There is no evidence that programs promoting safer sex measures along with sexual abstinence lead to more sexually transmitted infections (STI), according to a new review of studies comprising nearly 40,000 young people.

Some supporters of abstinence only programs have suggested that the safer sex component of abstinence plus programs might increase the incidence of STI.

However, those who enroll in these “abstinence-plus” programs are less likely to engage in risky behaviors such as unprotected sex, at least for a few months after the program.

The review is the first to focus on the role of such programs in HIV prevention in high-income countries such as the United States. The results suggest, “Abstinence-plus interventions do not significantly exacerbate sexual behaviors and might reduce risk for HIV transmission,” among participants, said co-author author Don Operario, Ph.D., of Oxford University in England.

The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Unlike abstinence-only programs, which offer abstinence as the only way to reduce the risk of sexual infection, abstinence-plus programs offer a “pyramid” of choices, suggesting that abstinence is the safest choice, followed by safe sex practices.

In part, the reviewers decided to look at abstinence-plus programs because they are “politically important” and “have important and promising implications for improving the health of young people,” particularly in the United States where the programs are popular and widespread, Operario said.

In a 2006 U.S. survey, 82 percent of participants said they would prefer programs that included some discussion of safe sex practices along with abstinence information.

“Abstinence-only programs, while a priority of the federal government, are supported by neither a majority of the public nor the scientific community,” said Amy Bleakley, Ph.D., a public health researcher at the University of Pennsylvania who led the survey group.

Operario and colleagues examined 39 studies that included 37,724 participants. The majority of the programs took place in schools and community centers.

Most of the studies seemed to have some effect on self-reported risky sexual health behaviors, lowering rates of unprotected sex, early sexual activity and sex with casual partners, among other risks.

Still, none of the studies included medical tests for sexual transmitted infections, including HIV or pregnancy, “which reflects a limitation of current research in this area,” said Operario.

The reviewers found hints that some abstinence-plus programs might have been more effective than other programs were, a finding they hope to follow up in future studies.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.VeroMaxx.com/ for more information.

Underhill K, Montgomery P, Operario D. Abstinence-plus programs for HIV infection prevention in high-income countries. The Cochrane Database of Systematic Reviews 2008, Issue 1.

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Increasing medical school enrollment to meet the nation’s rising demand for physicians isn’t as simple as adding a few more chairs to a classroom, according to “Medical School Expansion: Challenges and Strategies,” a new report released today by the AAMC (Association of American Medical Colleges). The report finds that medical school administrators face numerous obstacles throughout their expansion efforts-including a lack of faculty resources, financial resources, and classroom and training space-but shows how careful planning can help overcome these challenges.

As of 2006, 93 of the nation’s 126 medical schools increased or were planning to increase enrollment over 2002 levels. Several U.S. medical schools are increasing their class size by 10 percent or more in response to the AAMC’s call for a 30 percent increase in enrollment by 2015 to address an anticipated national physician shortage. Six of these institutions were selected for this study, which was conducted through site visits, focus groups, and extensive interviews with medical school and university officials, staff, and faculty; community leaders; and medical students. The six participating institutions were: Boston University School of Medicine; Michigan State University College of Human Medicine; Oregon Health & Science University School of Medicine; Texas A&M Health Science Center College of Medicine; University of Arkansas for Medical Sciences College of Medicine; and University of Texas Medical School at Houston.

Some of the common challenges these schools addressed while planning for expansion include:

- Finding additional classroom and laboratory space and equipment for first- and second-year students
- Securing sufficient clinical training sites and faculty for third- and fourth-year students and ensuring that students on different campuses have comparable experiences
- Maintaining student support services and administrative infrastructure despite increased demand on admissions, financial aid, and other resources
- Developing accurate cost estimates for the expansion, and obtaining financial support through state appropriations, tuition, and donations
- Acknowledging increased demands on current faculty, and recruiting additional faculty
- Creating interdisciplinary planning teams and strategic partnerships.

The new study found that class size expansion at existing medical schools typically follows one of two models for growth: “in place”-in which more medical students are enrolled on an existing academic medical center campus by increasing infrastructure capacity-or the regional campus model.

The regional campus model can follow two paths. Under the traditional path, a medical school accommodates a larger class by providing students with their third- and fourth-year clinical education at a regional campus location (after having completed their first two years of basic science education on the main campus). Under the second path-which the AAMC has identified as an emerging trend in medical education-a medical school creates a new branch campus that offers all four years of medical education while operating within the accreditation of the four-year program on the main medical school campus.

“The consensus from the medical school administrators and staff on the front lines of these expansion efforts is that planning is the most critical-and iterative-process involved,” said Sarah Bunton, Ph.D., senior research associate for organization and management studies at the AAMC and lead author of the report. “Expansion can be relatively uncharted territory, and even the most attentive and organized administrators found themselves reassessing and revising their plans throughout the expansion process.”

To purchase a copy of “Medical School Expansion: Challenges and Strategies” go to http://www.aamc.org/medicalschoolexpansion. The latest issue of AAMC Analysis in Brief also examines some of the findings from this medical school expansion report: see here.

The Association of American Medical Colleges is a not-for-profit association representing all 126 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 68 Department of Veterans Affairs medical centers; and 94 academic and scientific societies. Through these institutions and organizations, the AAMC represents 109,000 faculty members, 67,000 medical students, and 104,000 resident physicians.
Source: http://www.medicalnewstoday.com/articles/96103.php