OBJECTIVE To examine trends in the prevalence of diabetes among delivery hospitalizations in the U.S. and to describe the characteristics of these hospitalizations. RESEARCH DESIGN AND METHODS Hospital discharge data from 1994 through 2004 were obtained from the Nationwide Inpatient Sample. Diagnosis codes were selected for gestational diabetes mellitus (GDM), type 1 diabetes, type 2 diabetes, and unspecified diabetes. Rates of delivery hospitalization with diabetes were calculated per 100 deliveries. RESULTS Overall, an estimated 1,863,746 hospital delivery discharges contained a diabetes diagnosis, corresponding to a rate of 4.3 per 100 deliveries over the 11-year period. GDM accounted for the largest proportion of delivery hospitalizations with diabetes (84.7%), followed by type 1 (7%), type 2 (4.7%), and unspecified diabetes (3.6%). From 1994 to 2004, the rates for all diabetes, GDM, type 1 diabetes, and type 2 diabetes significantly increased overall and within each age-group (15–24, 25–34, and ≥35 years) (P < 0.05). The largest percent increase for all ages was among type 2 diabetes (367%). By age-group, the greatest percent increases for each diabetes type were among the two younger groups. Significant predictors of diabetes at delivery included age ≥35 years vs. 15–24 years (odds ratio 4.80 [95% CI 4.72–4.89]), urban versus rural location (1.14 [1.11–1.17]), and Medicaid/Medicare versus other payment sources (1.29 [1.26–1.32]). CONCLUSIONS Given the increasing prevalence of diabetes among delivery hospitalizations, particularly among younger women, it will be important to monitor trends in the pregnant population and target strategies to minimize risk for maternal/fetal complications.

BACKGROUND:Women who are the most vulnerable to sexually transmitted diseases/HIV are often unable to consistently use condoms. One potential alternative method currently under investigation is the diaphragm.GOALS:The goals of this study were to assess diaphragm uptake and use over time in Zimbabwe and to identify factors associated with self-reported consistent diaphragm use.STUDY:Women attending family planning clinics who were inconsistent condom users received a diaphragm intervention and were followed for 6 months.RESULTS:Of the 186 participants, 99% ever reported using the diaphragm, and, at study exit, 96% had used it in the previous 2 months. Consistent diaphragm use since the previous visit was reported by 13% to 16% of the women, and in multivariate regression analysis, it was significantly associated with never using condoms (adjusted odds ratio, 24.08; 95% confidence interval, 6.71-86.34). Other factors included discreet use, preferring diaphragms to condoms, timing of insertion, domestic violence, and contraception.CONCLUSION:Diaphragms were well accepted among women at risk for sexually transmitted diseases/HIV.

This study evaluated Amsel's criteria, the FemExam card and pH plus amine methods for the diagnosis of bacterial vaginosis (BV) in a resource-poor setting. Two hundred Azerbaijani women participated in a study about reproductive health that included a gynaecological examination and an interviewer-administered survey. Using the WHO syndromic diagnosis algorithm, nearly all women (99%) had abnormal vaginal discharge. The prevalence of BV by Gram stain was 35%; using pH plus amine, the FemExam card and Amsel's criteria, prevalence ranged from 29% to 49%. No behavioural or demographic characteristics were associated with BV as diagnosed by Gram stain. The sensitivity ranged from 0.59 to 0.74 and specificity from 0.65 to 0.92 using the three methods. The pH plus amine test is better than syndromic management protocols, and although it is not the most sensitive or specific of the three methods it will be easiest to implement in resource-poor settings.

CONTEXT: Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at improving their protective behaviors. METHODS: Between 1999 and 2001, 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups, and multivariate analyses assessed associations between consistent use and various characteristics. RESULTS: Among women who had used condoms consistently before starting on DMPA or the pill, 54% discontinued consistent use after taking these contraceptives. Overall, 20% of women consistently used condoms with their hormonal method, and such use did not vary significantly by contraceptive type. Seventy-five percent of women in nonmonogamous relationships were inconsistent users, though nearly a third had been consistent users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner's positive opinion of condoms (odds ratio, 3.3) and the woman's strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). CONCLUSIONS Many women at highest risk for disease have a decreased likelihood of using condoms, and disease prevention programs should be customized to target these women. Educational efforts focusing on women's attitudes and negotiation skills may be the best means of increasing dual method use.

Background. Despite the availability of condoms and theoretically based interventions to promote their use, sexually active women aged 15 to 25 years continue to put themselves at risk for sexually transmitted diseases and unintended pregnancy.Methods. One hundred ninety-eight inner city women were interviewed about knowledge and attitudes about condoms. Using the Transtheoretical Model, regression techniques were used to identify factors associated with condom use at last sex and the proportion of acts protected by a condom in the last 90 days.Results. Constructs including intention to use (OR = 1.69, CI 1.07-2.65) and positive outcome expectancies (OR = 1.59, CI 1.03-2.46) were associated with condom use at last act of sexual intercourse. Similarly, intention to use condoms (RR = 1.58, CI 1.37-1.82), positive outcome expectancies (RR = 2.71, CI 2.41-2.99), perceived peer's use of condoms (RR = 2.25, CI 1.95-2.60), and number of places condoms were discussed (RR 1.05, CI 1.02-1.07) were associated with the proportion of protected acts.Conclusions. Constructs specified in the Transtheoretical Model are useful in describing condom use and have implications for targeting human immunodeficiency virus (HIV)/sexually transmitted diseases (STD)/unintended pregnancy interventions. Published by The Institute For Cancer Prevention and Elsevier Inc.

Background: Prenatal screening for chromosomalabnormalities is routinely offered to allpregnant women who present for care by their20th gestational week. Not all women,however, choose to undergo one of these tests,and choice of which test(s) to undergo alsovary. The reasons for variation in screeningtest behavior have not been fully explored.Methods: We examined the psychometricproperties of scales developed to measurefactors related to prenatal screening usingdata collected as part of a survey of 448racial/ethnically diverse pregnant women. These women were consecutively recruited fromprenatal care clinics when they were betweentheir 12th and 20th week ofpregnancy. The Theory of Reasoned Action wasused to develop to measures of attitudes towardand beliefs about prenatal screening. All itemswere subjected to factor analysis. Scalesidentified in the factor analysis were thensubjected to reliability analysis. Allanalysis was conducted for the entire studygroup as well as separately for eachracial/ethnic group.Results: Six scales emerged: who makes medicaldecisions, fatalism, health care trust, valueof screening, fear of screening and value ofpregnancy. All scales had adequate reliabilitywhen the analysis was conducted for the entirestudy group; however there were differences inreliability across racial/ethnic group.Conclusions: Because of these between groupdifferences comparisons of racial/ethnic groupmay be difficult to interpret and potentiallylead to erroneous conclusions.

This study assessed hypotheses that measures of power and control over male condom (MC) use would predict use of the female condom (FC) among women with main partners from two public STD clinics (n = 616). The women (mean age 24 years, 87% African American) were enrolled in an intervention study to promote barrier contraceptive use and were interviewed at baseline and at 6 monthly follow-up visits. Seven baseline predictor variables were assessed: her having requested MC use, his having objected, her having wanted a MC used but not asking, percentage of MC use, perceived control over MC use, anticipated consequences of refusing unprotected sex, and physical violence. In the first Poisson regression analysis, none of the hypothesized predictors was significantly associated with FC use during follow up. In the second regression analysis, which assessed the influence of the hypothesized set of predictors on follow-up FC use in situations when MCs were not used, we found two effects. Either no or inconsistent MC use before study entry was associated with less subsequent FC use; women who reported, at study entry, having more control over MC use were more likely to use FCs during follow up. We found no evidence of adoption of the FC by women in relationships marked by history of conflict over the MC, circumstances in which alternatives are most needed. On the contrary, we found that women with a history of control and consistent use of MCs were the most likely users of FCs when MCs were not used.

Previous reports have shown that forced sexual intercourse and other forms of gender-based violence are a persistent public health problem for refugee or internally displaced women.1–6 (Internal displacement is defined as forced relocation within a person’s country of citizenship because of some catastrophic event.) In some settings, the proportion of refugee or internally displaced women reporting some type of gender-based violence exceeds 60%.7,8 Sexual violence against refugee or internally displaced women can cause women to flee their homelands.9–14 Unfortunately, these women are not always safe from harm after their relocation or after resettlement.4,12,15–18 Investigation of sexual violence affecting these women, its incidence, prevalence, and correlates is critical to the development of effective treatment and prevention strategies.

PURPOSE: This article demonstrates techniques for developing reliable multi-item scales for analysis of complex public health data.METHODS: Information from a questionnaire designed to evaluate the acceptability and efficacy of the female condom as a method for STD/HIV prevention was summarized using psychometric analysis. 1159 high-risk women attending STD clinics participated in this study. Questionnaire items were designed to measure nine domains of predictors of condom use.RESULTS: Principal components analysis was employed to reduce the number of potential predictors. Reliability of the multiple-item scales was assessed using Cronbach's alpha. Pearson's correlation coefficients were calculated to evaluate collinearity among multi-item scales. Approximately half (51%) of the questionnaire items that were analyzed were retained in the final scales. Data reduction procedures identified several multi-item scales with acceptable reliability (Cronbach's alpha >0.70). The correlation coefficients between scales was never >.5, suggesting that there was little collinearity among the scales.CONCLUSIONS: When focused on multiple partially interdependent determinants of an outcome, data reduction decreases the number of independent variables to be evaluated, ensures they have adequate reliability, maximizes strength of their association with outcomes, and reduces collinearity among predictors. (C) 2003 Elsevier Inc. All rights reserved.

OBJECTIVES The United Nations High Commissioner on Refugees (UNHCR) and United Nations Children's Fund (UNICEF) policy encourages foster care during refugee emergencies. We examined evidence to support this policy using data from the 1994 Rwandan refugee crisis. METHODS The association of weight gain and acute illness with family status (foster children vs children living with their biological families) was examined using latent growth curve and repeated measures logistic regression analysis. RESULTS Weight gain for all children averaged 0.40 kg/month and was associated with child's age but not with family status, child's or caregiver's sex, caregiver's marital status, possession of blankets or plastic sheeting, severe malnutrition, month of enrollment, or acute illness. Illness was not more common among foster children than among children living with their biological families. CONCLUSIONS This analysis supports the UNHCR/UNICEF recommendation of fostering for unaccompanied children during an acute refugee crisis.

OBJECTIVE: To evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women.METHODS: A randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n = 77) or a control group (n = 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses, t and chi(2) tests were used to compare the treatment and control groups, and paired t tests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy).RESULTS: Women in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P = .001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P = .001), which was maintained over 6 months (P < .004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 754 improved, and 50 (52%) at least 500,16 improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control).CONCLUSION: A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women. (C) 2002 by The American College of Obstetricians and Gynecologists.

This article describes the frequency of initial difficulty inserting the female condom and identifies predictors of insertion difficulty among women at risk of sexually transmitted diseases (STDs). Female STD clinic patients (n = 1144) were taught how to insert the female condom by using an anatomic model, then given an opportunity for self-insertion practice. Correct placement of the condom was verified by a nurse clinician, and the number of attempts required for correct insertion was recorded. Sociodemographic and psychosocial predictors of refusing the insertion practice and of difficulty inserting the female condom were evaluated using logistic regression. Only 5% of study participants refused the self-insertion practice. Women who never had a Papanicolaou smear test, did not use tampons, never used an inserted method of STD prevention/birth control, and disliked the insertion features of intravaginal barrier methods were more likely to refuse the self-insertion practice. Of those who attempted self-insertion, 25% were unable to insert the female condom correctly on the first attempt. Women who never expressed their sexual likes and were indifferent to the positive features of intravaginal contraceptive methods were more likely to experience difficulty their first insertion attempt. Other variables associated with insertion difficulty included longer fingernails. Insertion refusal and difficulty affect use of the female condom for a sizable proportion of women. Women in this study who refused the self-insertion practice had greater aversion to inserting intravaginal barrier methods. Women who had initial difficulty inserting the female condom had a different profile from those who refused and can benefit from intensive skills training that includes supervised self-insertion practice.

In refugee crises, aid programmes targeted at refugees and internally displaced persons can result in the standard of living of the refugees being higher than that of the local population, which can lead to animosity between the groups. The study investigated the differences in demographics, economic status, and use of reproductive health care services between local and internally displaced women in the same community. Approximately seven years after relocation, internally displaced women were less likely to own homes or electronic equipment, and were more likely to be unemployed. They did not appear economically disadvantaged on other indicators such as household income, money for basic living needs, and recent homelessness. Local women were more likely than displaced women to seek abortion services at the Ministry of Health while those women with a higher income were more likely to use private clinical services. Results suggested that there were no demographic differences between the two groups of women. Despite ongoing aid programmes, internally displaced women continue to be disadvantaged with regards to material wealth and were not using ministry of health clinics.

BACKGROUND Despite evidence of decreased mortality, recommendations for colon cancer screening have not been widely implemented by physicians. The objective of this study was to determine patient and clinician factors associated with screening for colon cancer. METHODS A retrospective review of computerized medical records from primary care practices in an academic medical center was performed. Patients comprised men and women aged 50-74 with at least one visit between July 1, 1995 and June 30, 1997. Measurements included Fecal occult blood testing in the past 1 or 2 years, sigmoidoscopy in the previous 5 or 10 years, or colonoscopy in the past 10 years. RESULTS A total of 6,039 patients were included in the analysis. Fecal occult blood testing had been performed in 44% of patients and sigmoidoscopy in 26%. Fifty-three percent of patients had undergone some type of colon cancer screening. In multivariate analysis, patient factors predictive of fecal occult blood testing included age (odds ratio (OR) per 5 years 1.05; 95% confidence interval 1.04, 1.06), Asian ethnicity (OR 1.23; 1.08, 1.41), number of visits during the study period (OR 1.05; 1.04, 1.06), recency of the last visit (OR 1.03; 1.02, 1.04), and having private insurance (OR 1.65; 1.04, 2.62). Predictors of sigmoidoscopy were similar except that patients with a family history of colon cancer and those with managed care insurance were also more likely to undergo sigmoidoscopy. Patients of nurse practitioners were less likely to receive fecal occult blood testing than were patients of physicians (OR 0.78; 0.65, 0.93). Patients of residents were less likely to undergo sigmoidoscopy than were patients of faculty (OR 0.79; 0.66, 0.94). CONCLUSIONS Among patients seen in primary care practices, rates of colon cancer screening remain low, especially in patients who are younger, who have been seen less frequently, who are uninsured, or who do not have managed care insurance. Future research should explore these differences and should focus on increasing screening in all patient groups, especially in those who are underscreened.

BACKGROUND:Previous research has identified factors associated with condom use. However, less information exists on the impact that a history of sexually transmitted disease (STD) has on condom use.GOAL:To identify factors associated with self-reported male condom use that relate to a history of STD.STUDY DESIGN:Women attending STD clinics completed a survey that assessed sexual behavior, STD history, and psychosocial characteristics. Binomial regression was used to estimate the association between these factors and condom use.RESULTS:Of the 12 factors included in the regression model, 11 were significant for all women. When the analysis was stratified by STD history, high condom use self-efficacy, high convenience of condom use, and high frequency of condom use requests were significantly associated with increased condom use among women with or without a history of STD. Factors such as greater perceived condom use norms, higher perceived level of risk, and greater need for condom use in long-term relationships were significantly associated with increased condom use among women with a history of STD. Factors such as shorter duration of a relationship, less violence in the relationship, and lifetime drug use were associated with increased condom use among women with no history of STD.CONCLUSIONS:The pattern of psychosocial factors determining condom use is modified by a positive history of STD. These findings suggest that a history of STD could be an important factor in targeting condom use interventions.