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Conclusion and summaryThe proposed method of bleeding pattern analysis avoids the problem of defining the menstrual cycle. The difficulty of maintaining a cyclical approach becomes acute when methods of fertility regulation are used which are known to disrupt seriously previously experienced bleeding patterns.By using eight simple measures relating to the pattern of bleeding over a fixed period of time, it is possible to present sensitive indicators previously available but not used. These indicators will permit a more meaningful comparison of data obtained from different groups of women or for the same woman over time. The eight measures relate to the number, average duration and variability of bleeding episodes taking place within a defined period of time; the variability of the bleeding-free interval; the average duration and variability of the bleeding episode and its succeeding bleeding-free interval; and the number of days on which bleeding has occurred.Agreement was reached by the Workshop participants regarding the terms to be used, the definition of these terms, the statistical approach to be adopted and the analytical procedures to be followed in the analysis of bleeding patterns. It is hoped that this alternative approach to bleeding pattern analysis will assist researchers, clinicians and other investigators in the collection, analysis and interpretation of menstrual bleeding patterns.An example of this approach is given in the following paper by D. Mayes. This example is based on data in the form of diary cards made available to the Family Planning Research Unit, Exeter University, by John Guillebaud of the Churchill Hospital, Oxford.

SummarySince the first rush of publications on IUDs following the start of Tietze's Cooperative Statistical Programme for the Evaluation of IUDs (Tietze & Lewit, 1970) there has rarely been a period in which a report relating to newer, 'second-generation' devices has not been published. There are degrees of sophistication in these reports varying from the odd anecdotal reference and highly subjective clinical impression to carefully constructed and evaluated large-scale clinical and field trials. This in itself creates problems, for the carefully constructed trials tend to be reported long after the clinical impressions have been publicized. In some cases the impressionistic information has so affected opinion that the presentation of data from large-scale trials providing greater validity and reliability becomes merely an academic exercise.

The possible influence of psycho-social factors on the use and effectiveness of the intrauterine contraceptive device (IUD) has not been seriously examined until recently. Inquiry into these factors has become feasible as large-scale projects—primarily designed to consider medical factors in IUD use—have been developed. Data obtained from a number of centres within and outside the United Kingdom indicate the existence of variation in the clinical efficacy of the same type of device. This variability suggests that success or failure of a given model does not necessarily depend on the device alone. Factors other than those generally considered 'medical' may play a significant role in IUD use and effectiveness.The procedures involved in organizing large-scale multi-clinic IUD trials and including efficient data-retrieval systems are described in detail.In addition, findings are reported on the trial of a stainless steel type of device, the M 213, which has been fitted in sufficient numbers in several UK clinics to permit analysis of variables associated with both the clinic and the doctor responsible for the IUD fitting. Evaluation of the data collected from two single-doctor clinics in two adjacent towns in the southwest of England using the M 213 and served by the same doctor, has revealed significant differences in the net cumulative pregnancy rate associated with the device. Age and parity of the IUD acceptors (and the interaction of age and parity) did not appear to be responsible for the difference. Although the general atmosphere and work load within the clinic setting may have differed it is not thought that this could fully account for the observed variations in the pregnancy rates between the two clinics.There appears to be sufficient evidence to suggest that the traditional purely 'medical' approach to the examination of IUD use—effectiveness should be extended to include the study of social and psychological variables associated with both the providers and the acceptors of the IUD service.

BACKGROUND: Common mental disorders are the leading cause of workplace absences. While the reasons for this are multifarious, there is little doubt that stigma related to common mental disorder plays a large role in sickness absence and in poor help-seeking. Frequently both managers and staff are unsure of how to approach and intervene with mental health related problems. We have therefore devised a mental health intervention programme (Prevail) that aims to reduce stigma and to educate staff about evidence-based low intensity psychological interventions. These can be used by the individual, as well as in collaboration with managers via co-production of problem-focussed solutions, with the aim of improving mental health, reducing sickness absence, and increasing workplace productivity. METHODS: This two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of Prevail. Eighty managers at a large UK government institution (the DVLA) and their teams (approximately 960 employees) will be randomised into the active intervention group or control (employment as usual) arms of the study. All participants will be invited to complete a series of questionnaires related to mental health stigma, their current and past mental health, and their recent workplace productivity (absenteeism and presenteeism). All employees in the active arm will receive the Prevail Staff intervention, which covers stigma reduction and includes psychoeducation about evidence-based low intensity psychological interventions for common mental disorder. The managers in the active arm will also receive the Prevail Managers programme which covers communication skills, problem formulation, and problem-solving skills. The questionnaire battery will then be given to both groups again 4 weeks post training, and 12 months post-training. Official records of absenteeism from Human Resources will also be gathered from both active and control groups at 12 months post-training. DISCUSSION: The treatment trial aims to evaluate if Prevail ...

Background  Whether the Flynn effect (the increase in the populations' IQ over time) affects the IQ scores of people with learning disability or borderline learning disability remains unclear. The issue is important as the Flynn effect should alter the number of people eligible for health service resources. A comparison of the Wechsler Adult Intelligence Scale‐Revised (WAIS‐R) with the Wechsler Adult Intelligence Scale‐Third Edition (WAIS‐III) in individuals with learning disability or borderline learning disability was conducted.Method  All participants completed the WAIS‐R and the WAIS‐III. Discrepancy scores were calculated for the Full Scale IQ score and the Verbal and Performance subscale scores.Results  WAIS‐III Full Scale scores were significantly lower by over 4 IQ points. Verbal and Performance Scale IQ scores were also significantly lower than the corresponding WAIS‐R scores.Conclusion  The shift from WAIS‐R to WAIS‐III means that 66% more people meet criterion A for the diagnosis of learning disability and hence this has major resource implications for health service providers.

The Implicit Association Test was used to measure cognitive associations between children and sex in men convicted of child-sex offences. It was hypothesized that these cognitions would be different in pedophilic-type offenders (defined by having a victim aged less than 12 years) and hebephilic-type offenders (only victims aged 12 to 15 years) such that only the pedophilic-type offenders would have an implicit association between children and sex. This was confirmed. It was also hypothesized that this association between children and sex in the pedophilic-type offenders would be present irrespective of their denial of offence history. This was also confirmed. These results demonstrate differences in the cognitive associations between children and sex held by subgroups of child-sex abusers, and they help establish the Implicit Association Test as an indirect means to assess cognitive factors related to sexual offences.