Search

Context There are few UK data on the prevalence and clustering of risky behaviours in ethnically diverse adolescents. Objectives To investigate the prevalence of reported alcohol use, smoking and vaping, and explore whether these behaviours are associated with increased numbers of sexual partners. Design Questionnaire survey of ‘Test n Treat’ chlamydia screening trial participants. Setting and participants Sexually active students attending six London technical colleges completed confidential questionnaires and provided genitourinary samples. Results The median age of the 509 participants was 17 years (IQR: 16‐18), 47% were male, 50% were of black ethnicity, 55% reported ≥2 sexual partners in the past year (67% of males and 45% of females) and 6.2% had chlamydia infection and 0.6% gonorrhoea. Almost half (48%) reported getting drunk in the past month, 33% smoked cigarettes and 7% had ever vaped. A larger percentage of students with ≥2 sexual partners than 0‐1 partners reported getting drunk in the past month (53.7%, 144/268% versus 42.2% 94/223, adjusted prevalence ratio: 1.33, 95% confidence interval: 1.11‐1.61) and smoking cigarettes (36.6%, 100/273% versus 30.2%, 67/222, 1.34 (1.05‐1.70)). By contrast, multiple sexual partners were not associated with vaping or chlamydia infection, but numbers were small. Conclusions We found high prevalences of risky behaviour and an association between multiple sexual partners and smoking and/or getting drunk. Findings support the introduction of compulsory sex and relationship education in UK secondary schools, including information about the adverse effects of alcohol and smoking. Public contribution Participants helped with study design, conduct and interpretation.

Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide. Maternal anaemia greatly increases the risk of PPH, and over a third of all pregnant women are anaemic. Because anaemia reduces the oxygen-carrying capacity of the blood, anaemic women cannot tolerate the same volume of blood loss as healthy women. Yet the same blood loss threshold is used to define PPH in all women. The lack of an established PPH definition in anaemic women means the most appropriate outcome measures for use in clinical trials are open to question. We used data from the WOMAN-2 trial to examine different definitions of PPH in anaemic women and consider their appropriateness as clinical trial outcome measures. Main body The WOMAN-2 trial is assessing tranexamic acid (TXA) for PPH prevention in women with moderate or severe anaemia at baseline. To obtain an accurate, precise estimate of the treatment effect, outcome measures should be highly specific and reasonably sensitive. Some outcome misclassification is inevitable. Low sensitivity reduces precision, but low specificity biases the effect estimate towards the null. Outcomes should also be related to how patients feel, function, or survive. The primary outcome in the WOMAN-2 trial, a ‘clinical diagnosis of PPH’, is defined as estimated blood loss > 500 ml or any blood loss within 24 h sufficient to compromise haemodynamic stability. To explore the utility of several PPH outcome measures, we analysed blinded data from 4521 participants. For each outcome, we assessed its: (1) frequency, (2) specificity for significant bleeding defined as shock index ≥1.0 and (3) association with fatigue (modified fatigue symptom inventory [MFSI]), physical endurance (six-minute walk test) and breathlessness. A clinical diagnosis of PPH was sufficiently frequent (7%), highly specific for clinical signs of early shock (95% specificity for shock index ≥1) and associated with worse maternal functioning after childbirth. Conclusion Outcome measures in clinical trials of interventions for PPH prevention should facilitate valid and precise estimation of the treatment effect and be important to women. A clinical diagnosis of PPH appears to meet these criteria, making it an appropriate primary outcome for the WOMAN-2 trial. Trial registration ClinicalTrials.gov NCT03475342, registered on 23 March 2018; ISRCTN62396133, registered on 7 December 2017; Pan African Clinical Trial Registry PACTR201909735842379, registered on 18 September 2019.

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction). We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz–3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day. Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m2 at home, 94 μW/m2 at school, and 100 μW/m2 overall. In general, restrictions at school or at home made little difference for adolescents’ measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure. Total exposure to RF-EMF in adolescents living in Greater London tended to be higher compared to exposure levels reported in other European countries. This study suggests that school policies and parental restrictions are not associated with a lower RF-EMF exposure in adolescents.

ObjectivesOropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-associated cancer in the UK, but little is known about the prevalence of oropharyngeal HPV in sexually active teenagers. We investigated reported HPV vaccination coverage (in females) and prevalence of oropharyngeal HPV in sexually active students attending six technical colleges in London, UK.MethodsIn 2017, we obtained mouthwash samples and questionnaires from male and female students taking part in the ‘Test n Treat’ chlamydia screening trial. Samples were subjected to HPV genotyping.ResultsOf 232 participants approached, 202 (87%) provided a mouthwash sample and questionnaire. Participants’ median age was 17 years and 47% were male. Most (73%) were from black and minority ethnic groups, 64% gave a history of oral sex, 52% reported having a new sexual partner in the past 6 months, 33% smoked cigarettes, 5.9% had concurrent genitourinary Chlamydia trachomatis infection and 1.5% Neisseria gonorrhoeae and 5.0% were gay or bisexual. Only 47% (50/107) of females reported being vaccinated against HPV 16/18, of whom 74% had received ≥2 injections. HPV genotyping showed three mouthwash samples (1.5%, 95% CI 0.3% to 4.3%) were positive for possible high-risk human papillomavirus (HR-HPV), one (0.5%, 0.0% to 2.7%) for low-risk HPV 6/11, but none (0.0%, 0.0% to 1.8%) for HR-HPV. Four samples (2.0%, 0.5% to 5.0%) were positive for HPV16 using a HPV16 type-specific quantitative PCR, but these were at a very low copy number and considered essentially negative.ConclusionsDespite the high prevalence of oral sex and genitourinary chlamydia and low prevalence of HPV vaccination, the prevalence of oropharyngeal HR-HPV in these adolescents was negligible.

BackgroundLow uptake of sexually transmitted infection testing by sexually active young people is a worldwide public health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The “Test n Treat” feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment for chlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technical colleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low (MethodsIn 2016–17 we conducted a qualitative study in the interpretative tradition using face to face or telephone semi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews were digitally recorded, transcribed and thematically analysed.ResultsFrom the student perspective, feelings of embarrassment and the potential for stigma were deterrents to sexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for some students volunteering to be screened exposed them to detrimental judgements by their peers. A small financial incentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchers confirmed these views. The very low level of knowledge about sexually transmitted infections influenced students to not view themselves as candidates for testing. There were also suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students and researchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing.ConclusionsThis study offers new insights into the acceptability of college-based sexually transmitted infection screening to young, multi-ethnic students. Future studies in similar high risk, hard to reach groups should consider linking testing with education about sexually transmitted infections, offering non stigmatising incentives and engaging peer influencers.

Background Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a ‘Test n Treat’ service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges. Methods Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate). Results The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected. Conclusions Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable. Trial registration ISRCTN58038795, Assigned August 2016, registered prospectively.

Mobile phone use, predominantly smartphones, is almost ubiquitous amongst both adults and children. However adults and children have different usage patterns. A major challenge with research on mobile phone use is the reliability of self-reported phone activity for accurate exposure assessment. We investigated the agreement between self-reported mobile phone use data and objective mobile operator traffic data in a subset of adolescents aged 11–12 years participating in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. We examined self-reported mobile phone use, including call frequency, cumulative call time duration and text messages sent among adolescents from SCAMP and matched these data with records provided by mobile network operators (n = 350). The extent of agreement between self-reported mobile phone use and mobile operator traffic data use was evaluated using Cohen's weighted Kappa (ĸ) statistics. Sensitivity and specificity of self-reported low (< 1 call/day, ≤ 5 min of call/day or ≤ 5 text messages sent/day) and high (≥ 11 calls/day, > 30 min of call/day or ≥ 11 text messages sent /day) use were estimated. Agreement between self-reported mobile phone use and mobile operator traffic data was highest for the duration spent talking on mobile phones per day on weekdays (38.9%) and weekends (29.4%) compared to frequency of calls and number of text messages sent. Adolescents overestimated their mobile phone use during weekends compared to weekdays. Analysis of agreement showed little difference overall between the sexes and socio-economic groups. Weighted kappa between self-reported and mobile operator traffic data for call frequency during weekdays was κ = 0.12, 95% CI 0.06–0.18. Of the three modes of mobile phone use measured in the questionnaire, call frequency was the most sensitive for low mobile phone users on weekdays and weekends (77.1, 95% CI: 69.3—83.7 and 72.0, 95% CI: 65.0–78.4, respectively). Specificity was moderate to high for high users with the highest for call frequency during weekdays (98.4, 95% CI: 96.4–99.5). Despite differential agreement between adolescents’ self-reported mobile phone use and mobile operator traffic data, our findings demonstrate that self-reported usage adequately distinguishes between high and low use. The greater use of mobile smartphones over Wi-Fi networks by adolescents, as opposed to mobile phone networks, means operator data are not the gold standard for exposure assessment in this age group. This has important implications for epidemiologic research on the health effects of mobile phone use in adolescents., Highlights • We assessed the validity of adolescents’ self-reported mobile phone use. • The study accounted for weekday and weekend use of mobile phones separately. • Findings show that self-reported usage distinguishes between high and low use. • We recommend a combination of self-reported use over Wi-Fi & operator traffic data. • Combined data will improve accurate exposure estimation in epidemiological studies.

Objectives\ud We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment (‘Test n Treat/TnT’) in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT.\ud \ud Methods\ud Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT).\ud \ud One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26).\ud \ud Results\ud Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9–17.4%) at 1 month and 10% (26/259; 6.7–14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1–14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs).\ud \ud Conclusions\ud Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal.\ud \ud Trial registration ISRCTN58038795

‘Test n Treat’ [1] is a NIHR funded cluster-randomised feasibility trial assessing the feasibility of conducting a future trial in FE colleges to investigate if frequent, rapid, on-site testing and...

Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates. We will recruit 80 sexually active students aged 16–24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT). One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive ‘thank you’ texts 1 and 4 months after recruitment. Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results. Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare. Findings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including: International Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795 , Registered on 31 August 2016.

Dear Editor,Abu-Odeh and colleagues [1] describe how they integrate population health into medical education. At St George’s, University of London, some students have the opportunity to help with f...

Background Expulsion of an intrauterine device (IUD) occurs in about 1 in 20 women and expulsion may not be noticed by the user. Current guidance recommends that users are instructed to check regularly for their threads. This is the first study to explore the reality of how women feel about checking their threads and the details surrounding how frequently checks are done. Methods One hundred consecutive IUD users were interviewed regarding their type of device, duration of use, frequency of thread checking, prompts for checking and reasons for not checking. Results Only 23% checked their threads regularly and 51% had never done so. The most common reason for not checking was forgetting about it. Conclusions Despite being advised to do so, the majority of users do not check their threads at all and fewer than one-quarter of them check regularly. We propose that advice offered about thread checking should be given less emphasis and suggested more for user reassurance.

• The majority of women use the less reliable methods of contraception. • The majority of oral contraceptive users miss two or three pills per packet. • Thinking has changed from promoting user-dependent to user-independent contraceptive methods. • Intrauterine devices do not cause pelvic infection or ectopic pregnancy. • There is no lower age limit for users of any long-acting reversible contraceptives, including intrauterine devices. Learning objectives: • To understand the advantages of user-independent methods of contraception. • To be able to combat myths and misunderstandings relating to them. Ethical issues: • Fraser competence should be sought whenever a new method of contraception is chosen by someone under 16 who is not involving their parents in their decision. • Some people may find the intrauterine copper device unacceptable, as one of its contraceptive actions may be to prevent an embryo from implanting. Please cite this article as: Fleming CF. Long-acting reversible contraceptives. The Obstetrician & Gynaecologist 2009;11:83–88.

Background The National Institute for Health and Clinical Excellence (NICE) has judged Implanon® to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. Methods The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. Results The annual cost for the method (using Implanon) was £77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. Conclusion The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice.

Background The authors9 service has child protection guidance listing locally agreed ‘markers’ of potential abuse and exploitation to aid identification of vulnerable young people. Objectives To review whether staff are identifying markers of sexual abuse and exploitation, and to review documentation relating to assessment of Fraser criteria in under-14s (young people) attending sexual health clinics in Gwent, South Wales, UK. Methods Analysis of case notes of 242 young people who made 598 visits to a sexual health clinic between 1 January and 31 December 2003. Results A total of 81 references to a marker of potential abuse or exploitation were recorded at 8% of visits and for 11% of young people. For 72 references a marker was present and for nine was absent. There was no reference to a marker being present or absent for any young males or for 81% of females. Increasing attendance was associated with increasing prevalence of recorded markers. All young people with three or more markers identified as present were referred onwards compared with 53% of those with one or two markers present. Referral did not deter future attendance. Reference to Fraser guidance assessment was recorded at 35% of visits or for 64% of young people and fully demonstrated at 7% of visits or for 16% of young people. There was no recorded assessment for 18% of females and 60% of males. Conclusions The authors9 service is not recording sufficient information to help identify young people (particularly males) at risk of abuse or exploitation or to demonstrate the service9s compliance with Fraser guidance.

Objectives To determine the gender, sexual history and reason(s) for visit for under-14s (young people) attending the authors9 sexual health clinics. Methods Analysis of case notes of 242 young people who made a total of 598 visits to a sexual health clinic in Gwent, South Wales, UK between 1 January and 31 December 2003. Results Of the 242 young people studied, 41% were male and males were responsible for 42% of visits. There was no written record relating to 7% of the total visits. Median age at both first registration and first heterosexual intercourse (when recorded) was 12 years for males and 13 years for females. Some 57% of females and 30% of males were already sexually active at first registration. Details relating to a young person9s partner and their experience of sex (e.g. willingness, autonomy and consensual nature of sex) were infrequently recorded, especially for males. 96% of males requested condoms and 99% received them, whilst 72% of females requested condoms and/or hormonal contraception and 86% received them. 35% of females were seen for the consequences of sex (i.e. pregnancy testing, emergency contraception, screening and/or treatment of sexually transmitted infections and unplanned pregnancies). 80% of these subsequently received condoms and/or hormonal contraception. The majority of young people saw a nurse exclusively (96% males, 71% females). Conclusions Of the young clients seen, 41% are male. Sexual history details are infrequently recorded, particularly for males. The majority of young people accessing the authors9 service are taking action to protect their sexual health and most will see a nurse exclusively.

Fourteen percent of couples in the UK use vasectomy as their method of contraception.1 Accessing vasectomy services should be made as easy and patient-friendly as possible. Unlike many surgical procedures, it is the patient who decides that it is indicated, not the surgeon. Most men requesting vasectomy are healthy and there are few for whom the procedure is not suitable. Men can assess their own suitability for the procedure with a simple questionnaire, and do not normally need to be examined beforehand. Although the operation carries slight potential for litigation, it has a low risk of serious complications and in most cases the decision on the risk/benefit balance is made by the patient, not a clinician. Preoperative counselling for vasectomy is mostly about providing information. Therefore it could be argued that men wanting a vasectomy should not routinely need to see a clinician preoperatively, and that requiring them to do so does not enhance the patient pathway. Attending an outpatient appointment is inconvenient for the patient, requiring time off work, travel to the clinic, and potentially causing apprehension. The Aneurin Bevan Health Board receives around 900 referrals per annum for vasectomy and most of these are self-referrals. Traditionally we have used structured, preoperative counselling in community-based clinic by doctors and more recently nurses. In a pilot survey, most patients in these clinics thought the information could be provided just as effectively by a DVD. Together with a production company, we produced a DVD that included all the information and advice that local and national guidelines suggest a man should receive before agreeing to a vasectomy.2 We wanted to inform patients fully, enable them to assess their suitability for the procedure and to decide whether or not they were one of the few patients who should be seen for …

We thank Drs Chukwu and Menon1 for their interest in our article,2 and are pleased to hear that their DVD is as popular with patients as ours is. We also started out requiring men who had a history …

Background The anticipated increase in uptake of intrauterine system (IUS) fittings is slower than predicted by the National Institute for Health and Clinical Excellence (NICE). There is evidence to suggest that this is because of a high perceived cost of providing this contraceptive method. Whereas studies to date have all guessed at these costs, we calculated the actual costs of providing the IUS. Methods We tracked the notes of 283 women who had an IUS fitted in our community sexual and reproductive health service for 5 years. We recorded duration of use, measured the actual cost of all appointments and interventions over the lifespan of the device, and compared our findings with NICE predicted costs. Results With 70% complete follow-up, the average duration of use of the IUS was 3.44 years compared to NICE9s prediction of 3.32. The average annual cost of providing an IUS for contraception in community clinics was £54.55 per woman; this compares with £70.49 modelled by NICE for provision in primary care. Most (80%) of the cost is incurred in the first year. The cost of managing problems is small. Conclusions Providing the IUS for contraception was 23% cheaper in the present study than that predicted by NICE and cheaper than providing combined oral contraception in our service. Fitting IUSs in community clinics may be cheaper than in primary care. Streamlining the patient pathway will reduce costs further. Restricting access to the IUS because of initial cost is a false economy.

The National Institute for Health and Clinical Excellence (NICE) has judged Implanon to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision.The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC.The annual cost for the method (using Implanon) was pound77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method.The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice.

The objective of this study was to undertake a survey of all obstetrics and gynaecology units in the United Kingdom to identify current views and facilities for the management of adolescents with gynaecological problems. A postal questionnaire was sent to all 248 departments of obstetrics and gynaecology in the UK. The survey was carried out by the Royal College of Obstetricians and Gynaecologists on behalf of the Royal College of Paediatrics and Child Health Intercollegiate Working Group on Adolescent Health. In total, 137 replies were received, giving a response rate of 55%. Only eight centres were able to quote an exact figure for the number of adolescent attendees and this ranged from 0.0035% to 4.8% of new gynaecological referrals. The cut-off age for paediatric patients ranged from 12 to 18 years. In response to the question regarding the definition of 'adolescence', most units that responded stated the range 12-16 years (81 units) and a further 30 units stated 12-18 years. Despite these large variations and also the lack of certainty of both the age range of adolescents and local criteria, 64 units considered that adolescents in their area had special needs, mainly for family planning issues, teenage pregnancy and drug or alcohol abuse. Sixty-three units (46%) provided family planning clinics for adolescents, 24 (17.5%) had a teenage pregnancy clinic, 22 (16.1%) had an adolescent sexual health clinic and 11 (8%) had a clinic for intersex conditions and developmental disorders. In conclusion, there is no consensus on the age range of the adolescent population and a lack of data on the numbers of adolescents with different obstetric and gynaecological problems. There is a perceived need for better data collection and designated facilities for adolescents who have gynaecological problems. Currently, there are no national guidelines for the management and referral of specialized problems, which should be addressed as a matter of urgency.