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The COVID-19 pandemic has made it necessary to find innovative strategies that facilitate safe, private assessment and intervention for intimate partner violence (IPV). IPV is a major source of morbidity and mortality, with women experiencing a lifetime prevalence rate of 22%. Screening pregnant individuals for IPV during the COVID-19 pandemic became critical because a 20% rise in IPV during the pandemic has been estimated. A multidisciplinary stakeholder panel created a process using technology to address this concern. An infographic poster with IPV screening questions and a Quick Response (QR) code was displayed in bathrooms in the perinatal service area. The infographic allowed respondents to signal a safety concern, launching an individualized plan of care to address their needs privately. The pandemic has highlighted how much work needs to be done to ensure that people who experience IPV continue to obtain access to support and health care., During the COVID-19 pandemic, creative strategies are needed to assess and intervene for intimate partner violence while adhering to policies to mitigate exposure to COVID-19.

Background: The COVID-19 pandemic triggered a natural experiment of an unprecedented scale as companies closed their offices and sent employees to work from home. Many managers were concerned that their engineers would not be able to work effectively from home, or lack the motivation to do so, and that they would lose control and not even notice when things go wrong. As many companies announced their post-COVID permanent remote-work or hybrid home/office policies, the question of what can be expected from software engineers who work from home becomes more and more relevant. Aims: To understand the nature of home telework we analyze the evidence of perceived changes in productivity comparing office work before the pandemic with the work from home during the pandemic from thirteen empirical surveys of practitioners. Method: We analyzed data from six corporate surveys conducted in four Scandinavian companies combined with the results of seven published surveys studying the perceived changes in productivity in industrial settings. In addition, we sought explanations for the variation in perceived productivity among the engineers from the studied companies through the qualitative analysis of open-ended questions and interviews. Results: Combined results of 7686 data points suggest that though on average perceived productivity has not changed significantly, there are developers who report being more productive, and developers being less productive when working from home. Positively affected individuals in some surveys form large groups of respondents (up to 50%) and mention benefiting from a better organization of work, increased flexibility and focus. Yet, there are equally large groups of negatively affected respondents (up to 51%) who complain about the challenges related to remote teamwork and collaboration, as well as emotional issues, distractions and poor home office environment and equipment. Finally, positive trends are found in longitudinal surveys, i.e., developers’ productivity in the later months of the pandemic show better results than those in the earlier months. Conclusions: We conclude that behind the average “no change” lays a large variation of experiences, which means that the work from home might not be for everyone. Yet, a longitudinal analysis of the surveys is encouraging, as it shows that the more pessimistic results might be influenced by the initial experiences of an unprecedented crisis. At the end, we put forward the lessons learned during the pandemic that can inspire the new post-pandemic work policies. © 2021 The Authors open access

The purpose of this study was to analyze the strength of executorial Grosse Debt Recognition Deed in practice in the Class 1A of Mataram District Court. The research method used is empirical normative research. First, based on the results of the research that the Strength of Grosse's Debt Recognition Act in Debt Payment Implementation has a strength that is undoubtedly very strong because it can immediately be submitted for execution without going through a lawsuit in court, which is due to an executive power in the Grosse deed the acknowledgment of Debt in the head of the Deed is that there is an order for justice based on the One and only God made by the Second Notary, Grosse deed of debt recognition can be carried out directly without going through a claim process in court, bearing in mind the Grosse deed of debt recognition provided the head of the office reads for the sake of justice based on the supreme divinity, so that with the power contained in the debt recognition deed, direct execution can be carried out by the creditor to the court if the debtor defaults, without going through the claim process in court. Third, there are several relationships in the execution of Grosse's deed. Debt recognition, for example, the community's knowledge of the gross debt recognition deed. The second, sometimes the notary in making debt recognition Grosse statements does not pay attention to material and formal requirements from the Grosse deed itself.

Context: More than 78 countries have developed COVID contact-tracing apps to limit the spread of coronavirus. However, many experts and scientists cast doubt on the effectiveness of those apps. For each app, a large number of reviews have been entered by end-users in app stores. Objective: Our goal is to gain insights into the user reviews of those apps, and to find out the main problems that users have reported. Our focus is to assess the “software in society” aspects of the apps, based on user reviews. Method: We selected nine European national apps for our analysis and used a commercial app-review analytics tool to extract and mine the user reviews. For all the apps combined, our dataset includes 39,425 user reviews. Results: Results show that users are generally dissatisfied with the nine apps under study, except the Scottish (“Protect Scotland”) app. Some of the major issues that users have complained about are high battery drainage and doubts on whether apps are really working. Conclusion: Our results show that more work is needed by the stakeholders behind the apps (e.g., app developers, decision-makers, public health experts) to improve the public adoption, software quality and public perception of these apps. © 2021 Elsevier Inc. open access

COVID-19, the disease caused by the SARS-CoV-2 virus, was declared a global pandemic by the World Health Organization on March 11, 2020. In addition to older individuals and those with underlying chronic health conditions, maternal and newborn populations were also identified as being at greater risk. It became critical for hospitals and clinicians to maintain the safety of individuals in the facility and minimize the transmission of COVID-19 while continuing to strive for optimized outcomes by providing family-centered care. Rapid change during the pandemic made it appropriate to use the plan–do–study–act (PDSA) cycle to continually evaluate proposed and standard practices. Our team established an obstetric COVID-19 unit for women and newborns, developed guidelines for visitation and for the use of personal protective equipment, initiated universal COVID-19 testing, and provided health education to emphasize shared decision making., Being prepared for rapid change is essential for nurses and other clinicians caring for the maternal–newborn population during a pandemic.

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, “You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her.” Madeleine, who was twenty‐four years old, was dying of end‐stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment—in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid‐19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients’ and families’ experiences at the end of life during a pandemic.

As I organize a pile of ethics consult chart notes in New York City in mid‐April 2020, I look at the ten cases that I have co‐consulted on recently. Nine of the patients were found to be Covid positive. The reasons for the consults are mostly familiar—surrogate decision‐making, informed refusal of treatment, goals of care, defining futility. But the context is unfamiliar and unsettling. Bioethicists are in pandemic mode, dusting off and revising triage plans. Patients and potential patients are fearful—of the disease itself and of the amplification of health disparities and inequities. There is so much to contemplate, but as I go through my cases, I worry about disability, about biases and racist stereotypes. In this pandemic, historically marginalized communities are at risk of further disenfranchisement.

This article describes the main results of an ethnographic study on citizen participation carried out in the context of the development of the Urban Initiative (2007-2015): Cuenca-Barrio de San Antón. Managed by the City Council of Cuenca and financed by the European Regional Development Funds (FEDER) under the Ministry of Economy and Finance at the Government of Spain The results of the research show how in the context of the application of neoliberal policies, citizen participation becomes the trigger for new conflicts between institutions and citizens. In this sense, it is worth noting how, in practice, institutions in their capacity as experts and not willing to dis-empower themselves, invoke citizen participation to try to legitimize their actions. Showing participation strategies based on logics that either deny or promote a merely symbolic level, and that confront the strategies of citizen participation deployed by the subaltern actors to challenge and stress the dominant practices

Objective: To determine the extent of testing, diagnostic episodes and management of genital Chlamydia trachomatis (CT) infection in UK primary care using a large primary care database. Methods: The incidence of CT tests, diagnostic episodes, treatments and referrals was measured for all adult patients in the General Practice Research Database between 1990 and 2004. Results: In those aged 12-64 years in 2004, rates of CT testing increased to reach 1439/100,000 person years (py) in women but only 74/100,000 py in men. Testing rates were highest among 20-24 year old women (5.5% tested in 2004) followed by 25 to 34 year old women (3.7% tested in 2004). 0.5% of registered 16 to 24 year old women were diagnosed with CT in 2004. Three-quarters of patients with a recorded CT diagnosis had had an appropriate prescription issued in 2004, a proportion which increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded CT diagnoses in females and 5.1% of those in males. Conclusions: Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women over 24. Extremely low testing rates of testing in men, together with high positivity, demonstrate a missed opportunity for CT diagnosis and contact tracing in general practice.

Objectives: To test the hypotheses that (1) women who know that human papillomavirus (HPV) is sexually transmitted will expect to experience higher levels of stigma, shame and anxiety if they test positive for the virus than women who are not aware of the mode of transmission and (2) women who are aware of the high prevalence of HPV infection will expect to experience lower levels of stigma, shame and anxiety than women who underestimate its prevalence. Methods: A web-based survey in which information about HPV was manipulated to generate a 2×2 design (awareness that HPV is sexually transmitted v no awareness; awareness of the high prevalence of HPV v no awareness). Participants (n = 811) were female students. They were asked to imagine that they had tested positive for HPV. Outcome measures were expected stigma, shame and anxiety. Results: Great differences were observed in emotional reactions to imagining testing HPV positive between the four groups based on knowledge of HPV. Knowledge of the prevalence was associated with lower levels of stigma, shame and anxiety. Knowledge that HPV is sexually transmitted was associated with higher levels of stigma and shame, but not anxiety. Women who knew that HPV is sexually transmitted but not that it is highly prevalent had the highest scores for stigma and shame. Conclusions: Raising public awareness of the sexually transmitted nature of HPV has the potential to increase women’s feelings of stigma and shame if they test positive for the virus. However, our findings suggest that ensuring women’s awareness of HPV being common may reduce these feelings and also reduce anxiety, perhaps by “normalising” the infection.

Objectives: To determine which of the options available to modernise genitourinary medicine (GUM) clinics in the UK are most acceptable to patients and potential patients; to assess whether the views of a general population sample differ from those of clinic attenders. . Methods: A questionnaire was used to explore the acceptability of different ways of delivering sexual healthcare including the potential trade-off between convenience/range of services with cost/staffing constraints. Potential differences in responses by age, sex, ethnicity and current attendance at a GUM clinic were evaluated using multivariate analysis. Results: 542 respondents in the community and 202 clinic attenders provided responses. Delivery of sexual healthcare by specialist nurses and general practitioners was acceptable to 81% and 72% of interviewees, respectively, assuming common protocols were adhered to. The proportion of individuals who would accept a consultation with a nurse increased to 91% if the waiting time for an appointment could be reduced as a result. Men were less likely to accept a consultation with a nurse (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.35 to 0.79), and Asian (OR 0.38, 95% CI 0.23 to 0.64) and other black (OR 0.41, 95% CI 0.2 to 0.87) ethnic groups were less likely to accept a consultation with a general practitioner. 44% of patients preferred walk-in clinics even if waiting times for an appointment were reduced to 48 h. Conclusion: Delivery of sexual healthcare by nurses and general practitioners was generally found to be acceptable, although this varies by patient sex and ethnicity. Some differences exist between the preferences of a general population sample compared with clinic attenders, but overall there is a high level of concordance. Walk-in clinics remain a popular choice even when appointment waiting times are short.

Objectives: To examine gender differences in sexual behaviour, the prevalence of laboratory-detected sexually transmitted infections (STIs) and self-reported genital symptoms in urban Chennai, Tamil Nadu, India. Study design: The data were based on a cross-sectional survey (n = 1649) of residents from low-income communities in Chennai. Data were collected during community-wide health camps comprising physical examinations, interviews and laboratory testing between March and June 2001. Results: The population was young, sexually active, with a low prevalence of STI. The most commonly detected STI was Herpes simplex virus type 2 (HSV2; 13.2%). Women had a higher prevalence of HSV2, but were more likely than men to be asymptomatic. Most of the self-reported genital symptoms could not be linked to a laboratory-detected STI. >10% of the cohort had a history of an ulcerative STI and >5% had an inflammatory STI. Conclusions: Given a high prevalence of HSV2 in the study population, interventions targeting HSV2 transmission may be particularly relevant for this population.

Objective: To develop a risk assessment algorithm that will increase the identification and treatment of women with cervical infection in rural Haiti. Methods: Study participants were randomly selected from new patients who accessed services at a women's health clinic in rural Haiti between June 1999 and December 2002. This case-control study included women who tested positive for chlamydia and/or gonorrhoea based on the Gen-Probe PACE 2 laboratory test as cases. Controls were women who tested negative for both of these infections. Results: Women from this area of rural Haiti had a limited level of education and lived in impoverished housing conditions. The sensitivity estimates of Haitian Ministry of Health and WHO algorithms for detecting chlamydia and/or gonorrhoea were generally low (ranging from 16.1% to 68.1%) in this population. Risk scores based on logistic regression models of local risk factors for chlamydia and gonorrhoea were developed and sensitivity estimates were higher for algorithms based on these risk scores (up to 98.8%); however, specificity was compromised. Conclusions: A risk assessment algorithm to identify women with chlamydia and/or gonorrhoea is more sensitive and less specific than the syndromic management approach advocated by WHO and adapted by the Haitian Ministry of Health. Using a risk assessment tool with high sensitivity based on local risk factors of cervical infection will maximise access to care, improve outcomes, and decrease morbidity in women who have cervical infection in rural Haiti.

Objectives: To describe antimicrobial self medication for reproductive tract infections (RTI) including sexually transmitted infections (STI), and to explore the understanding and use of health information among the adult population self medicating with antimicrobials for RTI/STI in two provinces of Laos. This could contribute to quality improvement of RTI/STI management. Methods: Cross sectional community based study. Structured interviews (household survey) were conducted among 500 subjects aged 18 or more, who had used antimicrobials as self medication for RTI/STI during the past year. They were recruited among 3056 family members in Vientiane capital and Champasak province, divided equally between the two study sites, and between urban and rural areas. Results: Among the 500 respondents reporting self medication for RTI/STI, 91% had bought the antimicrobials from local private pharmacies without a physician’s prescription. 58% of those were advised to buy the drugs from drug sellers. Ampicillin (not recommended as syndromic treatment for RTI/STI) was used in 83% of all cases, in 28% combined with tetracycline. 79% of respondents used antimicrobials for a non-recommended duration of time. Most respondents had access to health messages for RTI/STI, largely from radio/television and drug sellers. However, only 17% of all respondents reported that they had ever used a condom. Conclusions: More than three quarters of respondents, self medicating for RTI/STI with antimicrobials, used inappropriate drugs bought from private pharmacies. There is a need to improve RTI/STI management, including health promotion, through interventions at community level, and to health providers, including private drug sellers.

Objective: To determine prospectively the relation between sexually transmitted infection (STI) diagnosis and depressive symptomatology. Methods: Secondary data analyses were performed on 175 sexually active African-American female adolescents, who were recruited from high risk neighbourhoods in Birmingham, Alabama, United States. Results: ANCOVA was used to compare adolescents who tested positive with adolescents who tested negative on three waves of depressive symptom scores, controlling for age. The STI positive group had higher depressive symptom levels at 6 months relative to the STI negative group. This result was moderated by baseline depressive symptom levels: for adolescents above the clinical threshold, the STI negative group experienced a decrease in symptoms at 6 months whereas the STI positive group maintained the same level. For adolescents below the clinical threshold, there were no changes in depressive symptom levels regardless of diagnosis. Conclusions: Receiving an STI diagnosis may affect depressive symptomatology for those at risk for depression. Screening for depression in settings that provide STI testing and treatment may be warranted for this population.

Aim: To attempt to assess demand for access to sexual health services in a community where a “closed” appointment system operates in the local genitourinary medicine (GUM) clinic. Setting: A large GUM clinic serving a provincial city in England. Appointments for new episodes are available only 1 or 2 days ahead. Service user complaints about repeated difficulty in getting through to book a visit prompted a review of all methods of access. Methods: A prospective review of all calls received in the departmental telephone booking service was performed. Temporary extra staff manned a cascade sequence of telephone lines and recorded all calls and caller characteristics such as age and declaration of symptoms. All attempts to book an appointment in person, by written referral, or by telephone in a period of 5 working days were also logged. This total demand was compared with the actual capacity and maximum theoretical capacity of the clinic during the same time period. Results: 626 appointments would be required in the working week to accommodate all patients within 48 hours of requesting to be seen. 84% of all calls requested a new appointment, and 77% all new appointment requests were by phone. There were 181 new appointments available; 72% of those requesting an appointment could not be seen. The clinic was working at 103% capacity. To accommodate demand at this quiet time of the academic year, the GUM service would need to increase capacity by 3–4-fold. Conclusions: Closed appointment systems in GUM services may produce an apparent “improvement” in waiting times to 48 hours, but many callers are not able to book an appointment at all. Demand for GUM services outstrips capacity to an extent that internal efficiency savings cannot hope to address.

Objectives: Anal cytology smears are either collected “blind” (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability. Methods: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure. Results: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as “unsatisfactory” for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p Conclusions: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.

Objectives: There is a lack of information describing levels of patient satisfaction among patients seeking sexually transmitted diseases (STD) care in a public clinic setting. We sought to identify patient, provider, and clinic characteristics associated with patient satisfaction within public STD clinics. Methods: A cross sectional survey with random sampling was conducted among patients attending two public STD clinics. Satisfaction was assessed using questions from validated national surveys. Outcomes for multivariate logistic regression analysis were ratings of overall health care and clinician. Results: 499/605 (82%) patients were enrolled. Patients were mean age 29 years, 51% male, 94% black. Lower rating of clinician technical skills (OR = 15.6 clinic A, OR = 7.9 clinic B) and clinic environment (OR = 3.9 clinic A, OR = 9.6 clinic B) were associated with lower healthcare rating, as was lower rating of television/video in waiting room (OR = 10.2, clinic A) and dysuria (OR = 4.2, clinic B). Higher clinician rating (OR = 0.58, clinic A) and receiving written materials (OR = 0.44, clinic B) were protective of lower healthcare rating. Risks for lower clinician rating at clinic A were greater pain, problems getting care, lower rating of clinician technical skill, and overall health care, while receiving written materials was protective. At clinic B, lower rating of clinician technical skill and clinic environment were risks for lower clinician rating. Conclusions: Patient satisfaction was associated with modifiable provider and clinic characteristics. Results from our study indicate a need to examine whether health outcomes of STD management vary by patient satisfaction.

Objectives: To assess the effectiveness of a newly developed triage tool to provide urgent access to genitourinary medicine (GUM) for patients. To appraise its value in compiling statistics for patients attending the department without appointments or those telephoning for advice. Method: Retrospective evaluation of triage forms completed by healthcare professional (HCP). Randomly selected triage forms completed for 250 male and 250 female patients attending a GUM clinic over a 3 month period. Result: Patients attending or telephoning with acute symptoms such as ulceration or abdominal pain, or as a result of sexual assault were offered same day or next day appointments in 100% of cases. However, for untreated chlamydial infection, testicular pain, and male urethritis the success rate fell to between 54–86%. Conclusion: The new form is easy to complete and allows a more structured triage of patients. It provides a standardised template for staff employed in GUM triage and facilitates accurate documentation and data collection of this important activity. All targets are not being met and patient distress is not adequately addressed or recorded to help service planning. However, accountable standardised data can be collected, which is important in defining the extent of the service and provides useful information for commissioners.

Background: Injecting drug users (IDUs) are a marginalised population, who infrequently access health services for screening for sexually transmitted infections (STIs) and blood borne viruses (BBVs), and are at high risk of these infections. Objectives: To use street outreach and self collection of samples for STI screening, to establish the prevalence of BBVs and STIs, and to identify risk behaviours among a group of culturally diverse street based IDUs. Methods: This was a cross sectional study of 314 IDUs in the central business district of Melbourne, Australia, conducted over 3 years (1999–2002). We used street outreach as the recruitment strategy with staff “on foot” in injecting and dealing locations, as well as self collected genital sampling to increase acceptance of screening for Neisseria gonorrhoeae, Chlamydia trachomatis , and Trichomonas vaginalis by polymerase chain reaction (PCR). Individuals were screened for hepatitis A, B, and C, syphilis and HIV, and given the option of a self collected or clinician collected blood sample to increase acceptance of screening for BBVs. Results: Street outreach was highly effective and self directed STI sampling was more acceptable than practitioner directed sampling (76% versus 9% acceptance, p

Hipotekarne obveznice in hipotekarno bančništvo je model zadolževanja, ki je sprejet od leta 2006 v naši zakonodaji, vendar pa do realne izdaje hipotekarnih obveznic vse do danes še ni prišlo. V magistrski nalogi sem predstavila zakonski okvir, spremembe zakona, razloge, zakaj se pri nas še ne posluje s hipotekarno obveznico in morebitne posledice v gospodarstvu in na nepremičninskem trgu v kolikor bi se hipotekarna obveznica začela uveljavljati pri nas. The main motive for writing a master's thesis entitled mortgage bonds was acquainted with the debentures, review and presentation of the Law on mortgage and municipal bonds, and the presentation of the benefits that brings to enact a law, if they were to use in practice.

Objective: To characterise patients who decline to provide their surname at a public sexual health centre. Methods: A case–control study of all patients first attending the Sydney Sexual Health Centre from 1998 to 2004, using proforma-collected electronic data to compare patients who did not provide their surname with those who did. In addition, the frequencies of the 10 most common surnames in the Sydney telephone directory were compared with the frequency of those names in the patient database. Results: Of 27 241 patients, 1350 (5%) declined to provide their surname. The most common surnames were also over-represented, suggesting that aliases remained pervasive among the centre’s patients. Sex workers, married people and people requesting HIV, hepatitis or sexually transmissible infection (STI) screening were all more likely to decline to provide a surname. By contrast, patients with symptoms, patients who were referred with a prior STI diagnosis and patients with a new bacterial or non-HIV viral STI or were a known contact with STI were all significantly more likely to provide a surname. Among patients who declined to provide a surname, 20 tested HIV positive. Conclusion: The anonymous option did not seem to eliminate the use of aliases. Although limited, there seems to be a market for anonymous sexual health screening, particularly for the asymptomatic.

Objective: To identify patient preferences for notification of sexual contacts when a sexually transmitted infection (STI) is diagnosed. Methods: A questionnaire survey of 2544 patients attending three large genitourinary clinics at Derby, Birmingham, and Coventry in the United Kingdom. Results: The median age of the respondents was 24 with 1474 (57.9%) women, 1835 (72.1%) white, 1826 (71.8%) single. The most favoured method of partner notification was patient referral, which was rated a “good” method by 65.8% when they had to be contacted because a sexual partner has an STI. Notifying contacts by letter as a method of provider partner notification is more acceptable than phoning, text messaging, or email. Respondents with access to mobile telephones, private emails, and private letters were more likely to rate a method of partner notification using that mode of communication as “good” compared to those without. With provider referral methods of partner notification respondents preferred to receive a letter, email, or text message asking them to contact the clinic rather than a letter, email or text message informing them that they may have an STI. Conclusion: Most respondents think that being informed directly by a partner is the best method of being notified of the risk of an STI. Some of the newer methods may not be acceptable to all but a significant minority of respondents prefer these methods of partner notification. The wording of letters, emails, or text messages when used for partner notification has an influence on the acceptability of the method and may influence success of the partner notification method. Services should be flexible enough to utilise the patients’ preferred method of partner notification.

Objectives: It is recommended that medical students learn how to take a sexual history and gain experience in genital examination, but patients’ reluctance may make this difficult to achieve, especially for male students. Methods: We performed a survey of 250 male and 250 female patients attending a genitourinary medicine (GUM) clinic to determine their attitudes towards the involvement of medical students during their visit. Data were collected on the patients’ age, ethnic origin, parity, number of visits to the clinic, and the sex of the student. Results: 92.8% of women and 79.2% of men participated. Younger women and men, those visiting the clinic for the first time, and women with no children were less likely to accept a student of either sex to take their history or observe their examination. Women were less likely than men to accept students of either sex to take their sexual history or be present during their examination, but were more likely than men to accept only same sex students. Conclusions: There was a high level of acceptability for the involvement of medical students; only 12.5% of women and 15% of men declined any medical student participation. Older women with children, and older men, were more likely to accept a student of either sex for all parts of the consultation. This information can be used to enhance the experience of male and female students and to minimise distress for those patients who are less likely to accept the presence of a medical student.

Objectives: Male chronic pelvic pain syndrome (CPPS) is difficult to manage. Although antidepressants are frequently used in clinical practice, to date no interventional study has been published. We investigated men with CPPS to assess their response to the serotonin specific reuptake inhibitor (SSRI) antidepressant, sertraline. Methods: Men with CPPS underwent a four glass test to exclude an infective cause for their symptoms. They were randomised to sertraline or matched placebo for 13 weeks after which they were unblinded. They were then allowed to either continue sertraline or cross over to active treatment for a further 13 weeks. Prostatic symptom severity (PSS) and frequency (PSF) scores, the Hospital Anxiety and Depression (HAD) scale and a psychosexual (PSex) questionnaire were completed at 0, 6, 13, and 26 weeks. Statistical analysis was by the Mann-Whitney U and Wilcoxon signed rank tests. Results: 14 men enrolled. At week 13 there was a mean reduction in PSS scores of 6.1 in the active and 2.0 in placebo group, and in PSF scores of 3.6 and 1.0, respectively. There was no statistically significant difference in the PSS and PSF scores between the active versus placebo group because of the small subject numbers. If analysed as a case series, there was a significant reduction in PSS (11.7; p = 0.01) and PSF (5.9; p = 0.03) from baseline following 13 weeks of sertraline. There was also a decrease in mean HAD depression score from 4.6 at baseline to 2.4. Conclusion: Sertraline led to a significant improvement in prostatic symptom severity and frequency from baseline following 13 weeks of treatment. Although this analysis does not exclude a placebo effect, the randomised placebo controlled findings show a trend to improvement with sertraline when compared to placebo.

Objectives: The prognosis for individuals infected with HIV has changed dramatically over the past 10 years, with patients living longer and requiring other specialist services. It is apparent that access of other healthcare professionals to clinical information about a patient’s HIV care differs between centres in the UK. Lack of awareness of an individual’s HIV status may compromise their clinical care. Aim: To establish current practice and identify the views of clinicians caring for patients infected with HIV. Methods: Lead consultants in all genitourinary medicine departments in the UK were invited to complete a questionnaire regarding use of combined HIV and hospital notes and ability of general practitioners and other hospital specialists to access information about individual patient’s HIV care. Clinician’s opinions on the “normalisation” of HIV management were also sought. Results: Combined notes (outpatient and inpatient) were used by 12% (16/130) of respondents. The patient’s identifying number was used to request blood tests in 86%. Of the respondents, 42% had encountered difficulties in communication that affected delivery of care for an HIV-positive patient. Conclusions: Centres using combined notes identified a higher frequency of communication with other doctors and specialties, suggesting a higher standard of care. Physicians involved in HIV care should consider combining patients’ HIV and hospital notes for improved clinical care.

Background: With the advent of molecular techniques, self-collected specimens without a clinician’s examination are often adequate to detect common genital infections. Objective: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. Methods: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. Results: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. Conclusion: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.

Aim: To compare computer-assisted self-interview (CASI) with routine face-to-face interview (FTFI) for sexual history taking from patients in a clinical setting. Methods: A randomised controlled trial was undertaken at the Melbourne Sexual Health Centre, Melbourne, Victoria, Australia, in 2005. New, walk-in patients triaged into the centre were eligible for the study. Those who consented to the study were randomly allocated (initially at a ratio of 2:1, then 1:1) to either CASI or FTFI. Those randomised to CASI also subsequently undertook FTFI. Results: During the study period, of 713 patients approached, 611 agreed to participate in the study; 356 were randomised to FTFI and 255 to CASI. Overall, the responses to questioning using CASI and FTFI were similar except that women undertaking the CASI reported a significantly higher median number of male partners for the preceding 12 months (3 v 2, p = 0.05) and the CASI participants reported previous hepatitis B vaccination more often (50% v 37%, p = 0.01). Most participants found the CASI either easy (31; 13%) or very easy (193; 82%) to complete; 83 (35%) were comfortable and 121 (51%) were very comfortable with it. Conclusions: CASI may be a reliable, efficient and highly acceptable method for the screening of sexual risk in clinical sexual health settings and could be used routinely to improve the efficiency of clinical services.

Objective: This qualitative study assesses knowledge about sexually transmitted infections (STI), identifies perceived barriers to STI testing, and recommends strategies to optimise participation in a home based STI testing programme. Methods: Five focus groups composed of 29 total participants were recruited using convenience sampling methods based on age (18–40 years), gender (male and female), and residency (Tartu region, Estonia). Results: The focus groups revealed significant knowledge deficits and a widespread attitude of denial. However, participants acknowledged that STIs are a serious problem and recommended strategies for increasing participation in an STI testing and treatment programme. Successful STI prevention programmes must address a number of challenges, including disease stigmatisation and privacy protection. Conclusion: The fear of enforced disease control methods coupled with the current stigmatisation of STIs creates a serious challenge for Estonian STI prevention and treatment efforts. This qualitative study provides a good contextual reference for STI control programmes in eastern Europe.

Objective: To determine whether a patient’s responses to sensitive questions about their sexual behaviour are influenced by the sex of their treating practitioner. Methods: An audit was conducted on the computerised medical records of all patients attending the Melbourne Sexual Health Centre through the walk-in triage system between January 2003 and July 2005. Patient responses to sensitive questions about their sexual behaviour were analysed according to patient group (based upon the sex of their sexual partners) and the sex of the treating practitioner. Results: There was no significant difference in the reported number of sexual partners, condom use, sex overseas, injecting drug use, or commercial sex work based on the sex of the treating practitioner for the different patient groups. This held true whether clients were homosexual men (n = 1609, p>0.07), heterosexual men (n = 4847, p>0.11), or women (n = 4910, p>0.08). Conclusions: The sex of the practitioner did not significantly influence patient responses to sensitive questions about their sexual behaviour.

Background: For many years, genitourinary physicians have taught that specula should be used without lubrication other than water, as it was assumed that gel would interfere with the processing of samples, but there seems little evidence to support this. Many clinics are now using plastic specula to avoid reusable instruments, and one of the commonest problems with such specula is increased friction. Methods: We looked at the effect of Aquagel on the culture of different dilutions of Neisseria gonorrhoeae on three standard laboratory media. The effect of Aquagel on the chlamydial strand displacement assay (SDA) test was also assessed by mixing different amounts of Aquagel with the positive and negative control and processing in the usual way. Results: There was found to be no inhibition of culture following emulsification of N gonorrhoeae in Aquagel at any concentration. All the results for the chlamydial SDA test were satisfactory following mixing with Aquagel. Conclusion: We think that the clinician should now be more confident that if a difficult examination requires the use of a lubricant, the test results will not be compromised.

To assess the effectiveness of a text message result service within an inner London sexual health clinic.Demographic data, diagnoses, and time to diagnosis and treatment were collected over a 6 month period for patients receiving text messages and a matched standard recall group. Data on messages sent, staff time, and cost in relation to result provision were collected.Over a 6 month period 952 text messages were sent. In the final month of analysis, 33.9% of all clinic results were provided by text, resulting in a saving of 46 hours of staff time per month. 49 messages requested that the patient return for treatment, 28 of these patients had untreated genital Chlamydia trachomatis (CT) infection. The mean number of days (SD) to diagnosis was significantly shorter in the text message group (TG) v the standard recall group (SG) (7.9 (3.6) v 11.2 (4.7), p0.001). The median time to treatment was 8.5 days (range 4-27 days) for the TG group v 15.0 (range 7-35) for SG, p = 0.005.Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of a text message result service. The introduction of this service has resulted in a significant saving in staff time.

Paper presented at IASSW Conference Global Social Work 2006, Santiago Chile

Objective: To determine the aetiology of genital ulcers and discharges in rural south western Uganda and to assess response to syndromic treatment. Method: A longitudinal, prospective study using laboratory testing and questionnaires to evaluate 561 adult men and women presenting with clinically verified genital ulcers, urethral, or vaginal discharge at a general outpatient clinic and two health centres between December 1999 and July 2001. Results: One third of patients had genital ulcers and two thirds discharges. There was good response to treatment in 461/508 patients (90.7%). Herpes simplex virus type 2 was found in 95/217 (43.8%) genital ulcers. In 24.1% of ulcer cases there was also a genital discharge. HIV seropositivity was high in ulcer cases (63.2%), with significantly more HSV2 and secondary bacterial infection than in seronegative cases. Neisseria gonorrhoeae was found in 135/204 (66.2%) male genital discharges. Female genital discharges were mostly associated with bacterial vaginosis (36.1%), Trichomonas vaginalis (18.9%), and candidiasis (18.6%). Conclusions: The aetiological pattern of STI syndromes reported will help inform revision of national STI guidelines. The importance of herpes simplex virus type 2, the variation in causes of genital ulcers according to HIV serostatus, the high frequency of multiple infections and secondary bacterial contamination of genital ulcers are notable. These results help explain the lack of effect of an STI intervention on HIV incidence in a recent trial in this area.

Background: Mondor's disease of penis is an uncommon genital condition involving the penile sulcus in a circumferential manner. Although this disorder is almost always self limited, it is associated with considerable psychological stress and sexual disharmony. Methods: All patients attending the sexually transmitted disease clinic during 1991–2003 were examined for evidence of Mondor's disease of penis. Detailed history and clinical findings were recorded in a specially designed proforma. Histopathological examination and staining with CD31 and CD34 monoclonal antibodies was also done in 11 patients. Results: 18 out of 1296 patients attending the sexually transmitted diseases (STD) clinic during the study period were found to have penile Mondor's disease, giving an incidence of 1.39%. 17 patients had history of one or more episodes of STDs. Histopathological specimens showed prominent vessels with plump endothelial cells and thickened blood vessel walls. The occasional vessel showed complete occlusion of its lumen. Conclusions: In our study we did not find any evidence of lymphatic involvement. Non-lymphatic vessels, mainly veins, were predominantly involved. In our opinion Mondor's phlebitis of penis or Mondor's disease of penis are better terms to describe the condition rather than non-venereal sclerosing lymphangitis.

Objectives: Evaluation of an intervention to improve quality of sexually transmitted infections (STI) care among 64 private general practitioners (GPs) working in two urban districts in Gauteng Province, South Africa. Methods: We implemented a multifaceted intervention, the core of which were four interactive continuing medical education seminars. Changes in STI treatment practices were evaluated through record reviews before and after the continuing medical education intervention in 17 randomly selected practices in the intervention districts and in nine randomly selected practices from a reference GP group (n = 34). Results: There were statistically significant improvements in the quality of drug treatment for urethral discharge but not pelvic inflammatory disease among both intervention and reference GPs. Conclusions: Improvements in STI quality were possibly the result of a background secular trend rather than the intervention itself. Further research is needed on financial and other incentives to improved quality of STI care in the private sector environment.

Objectives: To develop scales assessing acceptability of human papillomavirus (HPV) testing in adolescents, to compare acceptability of self to clinician testing, and to identify adolescent characteristics associated with acceptability. Methods: Female adolescents 14–21 years of age attending a hospital based teen health centre self collected vaginal samples and a clinician, using a speculum, collected cervicovaginal samples for HPV DNA. Acceptability of and preferences for self and clinician testing were assessed at baseline and 2 week visits. Results: The mean age of the 121 participants was 17.8 years and 82% were black. The acceptability scales demonstrated good internal consistency, reliability, test-retest reliability, and factorial validity. Scores were significantly lower for self testing than clinician testing on the acceptability scale and three subscales measuring trust of the test result, confidence in one's ability to collect a specimen, and perceived effects of testing (p

Background: Audio computer assisted self interview (ACASI) may minimise social desirability bias in the ascertainment of sensitive behaviours. The aim of this study was to describe the difference in reporting risk behaviour in ACASI compared to a face to face interview (FFI) among public sexually transmitted diseases (STD) clinic attendees. Study design: Randomly selected patients attending a public STD clinic in Baltimore, Maryland, sequentially took an ACASI formatted risk behaviour assessment followed by an FFI conducted by a single clinician, with both interview modalities surveying sexual and drug use behaviours. Binary responses were compared using the sign test, and categorical responses were compared using the Wilcoxon signed rank test to account for repeated measures. Results: 671 (52% men, mean age 30 years, 95% African American) of 795 clinic attendees screened consented to participate. Subjects affirmed sensitive sexual behaviours such as same sex contact (p = 0.012), receptive rectal sexual exposure (p

To determine the extent of self reported symptoms perceived to be related to sexually transmitted infections and the patterns of subsequent treatment seeking behaviour in a predominantly rural population of Zimbabwe.A population based survey of 4331 men and 5149 women was conducted in rural Zimbabwe during 1998-2000. Structured confidential interviews collected data on self reported sexually transmitted infection symptoms, treatment seeking behaviour, sociodemographic characteristics, and sexual behaviour.25% of men aged 17-54 years report experiencing genital sores and 25% of men report experiencing urethral discharge; 30% of women aged 15-44 years report experiencing vaginal discharge. The lifetime number of sexual partners, age, and years of sexual activity were all significant predictors of symptoms for both men and women (all p values0.001). 92% of men and 62% of women had sought treatment for their symptoms in the past year (p value0.001). Men and women were equally likely to have sought treatment at a local hospital or clinic, but women were much less likely than men to have sought treatment at a different hospital or clinic. Among those who had sought treatment, men sought treatment faster than women and were more likely to report being "very satisfied" with their treatment than women.The gender differences in treatment seeking are of major concern for control efforts and further work on determining the reasons for these should be a priority. This would inform the likely impact of both increasing availability of local services and further reducing the stigma faced by those wishing to access such services.

Objectives: This pilot test assessed the feasibility of a cost effective population based approach to STI monitoring using automated telephone interviews, urine specimen collection kits sent out and returned by US Postal Service mail, and monetary incentives to motivate participation. Methods: 100 residents of Baltimore, MD, USA, completed an automated telephone survey and agreed to mail in a urine specimen to be tested for chlamydia and gonorrhoea. Participants were paid $10 for completing the survey and $40 for mailing the specimen. Results: 86% of survey participants mailed in a urine specimen for testing. Conclusions: Automated telephone surveys linked with testing of mailed-in urine specimens may be a feasible lower cost (relative to household surveys) method of estimating infection prevalences in a population.

Objective: In the United Kingdom many genitourinary medicine clinics use oral doxycycline and metronidazole to treat pelvic inflammatory disease (PID). A retrospective case note review of PID treatment at our department in 2000 showed that the clinical cure rate (CCR) was only 55% with oral doxycycline and metronidazole for 2 weeks. We therefore added ceftriaxone 250 mg intramuscularly to the doxycycline and metronidazole for treating PID. We have repeated the review and compared the results with those from 2000. Methods: All patients diagnosed as having PID between 1 July 2002 and 31 December 2002 were identified. These episodes were diagnosed on clinical presentations of pelvic pain, vaginal discharge or bleeding, and cervical motion tenderness on physical examination. The CCR was defined as patients who fully resolved their symptoms and signs during 2 week and 4 week follow up. The results were compared with those from 2000. Results: Women receiving ceftriaxone, doxycycline, and metronidazole had a CCR of 72%. In 2000 the CCR for women receiving only doxycycline and metronidazole was 55%. There were only 8% non-responders in 2002 compared with 18% in 2000. Comparing CCR and non-response rate, in 2002 there was a significant improvement in cure rate, OR 3.01 (95% CI 1.28 to 7.47) p = 0.009. Using an intent to treat analysis and including the defaulters as treatment failures there was still a significant improvement in cure rate, OR 2.03 (95% CI 1.18 to 3.50) p = 0.009. Conclusions: The treatment of PID with ceftriaxone, doxycycline, and metronidazole gave a significantly higher CCR than doxycycline and metronidazole. Our experience would suggest that doxycycline and metronidazole alone is not a suitable regimen for treatment of PID in the United Kingdom.

Background: The prevalence of cervical cancer is extremely high in low income countries, primarily because of a lack of cytological screening. The link between human papillomavirus (HPV) and cervical cancer has long been recognised, and it has been suggested that isolated HPV testing in women who do not participate in existing screening programmes may be used to identify women at higher risk of developing cervical cancer. This community based study compares two self administered techniques for detecting HPV (tampons and self administered swabs) with a clinician directed technique, the cervical cytobrush. Methods: 377 rural women were interviewed and of these 210 women had full gynaecological examination, and accepted all three sampling methods for HPV. HPV typing of DNA extracts was performed using polymerase chain reaction and enzyme linked immunosorbent assay techniques. Results: Using the cervical cytobrush as the gold standard, self administered swabs (SAS) showed a sensitivity of 63.9%, and tampons showed a sensitivity of 72.4%. The acceptability of these two tests was 97.1% and 84.6% respectively. When combining acceptability with sensitivity, the SAS detected 61.9% and the tampons detected 60.9% of the true positives. Conclusion: In a setting where women are at a considerable risk of developing cervical cancer, with no access to a formal screening programme, self directed HPV testing could be a useful screening tool in identifying those women at increased risk who may require further investigation.