A survey describing the use of complementary therapies and medicines by women attending a family planning clinic.

BACKGROUND: Complementary medicines (CMs) are widely used by women. Although, women in Australia are frequent users of CM, few studies have examined their utilisation by women attending a family planning service. The aim of this study was to examine (i) the extent of and type of CM, (ii) women's views about safety and efficacy, and (iii) the factors influencing women's decision-making. METHODS: A cross-sectional survey using a convenience sample of 221 women aged greater than 18 years attending a family planning (FP) service was undertaken over a two week period in Sydney, Australia. An anonymous self-administered questionnaire was designed to examine women's current and previous use of CMs, their attitudes towards safety and effectiveness, the factors influencing their decision-making, and their disclosure of CM use to a FP health professional. Demographic questions were designed to describe the diversity of the participants. Logistic regression was used to examine the association between CM use and demographics. RESULTS: Sixty-seven percent of women surveyed were currently using CMs, and 83% reported use during the previous 12 months. Most respondents utilised CMs to maintain their general health or for prevention of ill health. Over 30% of women lacked information to make an informed response to questions examining their views about the safety of CMs. Forty-four percent of participants stated they discussed their use of CMs with their FP providers. The main reason why women did not mention CMs was they did not see the relevance to their consultation (43%). Lower rates of CM use were found for younger women (OR 0.24, 95% CI 0.09-0.61), and those not completing high school (OR 0.44, 95% 0.20-1.00). CONCLUSION: The use of CM is very common among women attending an Australian FP clinic, however our findings may not be generalisable to all women. We identified a notable gap in women's awareness of the potential for interactions between CM and prescribed medication. Our findings also emphasise the need for healthcare providers to initiate discussions with clients about their utilisation of CM.

When online becomes offline: attitudes to safer sex practices in older and younger women using an Australian internet dating service.

BACKGROUND: The prevalence of sexually transmissible infections (STIs) is increasing among older Australian women, partly due to re-partnering after divorce or death of a spouse. Older women may be less likely to use condoms with new sexual partners, exposing themselves to STIs. An online survey compared characteristics of internet dating women aged 40 and above with 18 to 39 year olds, and determined the factors associated with protective safer sex attitudes. METHODS: An email directed women who had logged onto the internet dating service 'RSVP' in the previous 6 months to a survey hosted by Family Planning New South Wales. The survey explored demographic factors, STI-related knowledge and attitudes towards safer sex practices. Factors associated with discussing STIs before sex and refusing sex without a condom with a new partner were analysed using logistic regression. RESULTS: The questionnaire was completed by 1788 women. Almost two-thirds (62.2%) were aged 40 or over. The majority (64.8%) were seeking a long-term partner. In the previous year, 41.5% of all women met a new sexual partner via the internet. Women aged >40 years were significantly more likely to discuss STIs with a new partner but less likely to refuse sex without a condom compared with younger women. CONCLUSIONS: The internet is a useful venue for women of all ages to meet new sexual partners. Older women are vulnerable to STI acquisition through failure to use condoms with a new partner. Research is needed to determine effective interventions to increase condom use in this age group.

Marrying research, clinical practice and cervical screening in Australian Aboriginal women in western New South Wales, Australia.

INTRODUCTION: Research shows that Australian Aboriginal women experience a significantly higher rate of mortality from cervical cancer than non-Aboriginal women. We now understand that infection with human papillomavirus (HPV) is a necessary pre-requisite for cervical cancer. This knowledge, together with the development of prophylactic vaccines against the HPV types most commonly associated with cervical cancer (16 and 18), made it vital to gain nationally representative HPV genotyping data for Australian women, including Aboriginal and Torres Strait Islander women. A research project, the 'Women, Human papilloma virus prevalence, Indigenous, Non indigenous, Urban, Rural Study' (WHINURS) was designed to obtain the HPV status of Aboriginal and non-Aboriginal women when they presented for their routine cervical screen. Family Planning NSW (FPNSW), an organisation that had previously worked in community based projects to increase Aboriginal participation in cervical screening, provided an investigator site in western NSW with the intention to recruit 50 Aboriginal women and 100 non-Aboriginal women. METHODS: The method was a consultative approach, including national and local frameworks for Aboriginal and Torres Strait Islander recruitment. The FPNSW Dubbo team devised a series of strategies to maximise recruitment when this did not progress according to plan. Strategies were developed to meet this challenge, including street walks, attendance at community forums, flexible appointments, drop-in times and assistance with travel and babysitting. RESULTS AND CONCLUSION: As a result of the activities listed above, 43 women were recruited to WHINURS, just seven short of the target. Collaborative community-based consultation, as well as the research study itself increased the number of Aboriginal women accessing cervical screening at the family planning clinic. This was sustained a year after the conclusion of the study.

An open-label randomized trial to determine the most effective regimen of vaginal estrogen to reduce the prevalence of atrophic changes reported in postmenopausal cervical smears.

OBJECTIVE: Atrophic Papanicolaou (Pap) smears from postmenopausal women may be unsatisfactory for assessment or result in a false-positive diagnosis of a cytological abnormality. We investigated the effect of vaginal estrogen treatment before the Pap test on the odds of an atrophic smear. METHODS: An open-label randomized controlled trial was conducted to compare the proportion of atrophic Pap smears from postmenopausal women assigned to either (1) a regimen of one 25-microg vaginal estradiol tablet inserted nightly for five nights before their Pap test, (2) a single 25-microg vaginal estradiol tablet before the test, or (3) a control group with no previous estrogen administration. All smears were reread and classified as atrophic or nonatrophic at the conclusion of the study by a single cytopathologist who was blinded to the study arms. RESULTS: One hundred fifty-four (94%) of the 164 postmenopausal women who consented to the study were included in the final analysis. Fifty-one women had received the five-night course of tablets, 50 had received one tablet, and 53 were assigned to the group with no previous estrogen use. The odds of an atrophic smear were significantly lower in women who used the five-night estrogen regimen than in women who did not use estrogen. The estimated odds ratio of an atrophic smear in the five-night regimen was 0.01 (95% CI, 0.03-0.26) compared with the no-estrogen control group. Moreover, using one tablet of estrogen had no significant effect on the likelihood of an atrophic smear compared with using none. The odds ratio of an atrophic smear in the single estrogen tablet group was 1.05 (95% CI, 0.48-2.29) compared with the no-estrogen group. CONCLUSIONS: The odds of an atrophic smear are significantly reduced for postmenopausal women who use a five-night regimen of vaginal estrogen before their Pap test.

Chlamydia trachomatis infection in the family planning clinical setting across New South Wales.

BACKGROUND: Following a small pilot study in 2003, a study was set up to determine the prevalence of genital Chlamydia trachomatis infection in young women presenting to Family Planning NSW centres across New South Wales and to evaluate the characteristics of those infected. METHODS: A cross-sectional survey of 621 consecutive women aged from 16 to 24 years was carried out over a 3-month period in 2004 at five Family Planning NSW centres. Urine samples were tested for C. trachomatis using the polymerase chain reaction (PCR) method. Women with a positive result were reviewed and treated. RESULTS: Of 925 eligible clients, 621 (67%) were recruited to the study. Chlamydia trachomatis was detected in 35 of the 621 recruits (5.6%, 95% CI 3.8-7.4). The prevalence at the Hunter centre was significantly higher than the combined prevalence at the other four participating centres (9.7% compared with 3.9%; P = 0.008). Two characteristics were identified as independent predictors of infection in this study: 'reporting a recent change ofpartner in the past three months' (crude odds ratio (OR) 3.33, 95% CI 1.67-6.64) and 'reporting three or more partners in the past year' (crude OR 3.69, 95% CI 1.83-7.46). Reported condom use, a history of one or more sexually transmissible infections and current combined oral contraceptive pill use were not associated with infection in this study. CONCLUSIONS: The prevalence of C. trachomatis infection is sufficiently high to support targeted testing of 16-24-year-old women in the Family Planning NSW setting and informs the development of a national screening strategy.