Factors associated with unintended pregnancy.

This research was designed to identify determinants of unintended pregnancy among women attending family practice or family planning clinics. Survey data were collected from 95 women who were categorized according to whether or not they had experienced an unintended pregnancy. Women reporting unintended pregnancy were younger, reported earlier sexual debut and a greater number of sexual partners than those not having experienced an unintended pregnancy. Those who had avoided unintended pregnancy displayed higher levels of preventive sexual self-efficacy, had more confidence in their ability to use contraceptive methods, perceived more negative consequences associated with having children in the near future, and believed pregnancy among unmarried women to be less acceptable than did women who had had unintended pregnancies.

Characteristics and experiences of American women electing for early removal of contraceptive implants.

The study describes the experiences of 430 women who had Norplant(R) contraceptive implants removed prior to the five years of method effectiveness. Each subject was surveyed when the implants were inserted and again at the time of removal. Descriptive data are presented concerning perceptions of the method before insertion and after removal, reactions to the contraceptive and experiences associated with the removal procedure. Subjects' use of Norplant implants ranged from 14 days to 40 months, with a mean of 13.3 and median of 13 months. Over 95% reported changes in menstrual bleeding patterns and 95% experienced other non-bleeding related side effects. Non-bleeding side effects were the most frequently indicated reasons for removal, followed by bleeding changes. The mean removal time was 34 minutes with a median of 25 minutes. Over 48% reported experiencing significant pain during the removal procedure, and 27% stated that the pain was greater than expected. Despite electing for early removal of implants,the majority of women surveyed indicated satisfaction with all aspects of the method save its effect on their overall health. Although method-related side effects were intolerable for most subjects, their overall perception of the method was generally satisfactory.

PIP: 430 women enrolled at the time of acceptance in a longitudinal study of Norplant acceptability elected to have their implants removed between May 13, 1991 and September 8, 1994 (within 40 months of insertion). 225 of these women were surveyed immediately after removal, and 205 were identified during the follow-up study. The study provided information sociodemographic characteristics of the women and on 1) contraceptive method used before and after Norplant; 2) concerns about Norplant which were expressed prior to insertion; 3) reasons indicated for having implants removed; 4) changes in bleeding patterns; 5) side effects unrelated to menstrual bleeding; 6) significant pain reported during each of six stages of the removal process; and 7) user satisfaction in terms of comfort, convenience, cost, health effect, insertion, removal, and medical care. Most of the women chose early removal because they were unable to tolerate the side effects, but 13% chose removal because of discomfort at the implantation site and 10% because they no longer desired contraception. Removal was related to a pregnancy in three women (not method failure), and five others were acting on their physicians' advice. 48% of the women reported significant pain during removal, which was a larger number than expected. Since the cost-effectiveness of Norplant depends upon longterm use, it will be helpful to identify women who might be better served by a shorter term contraceptive. Despite the desire for removal, more than 25% of the women stated that they would consider Norplant use again in the future. Because side effects caused most women to discontinue, it is important that patients be properly counseled on the disadvantages of a longterm method.

Characteristics of teens tested for HIV in a metropolitan area.

PURPOSE: This article describes the status of HIV infection in an adolescent population attending publicly supported HIV testing clinics in Houston. METHODS: Records were reviewed of 4017 teenagers receiving HIV counseling and testing services over a period of three years (January 1990 to December 1992). We analyzed demographic characteristics, risk exposure groups, results of HIV antibody testing, and post-test counseling return rates. RESULTS: An overall seroprevalence rate of 10.2 per 1000 was observed, with the majority of cases seen among black females. Forty-nine percent of teens with the virus failed to acknowledge a risk factor, but of those who did, male-to-male sexual contact was the most frequently reported. None who tested positive reported injected drug use. The majority of teens tested never returned to obtain their test results and post-test counseling. CONCLUSIONS: In order to reinforce preventive behavior, institutional and other barriers should be examined and priority given to contacting both seropositive and high-risk clients who have sought testing. Interventions that encourage condom use or address sexual behavior may be more beneficial to teens than those that simply focus on drug use.

HIV exposure in the city of Houston.

Demographic characteristics and risk factor data for 76,672 clients were studied to characterize the distribution of infection with human immunodeficiency virus (HIV) and the use of counseling and testing facilities in Houston, Tex. The number of clients who received free, voluntary HIV counseling and testing services between January 1990 and December 1992 doubled, while the seroprevalence rate declined from 6.1% to 2.9%. Rates were highest for white males, clients attending freestanding HIV testing sites, and those reporting male-to-male sexual contact. The number of females testing positive had increased by 67% over time and consisted almost entirely of blacks. Only 57% of clients who were tested returned for test results and received posttest counseling. Among those who were HIV negative, high-risk behaviors were frequently reported. Behavioral change must be reinforced, and priority must be given to contacting both seropositive and high-risk clients who seek testing.

Clinical manifestations, disability and use of folk medicine in dracunculus infection in Nigeria.

A cross-sectional survey of households was carried out in a dracunculiasis endemic village in Oyo state Nigeria. Data were collected on history of dracunculiasis, occupational and domestic sources of drinking water, clinical manifestations, disability, use of folk medicine, and incorporation of previous dracunculiasis control programmes. The findings indicated that dracunculiasis patients were usually unaware of their infection 3-5 days before the appearance of a bleb; that religious affiliation appeared to be positively related to increasing morbidity; and that ulcers were predominantly in the ankles and feet, particularly among young children. Severe disability was related to age, site and number of ulcers, and the form of selected treatment. Indigenous remedy was the treatment of choice, although traditional healers in the community indicated no knowledge of any efficacious remedy. Mortality from secondary tetanus infection was associated with outbreak of dracunculiasis. The impact of dracunculiasis on agricultural, economic and recreational activities was considerable, with the infected farmers being unable to attend to their farms at the critical farming period. Sixty-one per cent of the residents were opposed on religious and aesthetic grounds to the treatment of the local surface water which contained cyclops species. Sixty-three per cent regarded the boiling and filtration of portions of their domestic water as an additional burden, cumbersome and impracticable.(ABSTRACT TRUNCATED AT 250 WORDS)

Source of drinking water supply and transmission of guinea worm disease in Nigeria.

During 1982, ecological factors associated with freshwater pollution were investigated in Idere, a rural Nigerian community with endemic guinea worm infection. Data were collected on the quality of all pond water sources, and on rainfall patterns and potable piped water available in the community. Pond water provided 76% of the total water used in Idere. This source of drinking water provided the classical ecological environment for the transmission of Dracunculus medinensis, other helminth parasites and bacterial enteric infections. The bacteriological analysis of drinking water from the ponds reflects the absence of sanitary arrangements for human waste disposal in the community, as the ponds are collectors of storm run-offs. Okina, the spring-fed pond which was nearest to the households, was the most reliable year-round source of water to the community; however, Okina also contained the highest density of infective Thermocyclops and the highest faecal coliform (FC) to faecal Streptococcus (FS) ratio (FC/FS), thus providing a central reservoir for guinea worm and bacterial infections. The transmission season of guinea worm infection corresponded with the period of greatest water scarcity in Idere. The amount of portable water available to Idere residents in 1981 was 3.6 litres per person per day. Frequent mechanical breakdowns, electric power failures, lack of fuel to run the water pumping engines and the direct link of the water pipeline supplying water to Idere with a water pipeline serving another major city in the same district were some of the reasons for potable water shortage in the community.