"They never tell you about the consequences": young people's awareness of sexually transmitted infections.

Young people are at risk from sexually transmitted infections (STIs)--the incidence of chlamydia in the UK is highest among young women aged 16-19. Despite this, young people lack knowledge about STIs and are more aware of the risks of unwanted pregnancy than their risk of acquiring an STI. This study used qualitative and quantitative methods to examine what teenagers know about STIs, their prevention, symptoms, treatment and services. Only one-third of respondents recognized chlamydia as an STI. The little knowledge of STIs that was revealed was superficial. Few were aware that special services existed for STIs. Condoms were seen as contraception, not as a method of preventing infection transmission. High teenage pregnancy rates have received much publicity but less attention has been paid to rising STI incidence. Programmes aimed at decreasing pregnancy rates through adoption of effective hormonal contraception not only fail to address STIs but may be detrimental to prevention efforts.

Teenage pregnancy: a comparative study of teenagers choosing termination of pregnancy or antenatal care.

A comparative study of 167 pregnant teenagers in Devon attending either antenatal booking clinics or for National Health Service (NHS) termination of pregnancy was carried out to determine differences in their characteristics, use and experience of local family planning services. Teenagers presenting for termination of pregnancy were younger and more likely to say that they had wished to avoid getting pregnant. Whether the teenager was in a stable relationship was strongly associated with the outcome of the pregnancy, with single girls being more likely to choose a termination of pregnancy. The termination of pregnancy group were also more likely to be condom users, and to have learned about their method of contraception from school rather than from health care professionals. Teenagers' frequency of contact with family planning services suggested that teenagers choosing a termination were less likely than antenatal attenders to have attended regularly. This was mainly due to differences in behaviour among teenagers attending their general practitioner (GP) for contraceptive advice: teenagers having a termination were more likely to describe their visit to their GP as embarrassing. These findings have implications for local family planning services attempting to reduce the number of unwanted teenage pregnancies.

PIP: 167 pregnant teenagers were interviewed in England to determine if those opting for abortion had different characteristics and patterns of use of local family planning (FP) services from those continuing their pregnancies. The teenagers were interviewed in 1 of 4 health districts during the period of August 1992 to January 1994. 95 of the teenagers had an abortion, and 72 were receiving prenatal care. It was found that the teenagers who chose abortion were significantly younger than the other group, were more likely to describe themselves as having tried to avoid pregnancy, were more likely to have relied on condoms for contraception, and were less likely to be involved in a stable relationship with a young man. Six of the teenagers receiving prenatal care had planned their pregnancies, and those planning to keep their babies were more likely to have used oral contraceptives. The teenagers choosing abortion were more likely to have received contraceptive information from a school teacher than from a clinic. These teenagers also found visiting a general practitioner to be embarrassing. With this confirmation of the study's broad hypothesis that differences exist between these two groups, more research is indicated to point out the relative importance of each difference as a factor in preventing unplanned and unwanted pregnancies.

Pregnant teenagers' knowledge and use of emergency contraception.

PIP: Emergency contraception is an effective way to prevent pregnancy from occurring after unprotected sexual intercourse. The authors report a descriptive study of pregnant teens in Devon, England, which examined the awareness and use of emergency contraception, and its potential for preventing unwanted teenage pregnancy. Findings are based upon interviews conducted with 167 pregnant women aged 13-19 years between August 1992 and January 1994. 57% were attending for a National Health Service termination 8-12 weeks pregnant, while 43% were attending booking appointments at hospital antenatal clinics 16-17 weeks pregnant. 12% of pregnancies were planned, 73% were unplanned, and in 25 pregnancies the teen was equivocal at the time of conception about preventing pregnancy. 81% of teenagers had heard of emergency contraception, although 88% did not obtain it. Of the 16 teens who did obtain postcoital contraception, the approach failed in 11 cases, one woman took the pills incorrectly, and four failed to take the pills.^ieng

Speech and language therapy: is it effective?

As part of a needs assessment of local speech and language therapy services, a review of the literature was carried out to examine the evidence for effectiveness of speech and language therapy. Purchasing authorities and general practice fundholders need to know whether what they are buying for their local population is effective, and whether the service is being provided in the most cost-effective way. This paper considers the published evidence and some of the limitations of the studies, and gives suggestions for purchasing speech and language therapy services based on current evidence. More evaluative work needs to be done to provide purchasers with the information necessary to decide which speech and language therapy services will result in real benefits for their population.

Screening for ovarian cancer: a review.

A review of the literature was done to assess the evidence for ovarian cancer screening, and the effectiveness of the different methods of screening. There is not yet sufficient evidence that an ovarian cancer screening programme would be cost-effective, given the current range of available tests. The high rate of surgical intervention makes the choice of screening test extremely important. No single test is able to provide a positive predictive value of greater than 10%. For women over 30 years of age with a strong family history of ovarian cancer (two or more first-degree relatives) there is an increased risk, potentially as high as one in two, of developing a carcinoma. These women should be offered counselling and annual serum CA 125 and ultrasonography as part of a coordinated research programme, which includes genetic studies.

Suicide in North and West Devon: a comparative study using Coroner's inquest records.

To determine the local characteristics of suicides of North and West Devon residents, and to compare them with (a) individuals resident outside the defined area but killing themselves within it, and (b) suicides in the remainder of England and Wales, a retrospective descriptive three-year review of data from the Coroner's confidential inquest records was carried out. The subjects were all persons killing themselves within the Coroner's catchment area for North and West Devon between 1 January 1988 and 31 December 1990. It was found that persons resident outside the area (n = 13) were significantly more likely to be male (p = 0.007) and have a history of deliberate self-harm (p = 0.03) than Devon residents (n = 59). They were also younger (mean age 36.5 years, as opposed to 47.5 years). Comparing the Devon residents with the rest of England and Wales, they were significantly more likely to die violently (p = 0.017); this was due to the increased likelihood of death from firearms (p = 0.016), and to the decreased likelihood of death from hanging, strangulation or suffocation (p = 0.02). This study highlights the influence that local factors have on the opportunity for suicide, such as isolated moorland where cars can be parked (13/72 deaths), or a high bridge over a road and river (3/72 deaths) and the ready availability of guns in a predominantly rural community (8/72 deaths). In addition, the local Coroner's verdict is an important influence on the suicide rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Public health medicine training.

Training in public health medicine uses a 'trainer-trainee' model for learning similar to that used in general practice. In order to examine the quality of training in the South Western region of the UK, a questionnaire was devised to assess both adequacy and importance of various factors for training. The results of the survey identified key areas for further discussion and were used as the basis of an interactive study day. One interesting finding was the difference in perceptions of trainers and trainees, possibly illustrating the differences between trainees' 'demands' and trainers' perceptions of trainees' 'needs'.

An asbestos hazard in North Devon.

In March 1990, following the careless removal of asbestos-based ceiling tiles in a leisure centre in North Devon, delay in action by the local authority meant that the risk to staff and members of the public was ignored for four months. The Director of Public Health was then approached to tackle the problem of providing advice to both leisure centre staff and the public in order to deal with the concern that had arisen as a result of the delay. There was a public statement, a report to the local authority, and a 'hotline' for members of the public. Leisure centre staff members were individually interviewed by a doctor using a specially designed occupational health questionnaire and followed up as appropriate. Twenty-one chest X-rays were taken on the advice of the local chest physician. Although the level of exposure was small, and there was no significant threat to health, the incident caused major public concern, was an embarrassment to the local authority, and involved the Health and Safety Executive and considerable input from the Department of Public Health Medicine. Most importantly for a small district, it was a major public relations exercise for Public Health Medicine. This paper examines the appropriateness and effectiveness of intervention by Public Health Medicine in a situation where the risks were known to be very low but public anxiety, fuelled by compensation possibilities, was very high.