Population-level intervention to promote chlamydia screening

Abstracts 34% on fitness/exercise, 26% on sex, 24% on alcohol/drug abuse, 20% on mental health, 14% on medicines, 12% on violence among peers, 10% on parenting, 8% on violence among dating partners, 7% on tobacco and smoking, 7% on emotional or physical abuse, 3% on sexual abuse, and 1% on illness support groups. Clinic girls were more likely to have tried to get information on sex (p ⬍ .001) and parenting (p ⬍ .001) from the Web. Many girls (59%) indicated that it was “very” or “extremely” worthwhile to have general health information on the Web, with no significant differences between high school and clinic girls. As well, 71% and 62% said it was “very” or “extremely” worthwhile to have access to contraceptive and diet/nutrition information, respectively. Conclusions. High school girls, as anticipated, were technologically savvy. Somewhat surprising, however, were the clinic girls’ high levels of Internet use and access. Significant differences revealed that the high school girls were more on-line than clinic girls, but clinic girls were still using the Web frequently. A considerable number or urban girls had tried to get a range of health information from the Internet. This study offers promising statistics on how urban adolescent girls are accessing and using the Internet, especially for health information. POPULATION-LEVEL INTERVENTION TO PROMOTE CHLAMYDIA SCREENING: MOVING TOWARD IMPLEMENTATION OF CHLAMYDIA HEDIS 2000 MEASURE M Kim Oh, MD, Diane Grimley, PhD. Gustavo Heudebert, MD. Schools of Medicine and Public Health, University of Alabama at Birmingham, AL Background: HEDIS 2000 measure includes chlamydia screening in women which is designed to assess the percentage of sexually active women 15 to 25 years who have received at least one screening test for chlamydia during the reporting year. This study is being undertaken to determine feasibility of implementing a population-level intervention within HMOs to promote chlamydia screening. This abstract presents preliminary findings from the Birmingham project of this multicenter study. Methods: In partnerships with two HMOs, series of outreach methods were used in a stepwise fashion to determine potential barriers and enabling factors for the implementation of chlamydia HEDIS measure in a conservative social environment. Mail outreach was sequentially combined with newspaper, TV, radio advertisements and poster displays. Both qualitative and quantitative impact of the outreach efforts were measured across the timeline. The measures included reporting for chlamydia screening (urine LCR) and infection rate, monitoring chlamydia hotline and staffed phoneline use, and assessment of untoward effects and cost-analysis of the chlamydia outreach campaign. Results: The key findings are: the benefit of chlamydia screening is not understood by general public, letters send by Health Plans to their members are not read by many subscribers, and there are wide gaps between adolescents and their parents, in knowledge, attitudes, beliefs in regard to obtaining information and accessing the screening ser-

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vices (teens prefer hotline, brochure in an envelop addressed to teens, incentives for reporting to the clinic for screening, vs. parents prefer staffed phone consults, “exposed” brochure addressed to parents, and no incentives). A month of sustained and repeat multi-media campaign resulted in 330 hotline calls, 83 phone calls and only 17 subjects being tested (3 were positive) though many more intended to come. Cumulative effects and cost of various outreach efforts are being monitored. Informational chlamydia brochures and free test cards mailed to the homes generated no negative response from the subscribers, contrary to the concerns of the HMOs. Conclusion: To be effective, investment in public education campaign and social marketing strategies must be integrated in population-level intervention for the implementation of the chlamydia HEDIS 2000 measure. OVARIAN CORTEX CRYOPRESERVATION IN PEDIATRIC AND ADOLESCENT MEDICINE A. Revel MD, V. J. Davis MD, R. F. Casper MD. Hospital for Sick Children, The Toronto Hospital, Toronto Canada Background: Increased pediatric/adolescent cancer survivor rates have enhanced awareness of long-term effects of therapy, specifically gonadal failure. Ovarian cortex cryopreservation may hold the promise of fertility for those at risk for ovarian failure due to medical therapy. The object of this study was to determine if an ovarian cryopreservation program is feasible and to define suitable candidates. Method: A MEDLINE search supplemented by bibliographies. The review was limited to English articles on ovarian failure rates following radiation and/or chemotherapy and on ovarian cryopreservation. Investigators in the field were consulted to identify other sources. Results: Approximately one third of postpubertal females exposed to chemotherapy or radiotherapy develop ovarian failure. The risk is mostly significant for patients exposed to pelvic radiotherapy (up to 32% decrease in fertility) and alkylating agent based chemotherapy (infertility in 22%). A ninefold increase in premature ovarian failure results from exposure to combined pelvic radiotherapy and alkylator based chemotherapy. Practically all patients exposed to multiple agent chemotherapy combined with pelvic radiotherapy at doses used in preparation for bone marrow transplant will undergo irreversible loss of ovarian function. Currently human ovarian cortex can be cryopreserved, thawed and stimulated with gonadotrophins to produce follicles when transplanted into immunosuppressed mice, however there has yet to be any human pregnancies. The immunosupressed mouse model could also serve as a test to determine whether the tissue carries metastatic risk prior to reimplantation into the donor. Conclusion: Based on the literature we propose ovarian cortex cryopreservation and banking for postpubertal females prior to chemotherapy and/or radiation therapy that holds a high risk of ovarian failure. In the future this may provide oocytes for reproductive purposes. A protocol is currently under approval by the Hospital for Sick Children’s ethics committee.