Press releases Monday 14 June to Friday 18 June 2010

Please remember to credit the BMJas source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Obesity may harm your sexual health
(2) Benefits of shared electronic patient records more modest than anticipated

(1) Obesity may harm your sexual health
(Research: Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours)
http://www.bmj.com/cgi/content/abstract/340/jun15_1/c2573
(Editorial: Obesity and poor sexual health outcomes)
http://www.bmj.com/cgi/content/extract/340/jun15_1/c2826

Being obese impacts on sexual health according to research published on bmj.com today.

The study reports that the rate of unplanned pregnancies is four times higher among single obese women than normal weight women, despite them being less likely to have been sexually active in the past year. Obese women are less likely to seek contraceptive advice or to use oral contraceptives. Obese men have fewer sexual partners in a 12 month period, but are more likely to suffer from erectile dysfunction and develop sexually transmitted infections than normal weight men.

Obesity is emerging as one of the fastest growing pandemics in modern times says the study, but its effects on sexual health are unclear. The research led by Professor Nathalie Bajos, Research Director at the Institut National de la Santé et de la Recherche Medicale in Paris, is the first major study to investigate the impact of being overweight or obese on sexual activity and sexual health outcomes such as sexual satisfaction, unintended pregnancy and abortion.

The authors undertook a survey of sexual behaviours among 12,364 men and women aged between 18 and 69 years of age living in France in 2006. Of the participants, 3,651 women and 2,725 men were normal weight (BMI between 18.5 and 25), 1,010 women and 1,488 men were overweight (BMI between 25 and 30) and 411 women and 350 men were obese (BMI over 30).

The results show that obese women were 30% less likely to have had a sexual partner in the last 12 months. Obese men were 70% less likely to have had more than one sexual partner in the same period and were two and half times more likely to experience erectile dysfunction.

Sexual dysfunction was not associated with BMI among women. However, obese women under 30 were less likely to seek contraceptive advice or use oral contraceptives. They were also more likely to report an unintended pregnancy. Obese men under 30 were far more likely to have had a sexually transmitted infection.

Obese women were also five times as likely to have met their partner on the internet, more likely to have an obese partner, and less likely to view sex as important for personal life balance. The authors suggest that social pressure, low self-esteem and concerns about body image may help explain these findings.

The authors conclude that the public health impact of these findings is important. They say: “The scale of the problem and the magnitude of the effects (particularly the fourfold increase in risk of unintended pregnancy among obese women) warrants focused attention. In terms of targeting advice and care, a considerable proportion of the population is obese, is easily identified as such, as is at increased risk in terms of poorer sexual health status.”

In an accompanying editorial, Dr Sandy Goldbeck-Wood, a specialist in psychosexual medicine, points to evidence showing that doctors find it difficult to discuss sex and weight issues with patients, and believes that clinicians must be prepared to address these difficult subjects which have such important effects on health and quality of life. She says: “We need to understand more about how obese people feel about their sex lives, and what drives the observed behaviours and attitudes.”

She concludes: “In public health terms, the study lends a new slant to a familiar message: that obesity can harm not only health and longevity, but your sex life. And culturally, it reminds us as clinicians and researchers to look at the subjects we find difficult.”

Contacts:
Research: Nathalie Bajos, Associate Professor, London School of Hygiene and Tropical Medicine and Research Director, Institut National de la Sante et de la Recherche Medicale, Paris, France
Email: nathalie.bajos@inserm.fr
Editorial: Sandy Goldbeck-Wood, Associate Specialist in Psychosexual Medicine, Camden and Islington Mental Health Trust and Specialty Doctor in Obstetrics and Gynaecology, Ipswich Hospital, UK
Email: goldbeckwood@doctors.org.uk

(2) Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study
(Head to Head: Do summary care records have the potential to do more harm than good?)
Yes: http://www.bmj.com/cgi/doi/10.1136/bmj.c2710
No: http://www.bmj.com/cgi/doi/10.1136/bmj.c2794

The benefits of the Summary Care Record (SCR) scheme, introduced as part of the National Programme for IT (NPfIT), appear more modest than anticipated, according to a study published on bmj.com today.

The findings are based on an independent evaluation by researchers at University College London and come as the new coalition government announces a review of the scheme.

The Summary Care Record is an electronic summary of patient medical records accessible over a secure internet connection by authorised NHS staff. In 2008, the English government began to roll out the scheme nationally with the aim of improving the quality, safety and efficiency of care, especially in emergency situations.

But the scheme has proved controversial with a range of alleged benefits and drawbacks, from better clinical care and fewer medical errors to high costs and threats to confidentiality.

Researchers set out to evaluate the scheme over a three-year period (2007-2010). They analysed data across three sites, including over 400,000 encounters in participating primary care out-of-hours and walk-in-centres and 140 interviews with policymakers, managers, clinicians and software suppliers involved in the scheme.

By early 2010, 1.5 million SCRs had been created, but the researchers found that creating SCRs and supporting their adoption and use was a complex, technically challenging and labour-intensive process which occurred much more slowly than originally planned.

In participating primary care out-of-hours and walk-in centres, they show that an SCR was accessed in 4% of all encounters and in 21% when an SCR was available. These figures were rising in some but not all sites.

Individual clinicians accessed available SCRs between 0 and 84% of the time. This varied considerably depending on setting, the type of clinician and their level of experience.

When accessed, SCRs seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a positive impact on preventing medication errors.

The research team found that SCRs sometimes contained incomplete or inaccurate data, but they did not see any cases where this led to harm because clinicians used their judgement when interpreting such data and took account of other sources of information. SCR use was not associated with shorter consultations, nor did it appear to reduce hospital admission - benefits which were anticipated by policymakers.

The evaluation also showed that successful introduction of SCRs required collaboration between stakeholders from different worlds, with different values, priorities, and ways of working. The authors say that these differences may have accounted for many of the misunderstandings and frictions occurring at the operational level. And they suggest that the programme’s fortunes will depend on the ability “to bridge the different institutional worlds of different stakeholders, align their conflicting logics, and mobilise implementation effort.”

They conclude: “This evaluation has shown that some progress has been made in introducing shared electronic summary records in England and that some benefits have occurred. However, significant social and technical barriers to the widespread adoption and use of such records remain and their benefits to date appear more subtle and contingent than early policy documents predicted.”

In two accompanying papers, also published on bmj.com today, experts debate whether summary care records have the potential to do more harm than good. Mark Walport, Director of the Wellcome Trust believes that the national electronic database of patient records will make valuable contributions to better care, but Ross Anderson, Professor of Security Engineering at the University of Cambridge, argues that it is both unnecessary and unlawful.

Contact:
Trisha Greenhalgh, Healthcare Innovation and Policy Unit, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London, UK
Email: ruth.howells@ucl.ac.uk

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