Provision of emergency contraception in general practice and confidentiality for the under 16's: results of a postal survey by general practitioners in Avon. (17/200)

OBJECTIVE: To describe the provision of emergency contraception and confidentiality for the under 16's by general practitioners (GPs) in Avon, in order to inform the development of a health promotion intervention in schools in Avon. DESIGN: Confidential postal questionnaire survey. SETTING: All principals in general practice in Avon Health Authority, South West England. SUBJECTS: Five hundred and eighty general practice principals were sent the questionnaire. RESULTS: Four hundred and eighty-six (84%) principals in general practice responded to the questionnaire. Only three (0.6%) GPs did not provide hormonal emergency contraception. Nearly half (232, 47.7%) would fit the intrauterine device (IUD) as emergency contraception. Fitting an IUD was associated with female gender of the GP (OR = 2.34, 95% CI 1.53-3.71), and whether the GP had a family planning qualification (OR = 4.55, 95% CI 2.41-8.60). Three hundred and fifty-two (72%) respondents would provide emergency contraception on a Sunday if requested to do so by a 14-year-old who reported having had unprotected sex the night before. Practice nurses in 26 (5%) of the respondent's practices were available to provide advice and tablets for patients requesting hormonal emergency contraception. However, 74 (21%) respondents employed a family planning trained practice nurse who was not involved in any way in the provision of emergency contraception. Practice nurses remain an under used resource in this area. CONCLUSION: Our findings suggest that most GPs provide hormonal emergency contraception. Only eight (1.6%) of respondents would need to ask for parental consent prior to providing hormonal emergency contraception to a 14-year old-girl. Young people need to be informed of GPs widespread adherence to current confidentiality guidelines.  (+info)

Do they understand? (part I): parental consent for children participating in clinical anesthesia and surgery research. (18/200)

BACKGROUND: Central to the tenet of informed consent is the quality of disclosure of information by the investigator and the understanding thereof by the research subject or his or her surrogate. This study was designed to measure parents' understanding of the elements of informed consent for clinical studies in which their children had been approached to participate. METHODS: The study sample consisted of 505 parents who had been approached for permission to allow their child to participate in a clinical anesthesia or surgery study. Regardless of whether the parent consented (consenters, n = 411) or declined (nonconsenters, n = 94) to their child's participation in a study, they were interviewed to determine their understanding of 11 elements of consent. Two independent assessors who were familiar with the study protocols scored the parents' levels of understanding. RESULTS: Parents perceived their overall understanding of the elements of consent as high (8.7 +/- 1.6; 0-10 scale); however, this represented a significant overestimation compared with the assessors' measures of parental understanding (7.3 +/- 1.8; P< 0.0001). Furthermore, consenters had greater understanding than nonconsenters (7.6 +/- 1.6 vs 6.1 +/- 1.9; P< 0.001). Several predictors of understanding were identified, including whether the parent consented, education level, clarity of disclosure, child in previous study, age of parent, parent listened to disclosure, and degree to which parent read the consent document. The day on which consent was sought had no impact on the level of understanding. CONCLUSIONS: Parents approached for permission to allow their child to participate in a research study had less than optimal understanding of the elements of consent. As such, investigators must make every effort to enhance understanding and ensure that parents have sufficient information to make informed decisions regarding their child's participation in research studies.  (+info)

School and family participation in a longitudinal study of tobacco use: some methodological notes. (19/200)

School-based recruitment of youth for a research purpose is problematic, as one has to deal with multiple ethical and practical constraints. This study reports on predictors of schools' and families' participation in a longitudinal study of tobacco use among 11-year-old children. School size, but not tobacco policy, was linked to participation. High parental education and average social status in the residence area were associated with parental consent. Given the social background, prevalence of parental tobacco use was close to the expected. Compliance of responsible adults in youth research cannot be predicted on the basis of simple behavioural models.  (+info)

Consent for clinical research in the neonatal intensive care unit: a retrospective survey and a prospective study. (20/200)

BACKGROUND: Recruitment into research studies in the neonatal intensive care unit has been problematic. Therefore suggestions have been made to take decision making about enrollment out of the hands of the parents. OBJECTIVE: To understand parental perceptions of the process of recruitment and enrollment for research in the neonatal intensive care unit. METHOD: A questionnaire was developed and used in both a retrospective survey and a prospective study of parents whose newborns were enrolled in trials in a neonatal intensive care unit. Closed ended and open ended questions were included, as well as demographic questions. RESULTS: The retrospective survey had a 79% response rate (29 of 38). Overall, 90% of parents felt that they had made informed decisions, and 93% were against the option that a doctor decide if the newborn should be enrolled into a study, rather than the parent. Although some parents (38%) found that recruitment did add "stress to an already stressful situation", 90% felt that they had made informed decisions and understood the elements of the study. Most parents had been requested to enroll their newborn into more than one trial, and, on average, they thought that they would be comfortable with enrollment into two studies (range 0-6). When asked how the process could be improved, parents suggested that information be made available before delivery. The responses of parents in the prospective study were mostly consistent with those from the retrospective survey. CONCLUSIONS: Overall the parents did not support the suggestion that decision making about enrollment be taken away from parents and put into the hands of doctors. The healthcare team should support parents in their role of decision maker, enhance availability of the research staff, and provide more information about the research.  (+info)

Screening Latino adolescents for latent tuberculosis infection (LTBI). (21/200)

OBJECTIVES: To investigate the rates of latent TB infection (LTBI) in a sample of young people in San Diego County and examine potential predictors of a positive tuberculin skin test (TST). METHODS: Latino and foreign-born students from ten public middle and high schools were invited to screenings along with a random 10% sample of all other students. After obtaining parental consent, Mantoux tests were placed (N=2,698) and read (n=2,667 [98.9%]) in 48-72 hours. A positive TST was defined as > or =10 mm induration. The mean age of the sample was 14.34 years (SD=1.81); 50.1% were female (n=1,353); 78.5% were Latino (n=2,108); 35.7% were foreign-born (n=939); and 44.3% were uninsured (n=930). RESULTS: The positive TST rate for Latinos was 21.8% vs. 5.6% for non-Latinos, p<0.001. Foreign-born Latinos had the highest infection rate (31.3%), followed by foreign-born non-Latinos (20.4%), U.S.-born Latinos (15.4%), and U.S.-born non-Latinos (1.0%), p<0.001. Logistic regression was conducted to determine predictors of TST positivity. Being Latino (odds ratio [OR]=3.27), uninsured (OR=1.60), foreign-born (OR=3.90), and living in the south county region closest to the U.S./Mexico border (OR=2.72) were significant predictors. CONCLUSIONS: Results suggest that Latino youth near the California/Mexico border are at high risk for infection, for remaining undiagnosed, and for being under-treated for LTBI.  (+info)

Screening for phenylketonuria in a totalitarian state. (22/200)

Living under a totalitarian regime has many effects on the structure, way of thinking, and relations in a society. However, it is the impact on neonatal genetic screening that we discuss in this paper. Genetic screening functions at the interface between health services and society at large. Being involved for over a decade in setting up the Bulgarian PKU screening programme, we have had to deal with ways and attitudes which may be difficult for the western mind to grasp. Yet comprehension is very much needed in the new world we are trying to create.  (+info)

The Supreme Court, abortion, and the jurisprudence of class. (23/200)

The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a woman's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's methods do not create an "undue burden" on the decision. Any restriction on abortion is a burden; whether it is "undue" (and therefore unconstitutional) depends on one's circumstances. The Court appears to view the difference between an undue burden and mere inconvenience from the perspective of privilege. The restrictions that were upheld may not significantly affect middle-class access to abortion, but they could prove insurmountable for many less privileged women.  (+info)

Participation of children in clinical research: factors that influence a parent's decision to consent. (24/200)

BACKGROUND: Given the initiatives of the National Institutes of Health and other agencies to include children in research, it is important to understand the factors that influence their participation. This study was designed to identify factors that influence parents' decisions to consent to their child's participation in clinical research. METHODS: This survey study consisted of 505 parents who had been approached for permission to allow their child to participate in a clinical anesthesia or surgery study at a large tertiary care children's hospital. Regardless of whether the parents consented to (consenters, n = 411), or declined (nonconsenters, n = 94) their child's participation in a study, they were offered the opportunity to complete a questionnaire eliciting information regarding factors that had influenced their decision. RESULTS: Consenters exhibited less uncertainty in their decision making, were more trusting of the medical system, had greater understanding of the research, and believed that the environment in which consent was sought was less pressured than nonconsenters. Predictors of consent included low perceived risk, degree to which the parent read the consent document, characteristics of the consent document, parental understanding, perceived importance of the study, and perceived benefits. CONCLUSIONS: Identification of factors that influence parents' decisions to allow their child to participate in a clinical research study will be important by way of developing strategies to improve the manner in which study information is disclosed and to ensure that parents are truly informed.  (+info)