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Biomedical subjects

F C Boag

Publications and source records attributed to F C Boag.

27 records · Page 2Linked to original sources

Incorporating patients' views in planning services for women with HIV infection.

OBJECTIVES: To determine the preferences of HIV seropositive women for out-patient care facilities. DESIGN: Cross sectional survey. SETTING: An HIV out-patient clinic, a genitourinary medicine (GUM) clinic and a self support group for HIV seropositive women. SUBJECTS: Fifty consecutive HIV seropositive women attending the out-patient clinic and 18 women attending the self support group. RESULTS: Eighty percent of the women were comfortable in the HIV clinic. The discomfort felt by the remainder related to time spent in the waiting room. All the women reported feeling comfortable in the GUM clinic. However, 46% indicated a preference for a clinic attended only by female patients and 34% stated that they preferred only female staff. At the time of the survey only 61% of women attending the self support group were attending an outpatient clinic. An HIV clinic with integrated family planning, gynaecology, social workers and a creche was a universal preference expressed by these women. They also indicated a preference for female doctors (83%). CONCLUSION: Women with HIV infection have clear views on the facilities which they would prefer to be available in regard to their out-patient care. In response to these wishes and particularly because of the high percentage of women not currently attending for outpatient care we have commenced a women only clinic.

Consumer Behavior↗

A women-only clinic for HIV, genitourinary medicine and substance misuse.

OBJECTIVE: To evaluate a multidisciplinary women-only clinic (WOC) providing HIV testing, HIV follow-up, genitourinary screening and a substance misuse service. The clinic is designed to attract women who are at risk of acquiring sexually transmitted infections, including HIV, yet are not using existing medical services. DESIGN: A questionnaire survey and review of the case notes of women attending the WOC during the first seven months (April to October 1991) and comparison with a mixed-sex, daytime genitourinary clinic (John Hunter Clinic), and a HIV out-patients clinic (Kobler Centre) all within St Stephen's Clinic. RESULTS: One hundred and twenty-nine women attended the WOC over the seven month period and 113 completed a questionnaire. The main reasons for attendance included a preference to be seen by a female doctor and staff, the presence of female patients in the waiting area, and the greater convenience of an evening clinic. In the absence of the WOC over half the patients (56%) indicated that they would not have attended a genitourinary medicine (GUM) clinic. The WOC attracted significantly more new patients than in the JHC (31.5% vs 15% p < 0.001). One hundred and four women (81%) were screened for genitourinary infection. Compared with the JHC there were significantly more cases of genital warts (33.9% vs 16.1% p < 0.001) and candidosis (41.5% vs 22.3% p < 0.001). A greater number of HIV tests were also performed (19% vs 9% p < 0.01). Sixteen (12.4%) women were HIV positive. Their attendance record at both first appointment (88% vs 64% p < 0.05) and subsequent follow-up appointments (81% vs 43% p < 0.05) was significantly higher than a comparable group of women seen by the same doctor (FB) in the Kobler Centre. The women also saw the health adviser more frequently. Although the number of injecting drug users was small (eight), all women currently injecting drugs entered a detoxification programme. CONCLUSION: The WOC has become an established and popular service at St Stephen's. Women not previously using medical services are attending. The multidisciplinary nature of the clinic encourages a wider use of medical and paramedical services. Attendance record for HIV positive women has improved significantly. Whether these factors will lead to improved standards of sexual health will require a longer period of audit. Seventy-nine per cent of women indicated they would use a family planning service if available. An integrated family planning clinic was introduced after the audit period.

Ambulatory Care Facilities↗

Comparison of vaginal flora after treatment with a clotrimazole 500 mg vaginal pessary or a fluconazole 150 mg capsule for vaginal candidosis.

The effect of antifungal therapy on the vaginal microbial flora was studied in 23 patients suffering from culture-positive, symptomatic vaginal candidosis. They were randomly allocated to receive either a 500 mg clotrimazole vaginal pessary or a 150 mg fluconazole capsule. Quantitative microbiological examination was carried out on samples of vaginal secretions obtained prior, and at intervals up to 10 days after, treatment. No significant difference was found in the vaginal flora before or after therapy in individual patients or between the treatment groups. In patients with C glabrata or C krusei, the yeasts persisted longer in the vagina with poorer response to either of the medications.

Administration, Oral↗

Assessment of psychiatric morbidity in patients attending a colposcopy clinic situated in a genitourinary medicine clinic.

OBJECTIVE: To determine the adverse psychological implications of referral for colposcopic screening within a genitourinary medicine clinic. DESIGN: Cross sectional survey. SETTING: A colposcopy clinic held within a genitourinary medicine clinic. SUBJECTS: 160 consecutive women referred to the clinic were assessed for psychiatric morbidity using the General Health Questionnaire (GHQ-28). Women were referred to the colposcopy clinic because of one or more of the following: abnormal cervical cytology, condylomata acuminata, HIV antibody positivity. A history of prior local ablative therapy to the cervix was also included in the analysis. RESULTS: There was no difference in psychiatric morbidity, as detected by the GHQ-28, in women referred to the clinic because of abnormal cervical cytology or condylomata acuminata. The total GHQ-28 scores indicated a significant increase in psychiatric morbidity, with increased sub-scores indicating social dysfunction, anxiety and somatic symptoms, in women who had had prior laser therapy to the cervix. Women with HIV infection attending the clinic were noted to have an increase in GHQ-28 sub-scores indicating social dysfunction and depression. CONCLUSIONS: Women who have undergone laser therapy to the cervix may benefit from psychological evaluation and supportive measures if they develop further genital lesions which require colposcopic evaluation. Women with HIV infection need further psychological evaluation prior to planning intervention and preventative strategies.

Anxiety Disorders↗

Women, contraception and STDs including HIV.

It is estimated that eight million women are infected with the human immunodeficiency virus (HIV) worldwide. Heterosexual transmission is the predominant mode of HIV transmission on a global basis and is becoming increasingly important in the Western world. Women have long used contraceptives as a means of protection against an unwanted pregnancy, some of which may also protect against sexually transmitted disease (STD) including HIV. We review the relationship between contraceptive methods and STD acquisition and transmission; HIV acquisition and transmission; and the implications of contraceptive use, particularly regarding disease progression, in those women who are already infected with the virus. It is important for all women that protection against both unwanted pregnancy and HIV acquisition and transmission are considered together and not in isolation as nowhere is the argument for a broad based multi-disciplinary approach more cogent.

Contraception↗