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PubMed1997

An investigation of geographic clustering of repeat cases of gonorrhea and chlamydial infection in San Francisco, 1989-1993: evidence for core groups.

To determine whether there were core groups of transmitters of gonorrhea and chlamydial infection among 14- to 35-year-olds in San Francisco during 1989-1993, sociodemographic risk factors for repeat gonorrhea and chlamydial infection were examined. During those 5 years, 8613 cases of gonorrhea were reported among males and 3893 among females; the proportions with repeat infection were 17.0% and 19.0%, respectively. There were also 2465 reported cases of chlamydial infection among males and 6996 among females; the proportions with repeat infection were 8.6% and 15.1%, respectively. Multivariate analyses reveal that for males, city planning region 5 was an independent risk factor for both repeat gonorrhea (relative hazard [RH] = 1.22; 95% confidence interval [CI] = 1.05-1.43) and repeat chlamydial infection (RH = 1.78; 95% CI = 1.23-2.57). For females, city planning region 4 was an independent risk factor for repeat gonorrhea (RH = 1.50; 95% CI = 1.12-1.98), and there was no high-risk planning region for repeat chlamydial infection. In San Francisco, there appear to be male and female core transmitters for gonorrhea but there may not be core transmitters for chlamydial infection.

Adolescent↗
PubMed1985

Biased selection in Twin Cities health plans.

The data in Tables 1 through 4 show significant differences in the enrollment of higher health-related financial risk individuals and their families among health plans. FFS enrollees are older and exhibit more chronic illness on average. IPAs enroll a greater proportion of females than do PGP or FFS plans. PGPs and IPAs do not differ significantly in the age and chronic illness of their enrollees, but IPAs enroll a significantly greater proportion of females than do PGPs. The age difference between FFS and prepaid plans appears to be greater for long-term enrollees. The same pattern is true of chronic illness, but the results are often not statistically significant. We do not have time-series data, however, and cannot conclude that future comparisons among long-term enrollees will remains as they are now. In any care our data do not support the hypothesis that biased selection is a short-term problem that will be corrected as the population in prepaid plans ages. Our data contain a cross-section of environments for health plans in firms: long- and short-term offerings, long- and short-term enrollees, high and low out-of-pocket premium costs, etc. Our strongest results are the simplest: across all plans and environments there are significant differences in enrollee characteristics. These differences would not be inefficient if all groups paid actuarially fair premiums. However, mandatory offering and community-rating allow prepaid plans to enroll a younger population with less chronic illness and to maintain an information asymmetry that prevents employers and employees from determining--either prior to or following enrollment--the relationship of the prepaid plan's premium to its marginal cost.

Age Factors↗
PubMed2000

Experience with self-administered emergency contraception in a low-income, inner-city family planning program.

OBJECTIVE: To evaluate women's use, knowledge of and attitudes toward self-administered emergency contraceptive pills (ECP) at the University of Pennsylvania family planning clinic (FPC). STUDY DESIGN: The University of Pennsylvania FPC is a Title X, publicly funded clinic serving urban, low-income women. All women attending the clinic were offered ECP packets. Exclusion criteria for ECP were current pregnancy or newly diagnosed hypertension. Women signed consent forms and were given specific instructions on using ECP with the standard Yuzpe method. Women were contacted for a phone interview after they had the ECP packets at home for six to eight months. RESULTS: One hundred ninety-two women received the ECP packets. Forty-eight were contacted and completed the survey. One hundred forty-four women had moved, no longer had phone service or were unreachable after three or more attempts. Eleven of the 48 women (22.9%) used the ECP, but only 2 of 11 (18.2%) took the pills correctly. One of these two women became pregnant. Of the women who had not used the ECP packets, only 25 of 37 (67.6%) could locate them, and only 9 of 37 (24%) could recall how to use them correctly. Four of 37 (10.8%) experienced an unplanned pregnancy. CONCLUSION: Emergency contraception utilization was far lower than anticipated, suggesting that ready access is not the only issue. Many of the women did not administer ECP correctly or could not state how they would use it in the future despite extensive instruction. Patients will require new and creative approaches to encourage their appropriate use of emergency contraception.

Adult↗