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The prevalence of antenatal depression in Bangladesh ranges from 18 to 33%. Antenatal depression has negative impacts on the mother and child such as suicidal ideations, low birth weight, and impaired fetal development. This cross-sectional study aims to determine the prevalence and social determinants of antenatal depression in rural Sylhet, Bangladesh. Data were collected from 235 pregnant women between March and November 2021. The validated Bangla Edinburgh Postnatal Depression Scale was used to measure antenatal depressive symptoms (ADS). Background information was collected using a structured questionnaire including the Duke Social Support and Stress Scale, pregnancy choices, and WHO Intimate Partner Violence questions. Point-prevalence of antenatal depression was 56%. Intimate partner violence (IPV) before pregnancy (adjusted odds ratio (AOR) 10.4 [95% confidence interval (CI) 2.7–39.7]) and perceived husband’s male gender preference (AOR 9.9 [95% CI 1.6–59.6]) were significantly associated with increased odds of ADS among pregnant women. Increased family support was a significant protective factor for ADS (AOR 0.94 [95% CI 0.91–0.97]). Antenatal depression commonly occurs in rural Sylhet, Bangladesh, highlighting the need for improved screening and management within these settings. The findings suggest the need for community-based interventions for women with low family support and experiencing intimate partner violence, and educational programs and gender policies to tackle gender inequalities.

Surgical incidents are the most common serious patient safety incidents worldwide. We conducted a review of serious surgical incidents recorded in 5 large teaching hospitals located in one London NHS trust to identify possible contributing factors and propose recommendations for safer healthcare systems.We searched the Datix system for all serious surgical incidents that occurred in any operating room, excluding critical care departments, and were recorded between October 2014 and December 2016. We used the London Protocol system analysis framework, which involved a 2-stage approach. A brief description of each incident was produced, and an expert panel analyzed these incidents to identify the most likely contributing factors and what changes should be recommended.One thousand fifty-one surgical incidents were recorded, 14 of which were categorized as "serious" with contributing factors relating to task, equipment and resources, teamwork, work environmental, and organizational and management. Operating room protocols were found to be unavailable, outdated, or not followed correctly in 8 incidents studied. The World Health Organization surgical safety checklist was not adhered to in 8 incidents, with the surgical and anesthetic team not informed about faulty equipment or product shortages before surgery. The lack of effective communication within multidisciplinary teams and inadequate medical staffing levels were perceived to have contributed.Multiple factors contributed to the occurrence of serious surgical incidents, many of which related to human failures and faulty equipment. The use of faulty equipment needs to be recognized as a major risk within departments and promptly addressed.

Introduction Sexism, lack of sexual freedom, and negative attitudes towards minorities are related to risky and discriminatory sexual behaviors. To date, no cross-cultural comparisons have been made regarding these sexual behaviors and attitudes. The study also explores the sexuality competencies of young adults undertaking vocational courses in higher education before their transition to professional practice. Methods The sample comprised 1235 university students (670 Spanish and 565 British) aged between 18 and 52 years (M = 22.06, SD = 4.38). During the years 2020 and 2021, respondents completed a survey structured in six standardized scales (HPSC, DSS, SOS, HATH, EANT, and TIBS). Results Results report that British students show less gender adherence (DSS) while the Spanish ones show more positive attitudes towards trans individuals (EANT) and pleasure (SOS). These findings indicate that students in this research engage in more sexual risk behaviors (HPSC), display similar rigid gender adherences (DSS), and more positive erotophilic (SOS), homophilic (HATH), and trans-friendly attitudes (EANT and TIBS) than those in previous studies. There were, however, significant differences by gender, religion, and program of study. Conclusions The research demonstrates the relevance of measuring cultural factors related to sexual behaviors and attitudes in youth and reflects a lack of attention to these issues in educational and healthcare settings. This is despite its broad impact on people’s health, as young people are more likely to display increased risky sexual behaviors. Policy Implications These findings emphasize the importance of the development of updated strategies in sex education among young people. The added importance of doing so with students in higher education who are likely to enter professions where they will educate or influence others on these matters is identified.

Objectives Some community pharmacies in England provide free chlamydia testing to young people, yet testing activity in the setting is low. This study aims to increase understanding of why that is, by investigating community pharmacists’ perceptions of barriers to delivering the service, and the reasons why some do not offer testing. Methods Semi-structured interviews were conducted with 22 community pharmacists in North East England between November 2018 and May 2019. The sample comprised both those who provided and did not provide chlamydia testing at the time of the interview. Data were subjected to thematic analysis, utilising the constructs of the normalisation process theory. Key findings Pharmacists found it challenging to sustain delivery of chlamydia testing, as very few young people either requested the test or accepted it when it was offered during consultations on other sexual health services. Pharmacists were cautious about offering the test, having concerns about making clients feel uncomfortable. They identified the value of training to enable them to communicate confidently with clients about testing. Pharmacists supported the suggestion that treatment for chlamydia be offered as part of a ‘test and treat’ package, as they felt that it aligned to their role in the provision of medicines advice. Conclusions Community pharmacies are well-placed to deliver chlamydia testing but are not operating as effectively as they might do. The provision of training on communicating with young people, integrating testing with more sexual health services, and providing ‘test and treatment’ for chlamydia could contribute to greater testing activity.

Background Perinatal mental health (PMH) is a worldwide public health issue crossing cultural boundaries. However, the prevalence of PMH conditions vary considerably. These disparities stem in part from poor understanding and stigma surrounding PMH which hinder pregnant women from seeking mental health care and may exacerbate their conditions. Bangladesh, India and Pakistan are South Asian countries with a higher burden of PMH conditions than in the Global North-West and very different social and cultural norms around gender and mental health. The aim of this systematic review (PROSPERO Ref: CRD42020167903) was to identify, synthesise and appraise the available literature on perceptions and attitudes of perinatal (pregnant and postpartum) women, their families and healthcare providers surrounding PMH in Bangladesh, India and Pakistan. Methods Five electronic databases, MEDLINE, Embase, PsycINFO, Scopus and Web of science, and grey literature were searched using predefined search terms. Qualitative or quantitative articles with a qualitative component reporting perceptions and attitudes surrounding PMH in Bangladesh, India and Pakistan were eligible for inclusion, if published in English between January 2000 and January 2021. The Critical Appraisal Skills Programme Qualitative Research Checklist and Newcastle–Ottawa Scale for cross-sectional studies were used to assess study quality. Findings were synthesised using thematic synthesis, as described by Thomas and Harden 2008. Results Eight studies were included. Five overarching themes comprising 17 sub-categories were identified. These descriptive themes were: perceived causes of PMH, perceived symptoms of PMH, perceptions of motherhood, accessing PMH care and emotional sharing and coping strategies. Sociocultural expectations underpin many of the themes identified in this review including the importance of familial and societal causes of PMH, emphasis on physical symptoms, sacredness of motherhood, lack of awareness, stigma, shame, limited resources allocated for mental health and lack of emotional sharing. Conclusions There is a complex range of perceptions and attitudes around PMH which influence women’s experiences and access to PMH care. These findings will inform policy and practice through targeted interventions to tackle stigmatising attitudes and increasing education and training for healthcare providers.

Background Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information, including a lack of meta-analysis, on the social determinants of antenatal depression or anxiety in these South Asian countries. This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan. Methods We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO using keywords and MeSH headings. Two investigators screened all search results independently. Supplementary searches included hand searching reference lists and citation searches using Google Scholar. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Quality of included studies were assessed using the Newcastle-Ottawa scale. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger’s test, respectively. The review was registered on PROSPERO (reference: CRD42020167903). Results The searches identified 3,372 studies; following deduplication, 1,987 studies remained for screening. Following screening and supplementary searches, a total of 34 studies were included in this review (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41–4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28–1.83), male gender preference (AOR 3.06, 95% CI 1.40–6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25–5.80) were significantly associated with antenatal depression. Conclusion Screening tools to identify pregnant women at high risk of antenatal depression should be integrated within antenatal care to prevent adverse outcomes. Knowledge of social determinants will inform the development of such screening tools and interventions. One limitation of this review is the language restriction; however, international journals largely publish in English. Future research involving qualitative studies to understand the mechanisms within the associations are needed.

ObjectivesChlamydia testing among young people in community pharmacies in North East England has been low compared with other remote settings offering testing for the past few years. To understand why this may be, to maximise service provision, the perceptions of young men and women about pharmacy testing and possible chlamydia treatment were gathered and interpreted.DesignIndepth, semistructured interviews.SettingFour youth centres in North East England.ParticipantsThe study included 26 young people aged 16–23. The sample of participants comprised those with a history of chlamydia testing as well as those never tested.InterviewsFace-to-face interviews were conducted between October 2018 and May 2019. The interview schedule covered young people’s perceptions of sexually transmitted infections, provision of pharmacy sexual and reproductive health and chlamydia testing, and potential chlamydia treatment. Data from the interviews were subjected to thematic analysis.ResultsThe geographical accessibility and long opening times of community pharmacies in North East England were perceived benefits of the service. However, young people had concerns about being judged by pharmacy staff or overheard by customers when requesting the test. Men did not want to be seen by their peers accessing the pharmacy. These barriers were associated with a perceived stigma of chlamydia. Despite this, young people thought that pharmacist advice on the test kit would be important to ensure they complete it correctly. Those never tested favoured how the kit could be taken home to complete the urine sample. The option of including chlamydia treatment was reported to be convenient and comforting.ConclusionSupporting pharmacies in North East England to offer a confidential chlamydia testing service is necessary to overcome young people’s perceived barriers to testing. Delivering testing as an integrated sexual health package with other pharmacy services, together with treatment where suitable, will increase acceptance for testing and timely access to treatment.

Objective Patient safety incidents can have a profound effect on healthcare professionals, with some experiencing emotional and psychological distress. This study explored the support medical and nonmedical operating room staff received after being involved in a surgical patient safety incident(s) in 5 UK teaching hospitals. Methods An invitation letter and information sheet were e-mailed to all medical and nonmedical operating room staff (N = 927) across the 5 sites. Semistructured interviews were arranged with a range of different healthcare professionals working in operating rooms across a wide variety of surgical specialities. Interviews were audio recorded, transcribed verbatim, and analyzed using an inductive thematic approach. Results We conducted 45 interviews with medical and nonmedical operating room staff, who emphasized the importance of receiving personalized support soon after the incident. Operating room staff described how the first "go to" people were their peers and reported feeling comforted when their peers empathized with their own experience(s). Other participants found it very difficult to seek support, perceiving it as a sign of weakness. Although family members played an important role in supporting second victims, some participants felt unable to discuss the incident with them, fearing that they might not understand. Conclusions There should be clear support structures in place for operating room staff who have been involved in surgical incidents. Health organizations need to offer timely support to frontline staff after these incidents. Senior clinicians should be proactive in offering support to junior colleagues and empathize with their own experiences, thus shifting the competitive culture to one of openness and support.

Background: Attention has turned in recent years to the broader inclusion of sociology and psychology in medical curricula. Despite this, there is limited published evidence about how best to assess these subjects. This lack of evidence is significant given that most medical schools are likely to include some form of assessment of sociology and psychology, and that sociology and psychology are included in areas examined in admissions tests and in licensing exams. Methods: We ran three one day workshops in the UK (London, Edinburgh and Manchester, June – July 2019), to consult with educators involved in sociology and psychology teaching in medicine on: what methods are being used to assess sociology and psychology in UK undergraduate medical education, and the challenges and opportunities experienced.36 participants attended the workshops, representing 19 of the 33 UK medical schools. Following the workshops, we collated the notes and presentations in order to develop a summary of current assessment practices and synthesis of the main themes identified. Results:There were many examples of good practice and development of innovative assessments, particularly in the early years of the programmes. At the same time, participants raised several challenges and tensions in relation tothe method, timing, and placement of sociology and psychology assessment. Participants reported that many of these issues related to dominant assessment cultures in medical education. As a result, assessing sociology and psychology in medicine can seem like fitting a square peg into a round hole. Solutions to these challenges may require wider changes to assessment practices and cultures. Conclusion: The challenges shared by participants are evident; nonetheless, there are important opportunities. Our participants were unanimous in their desire to become involved in dialogue and consultation about assessment. This article, reporting on the views of UK SBS educators, is a positive step towards creating a more robust evidence base upon which to engage in these conversations and inform best practice in sociology and psychology assessment. &nbsp

Background Surgical incidents can have significant effects on both patients and health professionals, including emotional distress and depression. The aim of this study was to explore the personal and professional impacts of surgical incidents on operating theatre staff. Methods Face-to-face semistructured interviews were conducted with a range of different healthcare professionals working in operating theatres, including surgeons and anaesthetists, operating department practitioners, and theatre nurses, and across different surgical specialties at five different hospitals. All interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach, which involved reading and re-reading the transcripts, assigning preliminary codes, and searching for patterns and themes within the codes, with the aid of NVivo 12 software. These emerging themes were discussed with the wider research team to gain their input. Results Some 45 interviews were conducted, generally lasting between 30 and 75 min. Three overarching themes emerged: personal and professional impact; impact of the investigation process; and positive consequences or impact. Participants recalled experiencing negative emotions following surgical incidents that depended on the severity of the incident, patient outcomes, and the support that staff received. A culture of blame, inadequate support, and lack of a clear and transparent investigative process appeared to worsen impact. Conclusion The study indicated that more support is needed for operating theatre staff involved in surgical incidents. Greater transparency and better information during the investigation of such incidents for staff are still needed.

The language we speak and how we communicate involves more than just the sounds we make, the words we use, and how we put the words together. How we communicate involves creating and sharing our meanings in unique and complex ways. Quite often the meanings we share cannot be translated easily from one language to another. This is because of the way cultural understandings that underpin language differ from one cultural group to another. Many Aboriginal and Torres Strait Islander (TSI) students speak Aboriginal English (AE) – a dialect of English, a creole, or a traditional Indigenous language as their home language. This is important, not only for day-to-day communication, but also as a way to maintain cultural self-identity. However, it must be recognised that there is considerable variability amongst all Aboriginal and Torres Strait Islander peoples in the form of their languages and how they use them. This is because they are strongly related to, and shaped by, their particular environmental and cultural contexts. There are important implications for students’ learning and for the way that teachers teach based on the language background of students. Furthermore, it is vital that all educators understand the consequence of language variation in the current environment of national curricular and testing regimes.

Learning about alternatives to violence is an essential part of change work with domestic violence perpetrators. This is complex work, seeking to tackle a sensitive issue by involving the development of deep, embodied learning for perpetrators who may lack perspective on their behaviour. Interactive storytelling has been providing users with the opportunity to explore speculative scenarios in a controlled environment. We discuss the design of Choice-Point: a web-based application that allows perpetrators adopt the role of different fictional characters in an abusive scenario for conveying the essential skill of perspective-taking. We evaluated Choice-Point through trials with three groups of perpetrators, a support group of victim-survivors and an expert critique from support workers. We discuss challenges in using such technologies - such as our system - for engagement; the value of perpetrator agency in supporting non-violent behaviours, and the potential to positively shape perpetrators' journeys to non-violence within social care settings.

This paper provides a critical examination of how digital systems within a charitable organisation in the North of England are being used to both support and challenge male perpetrators of domestic violence. While there exists a range of digital tools to support the victim-survivors of domestic violence, no tools are available to challenge the abusive and harmful behaviours of perpetrators. Through this work, we uncovered the compelling moral responsibilities intrinsic within interactions with technological systems between perpetrators and support workers. As such, we highlight four spaces of negotiation concerning a person's responsibility in changing their abusive behaviour, which we have coined as mechanisms to represent their fundamental and interconnected nature. These mechanisms include self-awareness, acknowledging the extent of harms, providing peer support and respecting authorities. These insights are the basis for offering some practical considerations for HCI scholars, policymakers and intervention designers in their work with perpetrators of violence.

This chapter provides a brief introduction to Aboriginal and Torres Strait Islander people and history, and a more comprehensive introduction to Nyoongar people and culture. Contemporary Nyoongar people and culture have been dramatically impacted by over 190 years of colonisation. To know the colonial history of Western Australia is to take a significant step closer to knowing and understanding Nyoongar people and community. This chapter can help non-Indigenous people to engage and connect with Nyoongar people because it is an overview of the most significant aspects of our colonial history that are essential knowledge for anyone who is seeking to work collaboratively with Nyoongar people.

When thinking about working with First Peoples in the field of education, there are several different aspects to be considered. Firstly, there are three tiers of education; then there is the teaching of First Nations students and non-Indigenous students; and finally there is a need to differentiate between what is taught and how it is taught. Chapter six is about teaching Aboriginal and Torres Strait Islander students and begins with an overview of education policy and some of the challenges faced by teachers working with Aboriginal and Torres Strait Islander students. There are three case studies. The first is called Moorditj Mob and it runs at Wesley College, a secondary school with a majority non-Indigenous student cohort and a successful Aboriginal student scholarship program. The second is a primary school called Djidi Djidi that caters specifically to Aboriginal children. And the third is a university education centre called the Curtin Centre for Aboriginal Studies that operates programs for Aboriginal and Torres Strait Islander students.

This chapter introduces the philosophy and methodology of action research as well as introducing some other Indigenous research methodologies. Action research is a democratic and participatory way of working that is ideally suited to First Nations communities. The practical process of action research is described as a cycle of look, think and act and it is this process that provides a framework for the case studies in all the following chapters. Like action research, Indigenous research methodologies offer similar democratic and emancipatory ways of working. Like action research, they have an underlying philosophy that is respectful of Indigenous protocols, decolonises the research space and prioritises an Indigenous world view.

This chapter acknowledges that many teachers feel unprepared to teach Indigenous content to their non-Indigenous students. It looks again at the policies as well as some of the difficulties teachers face at different stages of a student’s education. There are two case studies. The first is a university cross-discipline service-learning program that aims to develop cultural awareness and cultural competency in students. The unit is called Aboriginal Community Engagement and it employs an action research framework for guiding the students’ relationships as they work with Aboriginal community partners. The second case study is the Nyoongar Culture and Identity unit that takes Curtin University students on-country for 5 days of cultural immersion.

Background: Adverse surgical incidents affect both patients and health professionals. This study sought to explore the effect of surgical incidents on operating theatre staff and their subsequent behaviours. Methods: Eligible studies were primary research or reviews that focused on the effect of incidents on operating theatre staff in primary, secondary or tertiary care settings. MEDLINE, Embase, CINALH and PsycINFO were searched. A data extraction form was used to capture pertinent information from included studies and the Critical Appraisal Skills Programme (CASP) tool to appraise their quality. PRISMA-P reporting guidelines were followed and the review is registered with PROSPERO. Results: A total of 3918 articles were identified, with 667 duplicates removed and 3230 excluded at the title, abstract and full-text stages. Of 21 included articles, eight focused on the impact of surgical incidents on surgeons and anaesthetists. Only two involved theatre nurses and theatre technicians. Five key themes emerged: the emotional impact on health professionals, organization culture and support, individual coping strategies, learning from surgical complications and recommended changes to practice. Conclusion: Health professionals suffered emotional distress and often changed their behaviour following a surgical incident. Both organizations and individual clinicians can do a great deal to support staff in the aftermath of serious incidents.

There is an expectation that medical students in the UK will be able to demonstrate conversancy with social science relevant to medicine and health, including the means by which the relevant bodies of knowledge are generated through the use of social science research methods. This paper explores the structural and pedagogical challenges and opportunities posed by this demand. To achieve this a small scale research project seeking to establish the ‘state of the art’ with respect to teaching and learning about these research methods was implemented. It was found that there is little formal reporting of practice in the literature and that this is a field largely unsupported with materials and resources. However, there were some common features in the ways that practitioners approach, organise and deliver the provision; and it was found that almost all the provision takes place in the early part of medical education. It is suggested that continuing problems with the status of social sciences, lack of clarity about whether the purpose is to enrich medicine with knowledge about health and generated by the social sciences, and/or explore the ontological and epistemological tensions between natural and social sciences coupled with the status of social scientists in medical education, may limit capacity to develop the field.

Using data collected through semi-structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help-seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help-seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help-seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of 'hegemonic masculinity' in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.

(1) Background: Negative attitudes towards sexual minorities are widespread in our society. The Scale of Negative Attitudes towards Transgender people (EANT) has been tested in Spanish-speaking countries in order to assess its applicability as a measure of harmful predispositions towards trans individuals. Understanding these predispositions is important because of transformations in the rights of people in terms of respect for gender diversity. (2) Methods: For the validation of this scale, an online survey was developed and distributed to 362 UK university students aged 18 to 45 years (M = 21.43, SD = 3.42). The sample was randomly divided in half, carrying out the exploratory factor analysis for the first 180 students and performing the confirmatory factor analysis for the remaining 182. (3) Results: The validation of this unifactorial instrument in English was obtained, with a high internal consistency (α = 0.810) that suggests high applicability to measuring this construct, as well as showing expected relationships with typical variables (HATH, TIBS, gender, sexual orientation, religion and education). (4) Conclusions: This study assesses attitudinal tendencies and reveals how sexual prejudice is still implicit in our societies and makes the stigmatisation and discrimination of trans people visible. These findings support the development of strategies to tackle these predispositions.

Coordinated input from a variety of health and social care professionals into medical education helps students to become strong, effective, successful and competent future practitioners able to function within the multi-disciplinary environment which characterizes modern medicine. This paper presents a new model of teaching developed within the context of the Phase 1 Medicine Programme at Durham, which has been used to help prepare students for this by intertwining a selection of lectures and activities run by external organizations with additional clinical exposure and experience. This one-week learning journey was called the Additional Clinical Experience (ACE) week, and now forms an integral part of the curriculum at Durham University.

Understanding the social basis of health and medicine and the contexts of clinical care are essential components of good medical practice. This includes the ways in which social factors such as class, ethnicity and gender influence health outcomes and how people experience health, illness and healthcare. In our Guide we describe what sociology is and what it brings to medicine, beginning with the nature of the ‘sociological imagination’. Sociological theory and methods are reviewed in order to explain and illustrate the role of sociology in the context of undergraduate medical education. Reference is made to A Core Curriculum for Sociology in UK Undergraduate Medical Education by Collett et al. (2016). Teaching and student learning are discussed in terms of organisation and delivery, with an emphasis on practice. Sections are also included on assessment, evaluation, opportunities and challenges and the value of a ‘community of practice’ for sociology teachers in medical education.

Since 2012, researchers and clinicians in one National Health Service (NHS) Trust have been involved in an NHS led and funded project to develop and evaluate a programme to support International Medical Graduates; (IMGs; graduates who have obtained their medical degree outside the country in which they work). The synthesis of this work is presented here as a toolbox, providing an evidence- guided example of best practice for supporting IMGs.

If you are a young female in the UK that uses social media (as 96% of 16–24-year-olds do),1 you may have come across an advert for Natural Cycles since they began their media campaign in late 2016, when using platforms such as Facebook, Instagram or Twitter. Natural Cycles is a ‘natural contraception’ app that was created by a Swedish particle physicist and her partner. For £39.99 per year, users log their body temperature each morning, and occasionally other details, such as their menstruation, and an algorithm determines their fertile days (during which the user would need to use barrier contraception or avoid sexual intercourse). It has been approved as a medical device for contraceptive purposes in Europe.2 The most recent study of the app was funded and primarily run by Natural Cycles. The study was a prospective observational study of 22 785 users who were mostly Swedish and had an average age of 29 (SD=5) years. They do not mention the previous contraceptive practices of their population. Women were considered pregnant if they reported it to the app, or if the timing of when they stopped using the app made it likely they were pregnant. With perfect use, Natural Cycles claims a failure rate of only 1.0 pregnancy per 100 woman-years. With typical use of the app, the failure rate increases from 1.0 to 6.8 pregnancies per 100 woman-years. However, less than 10% of the user data qualified as ‘perfect use’ and contributed to the analysis. If they included all women for which the pregnancy status was unknown (who could possibly be pregnant) this went up to …