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Trial of anonymous versus confidential human immunodeficiency virus testing.

Before December, 1986, all public human immunodeficiency virus (HIV) testing in Oregon was done confidentially (using names). In December, clients were offered the option of either anonymous or confidential services. As judged by questionnaire responses, the availability of anonymity increased overall demand for testing by 50%: 125% for homosexual/bisexual (gay) men, 56% for female prostitutes, 17% for intravenous drug users, and 32% for other clients. The number of gay clients who had tests increased from a mean of 42 per month during the 4 months before anonymity was available to 108 per month during the 4 months after, whereas, at public sites in Colorado or California and private sites in Oregon, the number of gay clients tested did not increase. Twice as many seropositive persons were identified during the 3 1/2 months after anonymity became available (n = 85) as in the 3 1/2 months before (n = 36). Thus, availability of anonymous HIV testing and counselling drew gay men who had not sought services under a confidential testing system.

California

Factors influencing breast-feeding among adolescents.

During a 15-month study period, 244 adolescent mothers under 18 years of age were surveyed, of whom 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were studied regarding the influence of several factors on the duration of breast-feeding. An attitude questionnaire was administered in the hospital within 48 hours of delivery. Follow-up interviews were obtained by telephone or in person at approximately 2 weeks and 2 months after birth. Eighty-three percent made the decision to breast-feed before the third trimester. Thirty-five percent discontinued breast-feeding within the first postpartum month, the most common reason being "nipple confusion" in the infant; 22% nursed for more than 1 month but less than 2 months, and 43% breast-fed for 2 months or more. None of the variables examined (maternal age, ethnic group, education level, involvement of the baby's father, timing of the breast-feeding decision, intended duration of breast-feeding, age at which formula supplementation was started, or availability of maternal support) was predictive of the duration of breast-feeding. Contrary to adolescent stereotypes, 65% of mothers chose breast-feeding because it was "good for the baby," and 67% identified the "closeness" of the nursing relationship as the most enjoyable part of breast-feeding. Twenty-eight percent cited modesty issues about breast-feeding as the greatest disadvantage, and 17% returned to work or school within the first 2 postpartum months, posing additional obstacles to breast-feeding. Our data suggest that adolescents are receptive to breast-feeding, but they may require close follow-up and anticipatory guidance tailored to their individual needs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Contraceptive practice of Irish married and single first-time mothers.

This study surveys 100 married and 100 unmarried primiparous mothers, attending the National Maternity Hospital, Dublin, with regard to their contraceptive practice, their planning of their pregnancy and the timing of their first antenatal visit. Nineteen per cent of the married women, but 64% of the unmarried women, had never used any contraceptive method. The contraceptive pill was the most popular method for both groups, but while three in five of the married women had at some time used the pill, only a little more than one in five of the unmarried women had ever used it. One quarter of the women who had used contraception reported that their pregnancy was the result of a failure in their contraceptive method. Eighty-nine per cent of the single group and 20% of the married had not planned their pregnancy. None of the married women, but almost a quarter of the single, delayed their first antenatal visit until after they were 20 weeks pregnant.

Contraception Behavior

DIGICALC: a restriction fragment analysis program.

DIGICALC is a program designed to aid in the acquisition, storage, and analysis of nucleic acid restriction fragment data. The chief considerations during program design were (i) ease of use for people with varying degrees of computer experience, (ii) minimal hardware requirements (e.g. an IBM PC), (iii) portability and ease of modification, and (iv) improved functionality in sizing and comparing restriction fragments over manual methods. The program accepts manual or digitizer input of nucleic acid fragment mobility, calculates the fragments' sizes, and provides the means to search the fragment database and to produce charts of fragment sizes.

Base Sequence

The mouse linkage map. A computer program.

Computer programs have been developed to serve as a method for storing, retrieving, and sorting mouse linkage data. The programs accept and store raw data and reference information for gene linkage; calculate recombination values for each data set and for combined data sets; retrieve, sort, and print-out raw data, references, and recombination values; and generate linkage maps.

Animals

Lessons for teaching cost containment.

Increasing financial restrictions on hospitals by the federal government and changing physician reimbursement procedures make it more important to control the use of medical care resources by physicians. A prospective controlled study was made of an educational program for the medical and surgical house staffs and for medical students designed to reduce unneeded orders for low cost, high volume ancillary and nursing services. The program was comprised of six mutually reinforcing components: lectures, medical record audits and reviews, group feedback in the form of cost summaries containing information on unnecessary ordering, hospital price booklets, current patient bills, and pertinent journal articles. Operating at a time of retrospective hospital cost reimbursement, the program achieved only modest reductions in the residents' and students' use of hospital services and no substantive effect upon hospital costs. However, the program participants accepted the program enthusiastically. Several factors crucial to such educational cost containment programs were identified. The authors believe that experience with the program has valuable lessons for other hospitals initiating cost-control efforts.

California

ADA dental product evaluation: case history.

The ADA Acceptance Programs entail a rigorous evaluation of products and offer clear benefits to manufacturers, dental professionals, and consumers alike. This paper outlines the implications of the ADA product-evaluation programs for each of these three constituencies and concludes that while there may be an occasional downside from the manufacturer's standpoint, their net effect is to provide assurances that products are safe, efficacious, and promoted properly.

American Dental Association

A national survey of medical risk assessment instruction in general practice residency programs (Part II).

This is the second part of a three-part series reporting a national survey of general practice residency directors and their evaluation of the medical risk assessment (MRA) instruction curriculum in their programs. The purpose of Part II is to evaluate the degree of success of the implementation of the ADA Commission on Accreditation's standard for MRA programs. Acceptable levels of achievement were attained in most areas of basic and intermediate-level skills. However, approximately one-third to one-half of general practice residency directors report that they are not achieving the standard for some intermediate or advanced assessment skills. When various instructor categories were compared, physicians scored significantly higher than oral and maxillofacial surgeons or other dentists in their ability to achieve acceptable outcomes in MRA instruction. The results of this survey, coupled with available literature concerning medical risk assessment instruction, support that changes in the undergraduate curriculum, a mandatory additional year of training, or modification of defined goals and outcomes should be considered.

American Dental Association

Towards better nutrition: lip service or a realistic fight?

Progress towards the objective of the World Food Conference of 1974 that "no child should go to bed hungry" is reviewed. The low market price of primary products keeps developing countries poor. Yet in these countries industry rather than agriculture has been supported by governments. All regions are increasing total food production but population growth threatens to offset this increase. In some areas there is decrease in food production per head of population. In many countries the social situation of women affects the nutrition of families. Other causes of malnutrition are discussed and future policies are recommended.

Africa

Utilization of health services by Mexican immigrant women in San Diego.

The limited empirical data available on maternal health problems among Mexican immigrant women in the United States suggest that they underutilize health services, especially general preventive care. Research conducted among legal and undocumented women in the Mexican immigrant population in San Diego, California, support these findings. Among undocumented mothers, 11.5% of their births in the U.S. occurred with no prenatal care or care sought in the third trimester, which is much higher than Mexican women legally in the country (3.6%) and the general San Diego maternal population (3.8%). When we examine births which occurred within the last five years by immigration status, we find that women legally in the country have a much higher rate of cesarean delivery of both undocumented women and women in the general San Diego maternal population. Undocumented women in our sample were much less likely than their legal counterparts to return for postpartum examinations for themselves, to seek neonatal care for their infants, and to have had Pap examinations or carry out breast self-examinations.

California

Childbearing and women's choice of nurse-midwives in Washington, D.C. hospitals.

This research focuses on the extent to which choosing a certified nurse-midwife (CNM) for the management of birth in the hospital is an option. Licensing laws affect this option by determining access to hospitals for CNMs in the form of hospital practice privileges. Data for this descriptive case study of Washington, D.C. hospitals were collected from interviews with CNMs and hospital personnel, including physicians, and from secondary sources, including legislative acts and hospital bylaws. Our findings suggest that although the option for a CNM managed birth has increased in the District with the granting of hospital privileges to CNMs in 3 of 9 hospitals providing obstetrical services, restrictions on CNM practice still exist. These are the capacity to admit patients in the CNMs' name and the issue of supervision of CNMs by a physician in the hospital.

Delivery, Obstetric

The well baby lottery: motivational procedures for increasing attendance at maternal and child health clinics.

A lottery system was used to improve attendance at four well baby clinics in four colonias in Tijuana, Mexico. Mothers earned one lottery ticket for each visit to each clinic during the intervention period. At the end of each month, ticket receipts were entered into drawings for one of three bags of groceries. The lottery system was evaluated within a "multiple baseline design" whereby the intervention was staggered across the four clinics on a month-by-month basis. Although attendance was not enhanced uniformly, an overall improvement of 25 percent was realized. The lottery system was at times hampered by administrative problems, such as the breakdown of a public address system used to announce the open hours of a clinic in one of the colonias.

Child Development

The selection and training of primary health care workers in Ecuador: issues and alternatives for public policy.

This article employs quantitative analysis to evaluate the effectiveness of the community health worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study first assesses CHW knowledge in the areas of prevention, maternal-child health, first aid, and treatment of common illnesses. The analysis reveals that CHWs retained less than 50 percent of what they learned one year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The second phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. These results yield some important implications for public health policy in Ecuador.

Community Health Workers