BACKGROUND:A woman who does not recognize her pregnancy early may not initiate prenatal care early. This study examined the relationship between the time of pregnancy recognition and the time of initiation of prenatal care, and the number of prenatal visits among women of childbearing age. METHODS:This study analyzed the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. The analysis sample was representative of resident women of childbearing age in 29 U.S. states who had live births within 2 to 6 months before being contacted. The data were weighed to reflect the complex survey design of the PRAMS, and binary and multinomial logistic regressions were used for the analyses. RESULTS:Most (92.5%) of the 136,373 women in the study had recognized their pregnancy by 12 weeks of gestation, and 80 percent initiated prenatal care within the first trimester. Early pregnancy recognition was associated with significantly increased odds of initiating prenatal care early (OR = 6.05, p < 0.01), after controlling for sociodemographic and prior birth outcome data, and was also associated with lower odds of having fewer than the recommended number of prenatal visits and higher odds of having more than the recommended prenatal visits (OR: <11 visits = 0.71 and >15 visits = 1.17, p < 0.01). CONCLUSIONS:Early pregnancy recognition was associated with improved timing and number of prenatal care visits. Promotion of early pregnancy recognition could be a means of improving birth outcomes by encouraging and empowering women to access prenatal care at a critical point in fetal development.

OBJECTIVE:To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. DESIGN:Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. SETTING:Twenty-nine states. PARTICIPANTS:Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. METHODS:Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. RESULTS:The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). CONCLUSION:Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.

OBJECTIVE:The purpose of this study was to evaluate the office-based component of delayed entry into prenatal care.STUDY DESIGN:Phone numbers for all obstetrics offices in a single state were obtained from a commercial list. A research assistant who posed as a newly pregnant, fully insured woman asked each clinic when she should come in for her first prenatal visit.RESULTS:Information was provided by 239 of the 279 (86%) offices. The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, which averaged 6.37 weeks. Twenty-five percent of clinics recommended a first appointment at >/=8 weeks. Scheduling calls were not a source of prenatal advice: <5% of clinics asked about smoking, alcohol, or medical condition; 88% of clinics did not mention vitamins.CONCLUSION:Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.

BACKGROUND:To reduce unintended pregnancy, it is necessary to understand why women have unprotected intercourse when they do not desire pregnancy.METHODS:We devised a survey of 42 potential reasons why women have unprotected intercourse based on the responses of a focus group we had previously convened. We administered the survey to women between the ages of 18 and 39 years who were visiting primary care clinics and were not trying to get pregnant.RESULTS:Of the 151 respondents, 84 (56%) were having unprotected intercourse. Women gave an average of 9 reasons for having unprotected intercourse. The most common reasons fell into 3 categories: lack of thought/preparation (87% of respondents), being in a long-term or strong relationship (70%), and concerns about side effects of contraception (80%). Eighty-three of the 84 women (99%) chose at least 1 of these categories.CONCLUSION:Basing survey questions on focus group responses provided important insights into the reasons women risk unintended pregnancy. A deeper understanding of this issue is critical to reducing unintended pregnancy.

OBJECTIVE:We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality.STUDY DESIGN:A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX).RESULTS:Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21).CONCLUSION:These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

pected number from a general population of the same age and sex was not done. This might have affected the trend assessment , because age-related residual confounding might have partially determined the increase in non–AIDS-defining cancers (ie, the median age of HIV-infected people was 46 years in 2005 and 41 years in 2000) [1]. Taking advantage of population-based data used for assessing post-AIDS survival in Italy [2], we compared the number of observed deaths due to pancreatic cancer among persons given a diagnosis of AIDS with the expected number. Briefly, data on all Italian citizens receiving a diagnosis of AIDS from 1999 through 2005 were linked with the Italian Mortality Database (De-cember 2006 version) to update their vital status and to identify conditions present at death (for details on the linkage procedure , see Dal Maso et al [3]). The number of person-years at risk of death was computed from the date of AIDS diagnosis to the date of death or to 31 De-cember 2006. The number of observed deaths attributable to pancreatic cancer (C25 in International Classification of Diseases , Tenth Revision) was divided by the expected number, which was computed from age-and sex-specific mortality rates for the Italian general population during the years 2000–2003. Thus, the standardized mortality ratio and its 95% confidence interval for death from pancreatic cancer among people with AIDS versus the general population were computed. Of the 8537 Italian patients, aged 25– 54 years, given AIDS diagnoses from 1999 through 2005 (who accumulated 31,437 person-years at risk of death), 2634 died. Five patients had pancreatic cancer at death, versus an expected number of 0.92. The corresponding standardized mortality ratio was 5.42 (95% confidence interval, 1.71–12.74), suggesting that Italian patients with AIDS had a statistically significant higher risk of dying from pancreatic cancer than did the corresponding general population. This finding from Italy seems to confirm the substantial burden of pancreatic cancer in the risk of death among people with HIV/AIDS noted during the HAART era in France. It is in accordance with a 2.5-fold higher incidence of pancreatic cancer among HIV-infected people reported in the United States during the HAART era [4], but it contrasts with incidence data from Italy, where no excess risk for pancreatic cancer was observed during the pre-HAART era compared with the HAART era [3]. Because HAART use has been associated with an elevated frequency of diabetes [5], which is …

PURPOSE:We sought to determine whether a brief intervention increased home pregnancy test utilization among women at risk for unintended pregnancy.METHODS:The intervention included education, consultation with a nurse, and the provision of a free home pregnancy test kit. Participants were 35 women aged 18-39 years from a Medicaid population who were having unprotected intercourse and who were not trying to conceive. The women received education on pregnancy testing and the importance of early recognition of pregnancy. All women received a free home pregnancy test kit. The main outcome measures were pregnancy test use and appropriateness of use.MAIN FINDINGS:During the 3-month follow-up period, 62% of participants used the home pregnancy test kit, which was approximately 3 times higher than the self-reported testing rate before the study (p < .001). The most common reason for use was a late period (median 5 days late when test was done). Women also purchased additional kits to confirm the initial test result (median 2 kits per episode of use).CONCLUSION:The intervention increased utilization of home pregnancy test kits among women at risk of unintended pregnancy. All study participants used the test appropriately. These results can serve as a framework for interventions to improve early pregnancy recognition.

Background: The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done oil how to make women at risk more alert to the possibility of pregnancy.Design: The study was an RCT performed and analyzed between 2006 and 2007.Setting/participants: Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive.Intervention: Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained.Main outcome measures: The main outcome measures were suspicion and testing for pregnancy.Results: Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001).Conclusions: Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.Trial registration: NCT00390754

Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18–24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.

In the above article, there were some incorrect statements printed. On page 361, it was incorrectly stated that data from 26 states and New York City were included in the analysis. This should have read 27 states (not New York City). To clarify, the analysis was restricted to the year 2002 PRAMS data. We regret any inconvenience or confusion this error may have caused. Reasons for unprotected intercourse: analysis of the PRAMS surveyContraceptionVol. 75Issue 5PreviewThis study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy. Full-Text PDF

BACKGROUND:Despite the increased availability of contraception, unprotected intercourse and unintended pregnancy are common among adult women. We sought to identify reasons why adult women at risk of unintended pregnancy have unprotected intercourse.METHODS:A comprehensive search of electronic databases of MEDLINE, CINAHL, and PSYCHOINFO, from 1995 to 2005, was conducted. Reference lists from relevant published papers and reviews related to contraceptive practices and pregnancy intendedness were also hand searched. The Bronfenbrenner ecological framework was used as a guide in the discussion of the findings.RESULTS:There were 16 studies that met inclusion criteria, and these provided numerous reasons why adult women had unprotected intercourse. Reasons were found at the individual, interpersonal, and societal levels. Individual reasons included concerns with contraceptive side effects, a low perceived risk for pregnancy, lack of knowledge, and attitudes and beliefs. Interpersonal reasons included partners, families, or friends who discouraged the use of contraception. Societal reasons included access problems, inconvenience, and cost.CONCLUSIONS:There are multiple reasons why women have unprotected intercourse. These reasons were located in overlapping domains of influence. Factors in a woman's environment at the interpersonal and societal level may significantly influence her contraceptive use behavior.

ObjectivesThis study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy.MethodsAs part of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey, women with a recent unintended viable pregnancy were asked after the birth why they had not used birth control.ResultsOf 7856 respondents, 33% felt they could not get pregnant at the time of conception, 30% did not really mind if they got pregnant, 22% stated their partner did not want to use contraception, 16% cited side effects, 10% felt they or their partner were sterile, 10% cited access problems and 18% selected “other.” Latent class analysis showed seven patterns of response, each identifying strongly with a single reason.ConclusionsAlmost half of women with viable unintended pregnancies ending in a birth felt they could not/would not get pregnant at the time of conception. Most women identified with a single reason for having unprotected intercourse.

A significant number of college women are at risk for alcohol-exposed pregnancy (AEP) owing to binge drinking paired with using contraception ineffectively. This article describes a randomized controlled trial of a one-session motivational interviewing-based intervention to reduce AEP risk among college women and presents 1-month outcomes demonstrating the early impact of this intervention. There were 228 female students from a mid-Atlantic urban university enrolled in the trial. Eligibility criteria were being in the age range of 18–24 years and being at risk for AEP. Risk for AEP was defined as having sexual intercourse with a man in the past 90 days while using contraception ineffectively (no use, incorrect use of an effective method, or use of an ineffective method only); drinking at risky levels was defined as engaging in at least one binge in the past 90 days or consuming an average of eight standard drinks per week. One-month outcome data were available for 212 of the 228 enrolled women (a follow-up rate of 93%), with complete data available for 105 women assigned to the control condition and 94 assigned to the intervention condition. At 1-month follow-up, 15% of the control subjects and 25% of the intervention women reported no risk drinking, a significant difference favoring the intervention group. Significantly fewer control subjects (48%) used effective contraception at 1-month follow-up as compared with intervention women (64%), χ2(1) = 5.1, p < .03. Significantly more intervention women (74%) were no longer at risk for AEP at 1 month as compared with control subjects (54%), χ2(1) = 8.15, p < .005. Factors that were associated with continued AEP risk at 1-month follow-up were a higher number of standard drinks per day consumed in the month prior to baseline (odds ratio, 1.1) and assignment to the control condition (odds ratio, 2.9). The risks of unintended pregnancy and AEP among drinking women in college merit greater prevention efforts. The results of this study show the promise of one preventive intervention that warrants additional study.

BACKGROUND:Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis.OBJECTIVE:To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs.PATIENTS AND METHODS:We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. RESULTS. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children.CONCLUSION:Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy.