Objective Short telomeres are associated with adult cardiovascular disease. Our aim was to determine whether small-for-gestationalage (SGA) newborns have shortened telomeres compared with appropriately grown controls.Design Prospective cohort study.Setting Large tertiary referral unit in Trent, UK.Population Seventy-two women who delivered at 35-42 weeks of gestation were recruited; 34 delivered SGA babies (less than or equal to the third birthweight centile) and 38 had appropriately grown babies (greater than the tenth centile).Methods Maternal and cord blood samples were collected at delivery. A Southern blot of DNA from these samples was hybridised with a 32 P-labelled telomeric probe and telomere length was measured.Main outcome measures Mean maternal and newborn telomere length.Results Maternal and newborn telomere lengths were significantly correlated in both the SGA and the control groups (r 2 = 0.25, P < 0.0001). Telomere lengths were similar in both maternal (control 8.41 ± 0.9 kb versus SGA 8.29 ± 1.0 kb, P = 0.57) and newborn (control 10.36 ± 1.5 kb versus SGA 10.33 ± 1.3 kb, P = 0.93) cohorts in the two groups.Conclusions Intrauterine events associated with impaired fetal growth do not appear to be associated with increased telomere shortening.

Objective To examine patients' understanding of the status, function, and remit of written consent to surgery. Design Prospective questionnaire study. Questionnaires were sent to patients within one month of surgery. Responses were analysed with frequencies and single variable analyses. Setting Large teaching hospital. Participants 732 patients who had undergone surgery in obstetrics and gynaecology over a six month period. Main outcome measures Patients' awareness of the legal implications of written consent and their views on the function and remit of the consent form. Results Patients had limited understanding of the legal standing of written consent. Nearly half (46%, 95% confidence interval 43% to 50%) of patients believed the primary function of consent forms was to protect hospitals and 68% (65% to 71%) thought consent forms allowed doctors to assume control. Only 41% (37% to 44%) of patients believed consent forms made their wishes known. Conclusions Many patients seem to have limited awareness of the legal implications of signing or not signing consent forms, and they do not recognise written consent as primarily serving their interests. Current consent procedures seem inadequate as a means for the expression of autonomous choice, and their ethical standing and credibility can be called into question.

Objectives  To evaluate women's experience of giving consent to obstetric and gynaecological surgery and to examine differences between those undergoing elective and emergency procedures. Design  A prospective questionnaire study. Setting  A large teaching hospital. Population  1006 consecutive patients undergoing elective or emergency surgery in obstetrics and gynaecology. Methods  Questionnaires were administered to women who had given consent to surgery following the introduction of national guidelines and consent form. Differences in responses between elective and emergency patients were assessed using frequencies, single and multivariable analyses. Main outcome measures  Patients' experience and recall of the consent process, their overall satisfaction and their views on what is important for adequate consent. Results  There were significant differences between patients undergoing elective or emergency surgery. Patients undergoing emergency surgery were less likely to have read (OR 0.22) or understood (OR 0.40) the consent form, and were more likely to report feeling frightened by signing it (OR 2.52). They were more likely to report they felt they had no choice about signing the consent form (OR 2.11), and that they would have signed regardless of its content (OR 3.14). Overall, significantly more patients undergoing elective (80%) or emergency (63%) surgery reported satisfaction with the consent process. Patients were more likely to report satisfaction if they read (OR 1.80) and agreed with (OR 3.49) the consent form, and if someone checked that they understood (OR 3.09). Conclusion  Patients' needs may not be adequately addressed by current guidelines for consent to treatment, particularly in emergency circumstances. The introduction of more complex forms and procedures appears to conflict with patients' need for personal communication and advocacy. The implications on the ethical and legal standing of consent are considerable.

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Objectives To examine final year medical students' experience of being taught to conduct intimate examinations.Design Prospective questionnaire study.Setting Medical school in the UK.Population Medical students in the final year cohort 2005/06.Methods Questionnaires were distributed to students in the final week of a final year obstetrics and gynaecology course. Responses to questions about course experience were analysed using frequencies and single-variable analyses.Main outcome measures Students' experience of and satisfaction with the teaching of intimate examinations and differences between male and female students.Results Male and female students performed similar numbers of intimate examinations, but clinical tutors were significantly more likely to introduce female students to patients (76 versus 52%; P = 0.001) and obtain consent on their behalf (75 versus 53%; P = 0.009) when compared with male students. Male students reported a greater degree of embarrassment (mean score 2.41 ± 1.25 versus 1.69 ± 0.90; P = 0.002), and a higher number of patients refusing consent to examination (median 2; range 0-12 versus 0; range 0-6; P = 0.0001).Conclusions Gender discrimination in the behaviour of tutors may impact on students' experience of intimate examinations. It is highly improbable that differences in behaviour are deliberately intended to disadvantage male students, and further research is needed to understand why tutors behave differently with them. In the meantime, tutors need to be aware of potential bias and ensure appropriate support is provided for both male and female students.Keywords Gender bias, intimate examinations, undergraduate training.Please cite this paper as: Akkad A, Bonas S, Stark P. Gender differences in final year medical students' experience of teaching of intimate examinations: a questionnaire study . BJOG 2008;115:625-632. IntroductionThe teaching of intimate examinations to medical undergraduates has received a great deal of attention in recent years largely because of the ethical and medico-legal issues surrounding patient consent. 1 However, problems of adequate delivery of the training and the quality of the student experience were also highlighted in a number of publications. Higham and Steer 2 demonstrated that male students are disadvantaged in terms of acquisition of practical examination skills in obstetrics and gynaecology, thus raising the possibility that inadequate exposure to skills training may diminish their interest in the specialty at postgraduate level. This concern is shared by the Royal College of Obstetricians and Gynaecologists (RCOG); in a recent RCOG publication on recruitment into the specialty, it was highlighted that the undergraduate experience has emerged as one of the major issues in encouraging medical students to consider a career in obstetrics and gynaecology. 3 It has been suggested that one of the reasons for male students' disadvantage was a higher rate of refusal by patients when compared with their female counterparts. 2 However, influences on s...