Navigating noisy waters: A review of field studies examining anthropogenic noise effects on wild fisha).

Anthropogenic noise is globally increasing in aquatic ecosystems, and there is concern that it may have adverse consequences in many fish species, yet the effects of noise in field settings are not well understood. Concern over the applicability of laboratory-conducted bioacoustic experiments has led to a call for, and a recent increase in, field-based studies, but the results have been mixed, perhaps due to the wide variety of techniques used and species studied. Previous reviews have explored the behavioral, physiological, and/or anatomical costs of fish exposed to anthropogenic noise, but few, if any, have focused on the field techniques and sound sources themselves. This review, therefore, aims to summarize, quantify, and interpret field-based literature, highlight novel approaches, and provide recommendations for future research into the effects of noise on fish.

Screening positive urine pregnancy tests for sexually transmitted diseases expedites the treatment of infected adolescent gravidas.

OBJECTIVE: To test the utility of screening the urine samples used to diagnose pregnancies at urban teen clinics for Chlamydia trachomatis and Neisseria gonorrhoeae by polymerase chain reaction (PCR). We hypothesized that urine screening would increase the proportion of teenagers treated for these two sexually transmitted diseases (STDs) before they initiated pregnancy-related care. DESIGN: A randomly selected subset of the urine samples used to diagnose 212 teen pregnancies were tested for C. trachomatis and N. gonorrhoeae by PCR. Endocervical testing was at the providers' discretion. Bivariate analyses were used to compare the teenagers randomized to the urine screening group (n = 102) and the non-screening group (n = 110). RESULTS: Of the 102 urine PCR tests, 14 (13.7%) were positive. Endocervical swabs were obtained in 31 (14.6%) of the 212 teenagers and five (16.1%) were positive. Since pelvic examinations were performed so infrequently, the net endocervical swab detection rate was significantly lower than the urine-based detection rate (1.8% compared to 13.7%; p = 0.001). Only one infected teenager was untreated when she initiated pregnancy-related care. Thus, the treatment rate was more than six times higher when urine samples were screened (12.7% compared to 1.8%; p = 0.003). CONCLUSIONS: Screening the urine samples used to diagnose teen pregnancies for two common STDs is a simple, non-invasive procedure that is acceptable to providers and patients, and significantly increases the number of teenagers who are treated for genital infection before they initiate pregnancy-related care.

To be rather than not to be--that is the problem with the questions we ask adolescents about their childbearing intentions.

OBJECTIVE: To demonstrate that rephrasing the questions used to assess childbearing intentions to quantify the strength of the intent to remain nonpregnant, rather than the strength of the intent to become pregnant, would make teenagers' responses more useful to health care providers, family planning counselors, and health policy makers. METHODS: Examples from the teen pregnancy prevention literature are used to support the recommendations for change. RESULTS: Teenagers rarely plan their pregnancies. However, because those who are having sexual intercourse must actively try not to become pregnant or they will likely conceive, teenagers often become pregnant because they lack a firm commitment not to do so. Thus, to accurately profile the antecedents of adolescent pregnancy, (1) the questions used to assess childbearing intentions must be rephrased so that teenagers who intend to remain nonpregnant can be distinguished from those who do not and (2) separate differential diagnoses must be developed for inconsistent contraceptive use within these 2 groups of teenagers who are at risk for unintended pregnancy. CONCLUSION: Asking sexually active teenagers about the strength of their intent to remain nonpregnant will make the results of office interviews and national surveys more useful because the responses such questions elicit will enable health care providers and policy makers to target common, modifiable antecedents of inconsistent contraceptive use for interventions.

Adolescent health care experience of gay, lesbian, and bisexual young adults.

METHODS: Subjects were 102 self-identified gay, lesbian, and bisexual youth aged 18-23 years. A confidential self-administered survey elicited demographic information, sexual orientation information, health care experiences, subjects' understanding of medical confidentiality during ages 14-18 years, and their suggestions for improving care to gay and lesbian adolescents. RESULTS: Two-thirds of subjects never discussed sexual orientation with their provider but reported a desire to do so. Fewer than one-half of subjects remembered being informed about their right to medical confidentiality; those who reported being so informed were three times more likely to have discussed their sexual orientation with their provider. Over 70% of subjects who reported not being informed about their right to medical confidentiality stated that they would have been more likely to discuss sexual orientation with their provider had they been so informed. Only 13 of subjects had disclosed their sexual orientation to their health care providers. Of these, only half of the males received information on human immunodeficiency virus prevention. CONCLUSIONS: Health care providers may be failing to fully address issues of confidentiality and sexual orientation with adolescents, despite a decade of increased information on adolescent homosexuality.

School-based prenatal and postpartum care: strategies for meeting the medical and educational needs of pregnant and parenting students.

Adolescent pregnancy is not a new phenomenon, but it is a source of concern to U.S. educators because of the many young women choosing to become parents and the profound effect early childbearing has on the educational and vocational careers of many young Americans. Strategies for addressing the unique medical, educational, and psychosocial needs of pregnant and parenting students will be examined. Documented physical and psychosocial risks associated with adolescent childbearing will be reviewed, and data related to the effect of young maternal age on pregnancy outcome and the effect of pregnancy on the life course development of adolescents will be emphasized. Specific elements of comprehensive, adolescent-oriented prenatal and postnatal care will be discussed, as well as the effectiveness of existing prenatal and postnatal programs at preventing the most serious sequelae of adolescent childbearing. The role of school-based services will be examined, and ways will be discussed for educators and health care providers to collaborate in providing medical, educational, and social services for adolescent parents and their children. In addition, topics for future research will be suggested.

Epidemiologic and clinical factors of Chlamydia trachomatis in black, Hispanic and white female adolescents.

Rates of genital infection with Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were determined prospectively in 396 sexually active female adolescents from three ethnically different urban teen clinics. The organisms were identified respectively in cultures of specimens from 21%, 7% and 6% of all adolescents; 28%, 16% and 20% of blacks; 23%, 4% and 2% of Hispanics, and 14%, 2% and 1% of whites. C trachomatis was identified in specimens from 27% of pregnant adolescents and from 42% of adolescents who had gonorrhea or trichomoniasis. Of 85 Chlamydia-positive adolescents, 47 (55%) were asymptomatic. Physical findings significantly associated (P <.001) with chlamydial infection were vaginal discharge, cervical inflammation and mucopurulent endocervical discharge. Not significantly associated (P >.05) with Chlamydia were the use of oral contraception or symptoms of lower abdominal pain, vaginal discharge or dysuria. Because in sexually active female adolescents C trachomatis is three times more common than N gonorrhoeae, care givers need to consider routine screening or epidemiologic treatment (or both) for both pathogens.

The diaphragm: its effective use among college women.

PIP: The use of the diaphragm was investigated in college women with particular reference to proper or improper application of the method, user satisfaction, pregnancy, and pregnancy outcome. A survey was mailed to all women fitted with diaphragms in the Gynecology Clinic, Wardenberg Student Health Service, in Boulder, Colorado during the calendar year of 1978. The final sample consisted of 232 respondents. Of 224 women who answered the question, 24 women reported a total of 26 unplanned pregnancies in 2876.5 months of diaphragm use. According to the Pearl formula, the failure rate of the diaphragm in actual use in this population was 11.75 pregnancies/100 woman-years. Only 6 respondents felt that the diaphragm itself had failed despite proper use, suggesting a method-failure rate of 2.7 pregnancies/100 woman-years. Therapeutic abortions were obtained in most cases. 31 women had discontinued use of the diaphragm. Of these, 32% did so because they wanted to become pregnant or had no current need for contraception. The other 68% indicated general dissatisfaction or mistrust after an unwanted pregnancy. About 62% of the users indicated they were satisfied with the method, 20.6% stated that they were not satisfied, and another 17.5% had significant reservations. Most complaints about the diaphragm were about inconvenience, messiness of the spermicide, and interference with spontaneity.^ieng