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The transition to parenthood is a high-risk time in a person's mental health and requires significant psychological adaptation to incorporate the parental role and creates a unique opportunity for intervention. This period has critical significance for infant development and for the emerging attachment relationship. The aim of this review was to identify and describe the effects of psychological interventions delivered in pregnancy which support the transition to parenthood and prepare parents for early parenting. A search of four key databases for papers published since 2000 identified only 13 eligible publications describing seven interventions. The included interventions involved variable treatment approaches, target outcomes and measures, and while they showed important applications of theoretical knowledge in empirical form, the results were highly mixed and aside from one intervention, were not replicated with a variety of samples over time. There are only a limited number of studies available despite strong theoretical and clinical knowledge which suggests these types of interventions would likely to beneficial and extremely important in preventing significant long-term issues. Significantly more research is needed to determine effective interventions which can be implemented in the antenatal period to prepare first-time parents for parenting and to avoid early relational trauma and attachment difficulties., Author(s): Clare Bellhouse [sup.1] , Louise Newman [sup.1] , Jade E. Bilardi [sup.2] [sup.3] [sup.4] , Meredith Temple-Smith [sup.2] [sup.3] Author Affiliations: (1) grid.1008.9, 0000 0001 2179 088X, Department of [...]

Abstract Background In pregnancy, untreated chlamydia infection has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. The aim of this study was to determine the acceptability of screening pregnant women aged 16-25 years for chlamydia as part of routine antenatal care. Methods As part of a larger prospective, cross-sectional study of pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, 100 women were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy. Women infected with chlamydia were oversampled (n = 31). Results Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. Women indicated a high level of acceptance and support for chlamydia screening, expressing their willingness to undertake whatever care was necessary to ensure the health of their baby. There was a strong preference for urine testing over other methods of specimen collection. Women questioned why testing was not already conducted alongside other antenatal STI screening tests, particularly in view of the risks chlamydia poses to the baby. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support. Conclusions Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies.

Abstract Background Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. Methods General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level. Results Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing. Conclusions A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12608000499381.

Abstract Background Targeted chlamydia screening has been advocated to reduce chlamydia associated reproductive sequelae. General practitioners are well positioned to play a major role in chlamydia control. The primary aim of this pilot study was to measure the effect of offering an online sexual health assessment tool, Youth Check Your Risk, on chlamydia testing rates among young people attending general practices. The secondary aim was to test the acceptability of the tool among general practitioners and young people. Methods General practitioners at three practices in Melbourne, Australia, referred patients aged 16 to 24 years to Youth Check Your Risk http://www.checkyourrisk.org.au for use post-consultation between March to October 2007. The proportion of young people tested for chlamydia before and during the implementation of the tool was compared. Acceptability was assessed through a structured interviewer-administered questionnaire with general practitioners, and anonymous online data provided by Youth Check Your Risk users. Results The intervention did not result in any significant increases in the proportion of 16 to 24 year old males (2.7% to 3.0%) or females (6.3% to 6.4%) tested for chlamydia. A small increase in the proportion of 16 to 19 year old females tested was seen (4.1% to 7.2%). Of the 2997 patients seen during the intervention phase, 871 (29.1%) were referred to Youth Check Your Risk and 120 used it (13.8%). Major reasons for low referral rates reported by practitioners included lack of time, discomfort with raising the issue of testing, and difficulty in remembering to refer patients. Conclusion Offering an online sexual risk assessment tool in general practice did not significantly increase the proportion of young people tested for chlamydia, with GPs identifying a number of barriers to referring young people to Youth Check Your Risk. Future interventions aimed at increasing chlamydia screening in general practice with the aid of an online risk assessment tool need to identify and overcome barriers to testing.

Background: Earlier detection of syphilis is needed to reduce infectiousness and transmission and improve control. PCR for Treponema pallidum is highly sensitive for detecting primary syphilis but in many settings is not widely available or used. The aim of this systematic review was to investigate what proportion of PCR-positive primary syphilis infections are seronegative for syphilis, when serology is performed at clinical presentation for primary syphilis. Methods: We undertook a systematic review to identify studies of patients presenting with primary syphilis where PCR for T. pallidum was performed on the primary syphilis lesion and serology for syphilis on the same occasion. The review was conducted according to the PRISMA checklist. Three databases (Medline, Embase, PubMed) were searched from 1 January 2000 to 27 November 2022. Only studies published in English were included. The search terms used were: 'primary syphilis', 'Treponema pallidum', 'polymerase chain reaction', 'PCR', 'nucleic acid amplification test', 'NAAT'. Medical subject headings (MeSH) were used where possible. Results: Of 2,569 studies identified, 10 studies were included: 2 prospective, 7 retrospective and 1 mixed prospective and retrospective. All studies were conducted in clinical/sexual health settings (Canada, Australia, UK, France, Czechia, Cuba). Across the 10 studies, there were a total of 1084 individuals who had T. pallidum positive primary lesions. This included 867 men: gender was not specified in 2 studies. A total of 1043 individuals with T. pallidum positive primary lesions had serology performed. Among these, 14% (147/1043) (95% CI: 12-16%) were negative by serology, ranging between 4% (4/108) (95% CI 1-9%) and 50% (51/102) (95% CI: 40- 60%). Among studies where the anatomical site of the primary lesion was provided there were a total of 503 anogenital and 8 oral primary lesions that were T. pallidum PCR-positive. Conclusion: Among patients with primary syphilis, a proportion will have PCR-confirmed primary infection when serology is negative. This proportion may vary depending on a number of factors. More widespread availability and appropriate testing with PCR for T. pallidum may improve detection of primary syphilis, resulting in earlier diagnosis. [ABSTRACT FROM AUTHOR]

Background: Syphilis epidemics are worsening in many countries and earlier diagnosis is needed to reduce infectiousness and transmission. Better detection of primary syphilis is needed in primary care settings as this is where many syphilis cases present. The aim of this study was to evaluate whether the use of multiplex PCR testing of anogenital lesions for Treponema pallidum and herpes simplex virus (HSV) in general practice improves the detection of primary syphilis. Methods: Between September and December 2022, multiplex PlexPCR VHS (SpeeDx) testing for T. pallidum and HSV type-1 and -2 was performed on all clinical specimens received from general practitioners across Victoria using the Melbourne Pathology laboratory network if HSV PCR testing of anogenital lesions was requested in a patient aged ≥18, even if T. pallidum PCR was not requested. Multiplex PCR was also performed if testing for other STIs or T. pallidum PCR was requested. Clinics were made aware of this testing via a letter that included a link to an educational video on PCR testing for syphilis. Results: During the period,1,291 multiplex tests were performed, 882 in women and 398 in men, 18 of which were positive for T. pallidum. Of the positive T. pallidum samples, 6/18 (33%) (95%CI: 13-59%) were from patients where the practitioner had requested PCR for HSV but not T. pallidum: 2 female and 4 male. All 6 cases were negative for HSV on PCR. Among the 2 females, both swabs were from genital sites. Among the 4 males, 3 swabs were genital and one anal. Four individuals (2 women, 2 men) resided in more socioeconomically disadvantaged areas known to have higher rates of syphilis in women of reproductive age. Conclusion: Multiplex PCR testing for syphilis and herpes in primary care resulted in the detection of primary syphilis in male and female patients which may have otherwise not been identified. This is likely to have led to earlier diagnosis and treatment, potentially reducing infectiousness and progression of infection. [ABSTRACT FROM AUTHOR]

Project: Implementation of routine syphilis screening in later pregnancy at antenatal services across Victoria, Australia. Issue: Syphilis is increasing among women globally, leading to an increase in congenital syphilis in many countries. Screening for syphilis in later pregnancy could help prevent congenital syphilis but is generally only advised for women identified as being at high risk for infection. However, there are barriers to the identification of risk. This project adopted an implementation science approach to embed syphilis screening into the routine 28-week antenatal clinic visit undertaken by pregnant women across several antenatal services in Victoria with differing health service systems. Results: Data analysis from seven metropolitan and rural antenatal services informed the development of a low-cost implementation package to support practice change, with routine syphilis screening at the 28-week visit. The package comprises four core elements: (1) clinical guidelines recommending routine inclusion of syphilis serology with other blood tests taken for the 28-week visit; (2) automation of pathology ordering that includes syphilis testing with other tests; (3) clinician reminders within clinical records; and (4) training and resources for midwives and obstetricians including an educational video on screening and management for syphilis (Table 1). Use of a hybrid implementation framework identified contextual and behavioural barriers and facilitators that guided the development and integration of these elements to fit within existing clinical workflows and systems, including different systems for pathology ordering and electronic records. The Consolidated Framework for Implementation Research facilitated a deep contextual analysis of the intervention settings, informing tailored implementation strategies. The COM-B model for behaviour change assessed motivation, capability, and opportunity for change, which informed the development of training and resources. Lessons learned: Applying a change in process across varied health service settings required a deep contextual analysis of existing systems, local practices and resources within each setting. Meaningful engagement with clinical staff underpinned by implementation frameworks enabled identification of key elements for implementation that can be tailored according to local conditions. The resulting implementation package could be useful across a variety of healthcare settings to address the preventable epidemic of congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: Miscarriage can result in significant psychological morbidity. Research suggests health professionals play a role in shaping women's experience of miscarriage. Aims: This study explored the views and practices of Australian health professionals in caring for women experiencing miscarriage. Materials and Methods: Twelve health professionals from disciplines including medicine, midwifery and sonography were purposively sampled. Semi‐structured interviews were recorded, transcribed and subjected to thematic analysis. Results: Participants acknowledged miscarriage is often a distressing event associated with feelings of grief and failure. They believed women who conceived through in vitro fertilisation, had experienced multiple miscarriages, or had a pre‐existing mental illness were likely to experience more distress than others. Despite limited training, participants generally felt competent in their abilities to provide emotional support. They viewed their role largely as guilt‐mitigation, which they achieved by stressing the frequency of miscarriage and emphasising that women were not at fault. Follow‐up practices varied, and where they did occur, focused on physical recovery. Generally, participants relied on women to express the need for further support. Participants reported that time and resource issues, compassion fatigue and a need for self‐protection restricted their abilities to provide better support care. Conclusions: There are discrepancies between the emotional support health professionals think women want and are able to provide, and the support women would like. This exploratory study suggests the need for further investigation into provision of improved health professional support for women. [ABSTRACT FROM AUTHOR]