The importance of local data in unintended pregnancy prevention programming.

OBJECTIVE: Lack of local data on pregnancy intendedness poses a serious problem for those responsible for regional program development and evaluation. This article demonstrates how the Boulder County Health Department addressed this problem by conducting its own assessment. The information gathered served as the basis for collaborative population-based programming and policy development aimed at decreasing unintended pregnancy in the county. METHODS: A random-digit-dial telephone survey of 300 men and 300 women was conducted to estimate the prevalence of unintended pregnancy and establish groups at highest risk. Qualitative data regarding the psychosocial and contextual factors associated with unintended pregnancy were gathered in six focus groups conducted with 46 males and females aged 18-28 who had experienced an unintended pregnancy. RESULTS: The prevention strategies identified by the focus group participants lead to the development of locally relevant interventions among specific high-risk populations identified in the telephone survey. Programmatic and policy initiatives included raising awareness among key service providers and the community at large, creative means of bringing information and resources to those at risk, strengthening the delivery of clinical services, and promoting school involvement in unintended pregnancy prevention. CONCLUSION: Maternal and child health authorities should encourage the collection and use of pregnancy intendedness data at the local level.

Renal papillary necrosis and urinary protein alterations induced in Fischer-344 rats by D-ormaplatin.

D-ormaplatin (previously called tetraplatin) produced dose-related renal papillary necrosis when given intravenously to Fischer-344 rats at doses of 2, 4, and 9 mg/kg. The lesions were most severe at 4 days postdosing and had repaired by day 9 in the 2- and 4-mg/kg dose groups. Blood urea nitrogen and the N-acetyl-beta-glucosaminidase (NAG): creatinine ratio were slightly elevated at day 4 while creatinine clearance was decreased. Body weight was reduced in a dose-related manner while kidney weights increased. Total protein excretion in male and female rats was elevated at day 4 postdosing. The evaluation of urinary proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) revealed an increase, primarily in high molecular weight proteins at 4 days postdosing, indicating an increase in glomerular filtration of albumin and transferrin. The morphologic appearance of the glomeruli was normal by light microscopy. At day 4 postdosing, alpha 1-microglobulin was elevated. This correlated with an increase in the NAG: creatinine ratio also seen at this time and the morphologic appearance of the kidney, indicating that the proximal tubules were affected but were not a major site of toxicity. Although the change in urinary proteins occurred at the same time as morphologic alterations in the renal papilla, these findings were not considered to be related. SDS-PAGE provided a useful method for detecting and localizing renal toxicity when used in conjunction with morphologic and clinical chemistry methods.

A survey of Colorado's migrant farmworkers: access to health care.

PIP: This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.^ieng