IUDs, sperm count and aggression

A review of this week's medical research. By GP Dr Gwen Lewis

Some respondents believed counselling a patient about IUDs could take longer than other methods (Photograph: Zephyr/SPL)

Use of IUDs in adolescents

J Ado Health 2012; 51(4): 319-24

As in the UK, the use of IUDs in adolescents is encouraged in the US as being safe and highly effective. However, many US providers do not recommend or provide IUDs to adolescents, a group that is at high risk of unintended pregnancy.

In this study from New York, 162 staff of school-based health clinics, including 69 clinical staff – doctors and nurses – and 93 social workers and health educators completed a survey on knowledge and attitudes regarding IUDs.

Of all respondents, 55% would recommend an IUD to those aged under 20 years, but would be less likely to do so to those with a recent (31%) or remote (37%) history of pelvic infection and in those not in a monogamous relationship.

Despite acknowledging that IUDs are safe for adolescents, 18% would be unlikely to recommend one to those under 20 years of age and 25% to a patient who had never been pregnant. Significantly, 61% believed that counselling patients about IUDs would take more time than other methods.

Low sperm counts in attendees at GUM clinics

Sex Transm Infect 2012; 88: 422-6

In this case-control study from Cambridge, 117 volunteers from GUM clinics and 417 controls from GP surgeries had their semen analysed for sperm count. Those attending the GUM clinic had symptomatic NSU or asymptomatic NSU, or were clinic controls.

Clinic volunteers were found to have significantly worse total sperm counts, volume of semen and percentage of abnormal forms compared with GP controls. Those men with asymptomatic NSU had significantly lower total sperm counts than other clinic volunteers and when compared with symptomatic NSU patients.

As part of the investigation of women before referral to fertility clinics, we undertake screening for STIs, in particular chlamydia, but we do not screen male partners. Perhaps we should.

Socioeconomic status influences BP control

Fam Pract 2012; 29(5): 503-10

In this cross-sectional study from Denmark, 5,260 hypertensive patients in 184 general practices were studied.

GPs reported information about BP and diabetes, while information about education, income, antihypertensive medication and other comorbidity was retrieved from Statistics Denmark. BP control was defined as <140/90mmHg in general and <130/80mmHg in patients with diabetes.

Those aged <65 years and with an educational level of 10-12 years had increased likelihood of BP control compared with those with educational level <10 years.

Patients aged more than 65 years were more likely to have good BP control if they were married or cohabiting compared with those who were single, while education and income had no impact in this age group.

Diabetics had significantly reduced odds of BP control irrespective of age, educational attainment or income level.

Perhaps these results give some indication about which patients we should concentrate our efforts on to reduce BP.

Experiencing aggression in the workplace

Med J Aust 2012; 197: 336-40

Reports of verbal or written and actual physical aggression to workers in the NHS are increasing. This would appear to be the case in Australia too.

A survey of 9,449 medical practitioners in clinical practice was undertaken. Of these, 3,515 were GPs or GP registrars, 3,875 were hospital specialists, 1,171 were hospital non-specialists and 888 were in training.

The survey revealed that 70.6% had experienced verbal or written aggression and 32.3%, actual physical aggression in the previous 12 months.

It was found that female GPs experienced less aggressive behaviour than their male partners, but in general, those more at risk of aggression were hospital-based clinicians (who were twice as likely to experience it as GPs), international medical graduates and females in hospitals.

Progesterone to predict pregnancy outcome

BMJ 2012; 345: e6077

Vaginal bleeding and pain in early pregnancy are common. Symptoms may be the first sign of possible miscarriage or ectopic pregnancy and cause much anxiety.

Miscarriage occurs in 10-20% of pregnancies, while 1.6% of pregnancies are ectopic. Transvaginal scans are the mainstay of investigation, but results are inconclusive in 8-31%, resulting in further anxiety. Measurement of beta-HCG is useful, but serial results have to be taken.

This study investigated the measurement of progesterone in these patients. A literature search was undertaken of studies of women with spontaneous pregnancy of <14 weeks' gestation in which a single progesterone measurement was used to predict primary outcome.

It was found that a single low progesterone measurement in women presenting with pain or bleeding in early pregnancy and an inconclusive scan result can rule out a viable pregnancy.

Sex education and teenage behaviours and outcomes

J Ado Health 2012; 51(4): 332-8

Is formal sex education associated with sexual health behaviours and outcomes? Data from the 2006-2008 National Survey of Family Growth in the US looked at 4,691 males and females aged 15-24 years.

It was found that receipt of sex education of any type was associated with delay in first sex for both genders as compared with no sex education.

Those receiving instruction about abstinence and contraception were significantly more likely to use contraception or condoms on their first sexual encounter.

It was concluded that sex education works by promoting healthier sexual behaviour and outcomes. The protective effect is not limited to if and when to have sex, but also to use of contraception, partner selection and reproductive health outcomes.

Sex education is surely essential in our efforts to reduce teenage pregnancy rates and STIs.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Perform a search for men with subfertility and low sperm count and ensure that they have been tested for chlamydia and NSU.
  • Arrange a meeting for all staff to discuss aggression within the surgery and what can be done to address the risks.
  • Undertake an audit of women who experience pain and/or bleeding in early pregnancy and perform progesterone blood level test to assess pregnancy outcome.

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