Contraceptive choices in HIV infected and HIV at-risk adolescent females.

PURPOSE: To describe reported contraception use in HIV infected and HIV uninfected but at-risk female adolescents, and determine associations with the reported consistent use of effective contraception methods, including its association with pregnancy. METHODS: HIV infected and at-risk female youth, aged 13-18 years, who were sexually active and reporting no intention to become pregnant, were included. Contraception use data from three consecutive visits (approximately 6 months apart) were used. RESULTS: Ninety-four percent of HIV infected and 89% of at-risk subjects reported choosing a main contraception method with demonstrated efficacy when used consistently. Approximately 50% chose partner condoms. HIV infected youth were more likely to report 100% partner condom use in the past 3 months (73% vs. 46%; OR 3.3; 95% CI: 1.7-5.6). At-risk youth were 2.5 times more likely than HIV infected subjects to report using nothing (95% CI: 1.1-5.8). Slightly more than half (56%) demonstrated the consistent reporting of effective methods (CREM) of contraception. In multivariate analysis, HIV infection (OR 4.0; 95% CI: 2.2-8.2) and African-American race (OR 2.7; 95% CI: 1.1-6.6) were significantly associated with CREM. Subjects reporting inconsistent or unreliable contraception use had higher 1-year pregnancy rates than CREM subjects (32% vs. 14%; p = .002). CONCLUSIONS: Only half of HIV infected and at-risk youth reported using effective contraception consistently, despite its availability. Additionally, regardless of reported contraceptive use, the rates of unplanned pregnancy were unacceptably high.

Active tuberculosis among U.S. Army personnel, 1980 to 1996.

OBJECTIVE: To describe hospitalization rates for active tuberculosis among U.S. Army personnel. METHODS: All hospitalizations for tuberculosis among Army active duty personnel from January 1, 1980, to December 31, 1996, were identified from an inpatient database. Incidence rates and trend analyses are presented for age, race, sex, and hospital location. RESULTS: A total of 936 cases of active tuberculosis required hospitalization. Hospitalization rates declined from 15.3 cases/100,000 (1980) to 5.1 cases/100,000 (1996). Significant declines in hospitalization rates occurred for white and black males but not for females. Tuberculosis rates were 3.5 times lower among soldiers compared with the general population for individuals 25 to 44 years of age. CONCLUSION: Because of medical, purified protein derivative, and human immunodeficiency virus screening, military populations represent a low-risk population for active tuberculosis. The Army's overall hospitalization rate for tuberculosis declined steadily but remained relatively high among minorities and females. Additional studies should address specific risk factors related to race and gender among healthy populations with adequate health care.

A method for monitoring the health of US Navy submarine crewmembers during periods of isolation.

BACKGROUND: With the expansion of the manned space program, an essential consideration in planning is the medical support necessary for long-term missions. Information on analogous populations serving in isolated and/or contained environments may be useful in predicting health risks for astronauts. METHODS: The present study evaluates rates of health events that occur in a highly screened, healthy military population during periods of isolation. A centralized database was designed to collect medical encounter data from U.S. Navy submarines and contains demographic information, crew rosters for each patrol, medical encounter notes, accident reports, medical evacuation reports, vital signs and laboratory data. The population included in the present analysis is composed of crewmembers aboard 136 submarine patrols between January 1, 1997 and December 31, 1998. RESULTS: A total of 2,044 initial visits to medical staff and 973 re-visits for the same condition were recorded during these patrols. Potentially mission-impacting medical events reported among crewmembers were rare (i.e., among a crew of 10 individuals, only 1-2 medical events would be expected to occur during a 100 d-mission). The most common category of medical events was injury, followed by respiratory illnesses (URIs), skin problems (minor infections, ingrown toenail), symptoms and ill-defined conditions, digestive disorders, infectious conditions, sensory organ problems (ear and eye), and musculoskeletal conditions.

Streptococcus pneumoniae-induced hemolytic uremic syndrome: a case for early diagnosis.

Hemolytic uremic syndrome associated with infection by neuraminidase-producing Streptococcus pneumoniae usually presents with fulminant pneumonia and has a high mortality rate. Post-pneumococcal hemolytic uremic syndrome may occur earlier in life than classical hemolytic uremic syndrome. We describe an 18-month-old male with hemolytic uremic syndrome, S. pneumoniae pneumonia, and T-antigen activation characteristic of neuraminidase activity. We have summarized the features of this case and 11 previously reported children. As the use of blood products containing IgM may aggravate this disorder, early recognition of hemolytic uremic syndrome associated with S. pneumoniae neuraminidase production may lead to improved patient outcome through the judicious use of blood products.