oral contraceptives in order to enhance the quality of the first contraception consultation in general practice, by either empowering patients or by introducing a computer decision support system (CDSS)., Method: A random sample of 45 GPs was distributed among three study groups. One group was visited by an 'empowered patient', one group's electronic medical record was supplemented with a CDSS, and one group served as the control group. Simulated patients (SPs) assessed the performance of GPs in daily practice before and after the interventions, using a validated 48-point checklist., Results: The baseline mean score of the 43 GPs was 26.16 (SD = 5.76). The SPs received sufficient information about correct pill usage, but not concerning factors associated with pill failure and drug interaction. After the intervention, the GPs' mean score was 26.39 (SD = 6.86). Only the intervention group with the 'empowered patient' scored significantly better (29.92 [SD = 7.11]). The computer group and control group scored lower (24.36 [SD = 6.60] and 24.82 [SD = 5.65], respectively)., Conclusion: Developing and distributing an evidence-based guideline did not change GPs' behaviour. However, empowering patients to participate more proactively significantly improved GPs' performance during a contraception consultation. A CDSS did not.

Unlabelled: In this study we examine the attainability and usefulness of opportunistic screening for Chlamydia trachomatis infection based on self-assessed risk, among university students in Belgium., Methods: A self-administered questionnaire was filled out by students (n = 243, 77.8% female, 22.2% male), who were asked to assess their own risk, to decide if their participation was useful, and to collect a first-void urine sample. Specimens were refrigerated and delivered to the laboratory on the same day. Screening for C. trachomatis DNA was performed by PCR. A Positive result was confirmed by another amplification assay., Results: Two hundred forty three students took part in the study. One hundred thirteen participants did not meet the inclusion criteria. Ages varied from 18 to 39 years, with a mean age of 21.49 years. The overall prevalence of C. trachomatis infection was 2.9%. The prevalence of C. trachomatis infection in the group of students who met the inclusion criteria was 5.4%. Having a new partner in the past six months and having had more than one partner in the last year were the most frequent reported risk factors in male and female participants., Conclusions: Screening students is a useful and feasible strategy to diagnose asymptomatic chlamydial infection. However assessing their own risk of infection seemed difficult for students. The overscreening of youngsters not at risk and the limited participation of males should get extra attention.

Objective: To evaluate how Belgian health care providers deal with a request for emergency contraception., Method: In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay., Results: All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents., Conclusion: The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

Background: STI surveillance systems are subject to qualitative and quantitative underreporting. General practitioners (GPs), who are key subjects in case reporting, explain their underreporting partly by their observation that taking a sexual history is embarrassing for patients, and that patients are reluctant to disclose information on their sexual practices. In this study we examine patients' willingness to provide data for STI surveillance., Methods: A questionnaire-based survey in a stratified population sample of 300 patients aged 18-60 years., Results: The large majority of respondents stated to be willing to give information on their sexual practices for the purpose of STI surveillance. They preferred to answer sexual history questions to their GP; filling in a form on the internet was the second best option., Conclusion: Based on these results, it is unlikely that the cooperation of patients would be a weak link in STI surveillance strategies. This observation, together with the fact that the majority of patients at risk for STIs have regular access to general practice services, justify renewed efforts to enliven primary care-based STI surveillance strategies.

Background: The incorporation of testing for human papillomavirus into protocols for cervical cancer screening has far-reaching consequences for counseling patients. The sexual transmission of HPV implies the recognition of sexual behavior of both men and women as a risk factor for cervical cancer. The aim of this study was to investigate which knowledge men have of the relation of HPV and cervical cancer., Methods: A patient questionnaire was developed in which 20 possible risk factors for cervical cancer development were suggested. In a family practice setting in Flanders, Belgium in 2004, male patients were asked to rate the importance of these factors on a five-point scale., Results: Participants (n=121) rated genetic factors highest (mean score 4.03) regardless of age or educational level. Not having cervical smears regularly (3.76), smoking (3.75) and infections were also perceived as important risk factors (3.69 for bacterial and 3.34 for viral infections). Sexual behavior of the male partner was scored much lower (2.63)., Conclusions: This study shows that awareness of HPV and its sexually transmitted nature is low among male general practice attendees. Promoting safe sex to reduce HPV transmission for primary prevention of cervical cancer should target at both male and female patients.

Introduction: We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium., Methods: The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample., Results: Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI., Discussion: Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.

To assess how Flemish general practitioners (GPs) are handling the first contraception consultation, we used standardized patients (SPs) as the best method to assess the performance of GPs in daily practice. Thirty GPs got a visit from one of the three SPs. Based on a validated checklist, the SPs scored the performance of GPs and they registered the circumstances and the duration of the consultation. Twenty-eight consultations were analyzed. General practitioners scored moderately on the content level of the consultation. Rarely, GPs asked about attitude regarding safe sex, took gynecological history or discussed contraindications. None of the GPs took a personal history to exclude pregnancy. The SPs received enough information about correct pill use, but there was minimal discussion on factors associated with pill intake and interactions with other medications. Few GPs (6/28) gave a prescription corresponding to the Flemish guidelines. The others were influenced by the pharmaceutical representatives. The girls felt, however, very satisfied with the consultation with the GPs.

An accurate algorithm for screening for chlamydial infections is available in general practice, but GPs experience numerous barriers to sexually transmitted infections (STI) counselling. In this study we assessed if a short educational package, under the form of a commented video footage on communication skills, was helpful in implementing the screening strategy. A cluster randomised controlled trial was carried out in 36 general practitioners in Antwerp, Belgium. Main outcome measures were: number of patients included in the risk assessment, number of patients tested, and proportion of appropriately tested patients. The results show that GPs in the intervention group did not include more patients overall, but that the quality of the screening process was significantly better (81.6% versus 56.2% appropriate tests, P = 0.02). Conclusively, GPs who participated in a short educational package on communication skills, selected eligible candidates for screening more accurately and decreased the risk of overscreening.

Objectives: To determine whether opportunistic screening for Chlamydia trachomatis, based on a selective screening, algorithm, is possible in general practice in Belgium; to assess feasibility of the screening strategy with respect to workload, acceptability, and organisational aspects., Methods: Implementation of a pilot screening programme by 37 GPs for a period of 15 weeks. GPs' screening practices were registered and compared with the guidelines they had received. Outcome measures were: the number of patients included in the risk assessment, uptake of screening by eligible patients, prevalence of previously unidentified infection, and uptake of treatment. After the study period GPs evaluated a number of feasibility issues on a scoring form., Results: 326 women underwent the risk assessment and 214 were tested by an amplification assay on a urine sample. Prevalence in woman at risk was 6.4%. Overall effective screening rate was 77.6%; 9 of 11 positives took up treatment. Participating GPs found the strategy feasible and perceived that it was well accepted by their patients., Discussion: The screening strategy was easily implemented by most GPs but some of them dropped out. The guidelines were followed relatively well and there were no major logistic problems. The uptake of treatment wat suboptimal. Efforts must be made to stimulate and educate more GPs to perform screening; laboratory and storage conditions should be optimised; refunding criteria should be revised; and overscreening must be avoided.

This paper evaluates the performance of an algorithm developed for opportunistic, selective screening of women for chlamydial infection in general practice in Antwerp, Belgium. Its performance was examined in 2 independent sets of patients: A) a cohort of 326 women participating in a pilot screening study, and B) a sample of 25 Chlamydia positive women, identified from the records of a laboratory of clinical microbiology. For group A, positive and negative predictive values were calculated and the accuracy of the algorithm was assessed. For group B, we examined the proportion of patients complying with the algorithm. In group A, the screening algorithm would have detected 73% of the cases in 35.6% of the population. The positive and negative predictive values were 7.7% and 98.4%, respectively. In group B, 84% of patients complied with the algorithm. The screening algorithm worked reasonably well in 2 datasets from a similar population studied 2 y later, but needs further validation.

Concordance of HPV between vagina and cervix may be influenced by sample taking and by differences in flow of cervical epithelial cells. To investigate the latter aspect, from 96 women visiting their general practitioner, and 63 sex workers visiting a STI clinic, both vaginal and cervical samples for HPV detection were obtained by the doctor to standardize sample taking. To identify factors that may influence the flow of cervical epithelial cells to the vagina, a questionnaire on intimate hygiene was obtained. The overall HPV prevalence was 22.8%; 14.3% in the general population (14.3% in the cervix, 11.9% in the vagina), compared with 34.4% in sex workers (31.1% in the cervix, 27.9% in the vagina). There was excellent agreement between HPV prevalence in vaginal and cervical samples. The overall agreement was 94.5% (kappa = 0.83, 95% CI: 0.77-0.89); in the general population agreement reached 97.6%, compared with 90.0% in sex workers. Vaginal infection may influence concordance, but for validation of this finding larger studies are necessary. The high concordance found between HPV prevalence in vagina and cervix warrants further study of the applicability of self-sampling to improve coverage rates by attracting women who would otherwise not obtain a pap test.

In this study, GPs predicted for each of their patients in a chlamydia prevalence study whether they would be infected or not. Prediction of infection did not correlate well with true infection risk. GPs who had infected patients at the beginning of the project included more patients afterwards than their colleagues who had only negative results. A rigid screening protocol is necessary to preserve GPs from choosing wrong candidates for screening and subsequently getting demoralized because no infections are diagnosed.

LiMn2O4 has been studied using magic-angle-spinning nuclear magnetic resonance (MAS NMR). 1D MAS NMR shows three Li resonances assigned to different crystallographic sites. At low temperatures an extra peak appears, indicating charge ordering of Mn3+ and Mn4+. Direct observation of the lithium dynamics was possible using rotor-synchronized 2D exchange NMR. A millisecond time scale exchange of lithium starts around 285 K between the 8a and the 16c site. At 380 K lithium even starts to hop between more than two sites. The activation energies and Li jump rates are derived and are in agreement with those determined macroscopically.

Recently much interest has been shown in the antipsychotic efficacy of neuroleptic-like neuropeptides in schizophrenia. In this article the clinical effects of the non-opioid fragments of gamma-endorphin, the so-called gamma-type endorphins DT gamma E and DE gamma E are reviewed. In addition, preliminary clinical studies of peptides related to cholecystokinin are considered. It is concluded that gamma-type endorphins possess antipsychotic properties in a subgroup of patients who may belong to Type I schizophrenia. With cholecystokinin-related peptides, in particular ceruletide, antipsychotic effects have been reported, which seem to be more or less comparable to those observed with gamma-type endorphins.