[Laparoscopy and hysteroscopy in Müllerian duct malformations: usefulness and reproductive results]. / Laparoscopia e histeroscopia en malformaciones müllerianas: utilidad y resultados reproductivos.

Determine the type and the possibility of corrective surgery, reproductive results of infertility patients with Müllerian malformations. The clinic and the laparoscopic and hysteroscopic evaluation were performed to 40 patients with Müllerian anomalies and infertility history analyzing the reproductive results. The uterine septum was present in 23/40 patients (57.5%), bicornual uterus in 6/40 (15%), didelfus uterus 5/40 (12.5%), arcuate uterus 4/40 (10%), unicorn uterus 2/40 (5%). After septum resection we had 13 pregnancies (56.5%). 2 abortions, 4 already delivered and 7 continue normal evolution with on twin case. Strassman metroplasty by laparotomy was performed in 4 cases of bicornual uterus achieving pregnancy in two cases. In one didelfus uterus, a salpingoclasy of the smaller horn was done as an alternative. Of the arcuated uterus, the small septum was removed. Of the unicorn uterus, one pregnancy was lost in the first trimester and the other one reach the term date. Our data show that the endoscopic procedures can perform the correct diagnosis of the Müllerian anomalies and of course the best surgical treatment improving the fertility rates.

Patterns of general health care and STD services use among high-risk youth in Denver participating in community-based urine chlamydia screening.

BACKGROUND: In the United States, youth are at highest risk for STDs, and innovative programs have been called for to increase their access to essential STD-related services. To guide the development of such programs, locally relevant information is needed on current use of general health care and STD services in this population. GOAL: To study access to and use of general health care and STD services in a purposive sample of high-risk youth in inner-city Denver. STUDY DESIGN: An interview-based survey conducted as part of a community program for urine chlamydia screening targeting black and Hispanic youth 13 years to 25 years. RESULTS: Of 221 sexually experienced youth in the survey, 72% had accessed general health services in the past year and 39% reported an STD evaluation at any time in the past. Community and school clinics were reported by 50% as a source for general health care and by 62% as a source for STD services. STD clinics were reported by only 14% as a source for STD services. Routine checkups were the most important reasons to seek general health care, yet of those who went for a routine checkup, only 34% reported an STD evaluation. Although few barriers appeared to exist in accessing general health care, anticipated anxiety about procedures and results formed the major barrier to accessing STD services. CONCLUSIONS: Use of general health services was common in this population of high-risk adolescents; however, the provision of STD services as part of general health care visits appeared to be low. On the basis of these findings, a comprehensive STD prevention strategy may be envisioned, which would include provider interventions to increase the provision of STD prevention services in general health care settings; community interventions to enhance access to general health care and STD services; and community-based screening programs for those not able or willing to seek clinic-based services.

PIP: To guide the development of innovative programs to increase the access of US adolescents and young adults to sexually transmitted disease (STD) prevention and treatment services, data should be obtained at the local level from nonclinic-based samples comprised of those at greatest risk. Such a survey was conducted in Denver, Colorado, in 1996-97 by Youth in Action--a community-level chlamydia urine screening program. Questionnaires were completed by 221 of the 277 predominantly Black and Hispanic inner-city youth 13-25 years of age who underwent urine analysis during the study period. 25 (11%) reported a history of an STD. On urine screening, 10.7% of males and 12.9% of females tested positive for chlamydia. 72% had accessed general health services in the past year, primarily for routine checkups, and 39% reported an STD evaluation at any time in the past. Community and school clinics were identified by 50% as a source for general health care and by 62% as a source for STD services. Only 14% of respondents attended STD clinics. In multivariate analysis, the following factors were associated with an STD evaluation: recruitment in field settings, female gender, age above 16 years, non-Hispanic ethnicity, vaginal sex in the past 30 days, presence of chlamydia on urine screening, and a general health visit in the past year. Of concern was the finding that only 34% of youth who went for a general checkup reported an STD evaluation. These findings indicate needs for interventions to increase the provision of STD prevention services in general health care settings and community-based screening programs for those unable or unwilling to seek clinic-based services.

Feasibility and yield of screening urine for Chlamydia trachomatis by polymerase chain reaction among high-risk male youth in field-based and other nonclinic settings. A new strategy for sexually transmitted disease control.

BACKGROUND: Inner-city youth are at disproportionate risk for Chlamydia trachomatis infection. Identification of infected individuals is hampered by the often asymptomatic nature of infection and access and utilization barriers to clinic-based screening services. The feasibility and yield of screening urine for C. trachomatis by polymerase chain reaction was studied among high-risk male youth outside traditional clinic settings. METHODS: As part of a community-level sexually transmitted disease (STD) prevention program among high-risk youth in Denver, outreach workers enrolled subjects, administered questionnaires, and collected first-catch urine samples in nonclinical facility-based and field-based settings. Facility settings consisted of community/recreation centers, high-schools, and an STD/human immunodeficiency virus prevention storefront. Field settings included alleys, parking lots, parks, and residences. Individuals who tested C. trachomatis positive were contacted by program outreach workers and provided with standard treatment and partner notification services. RESULTS: Over a 20-month period, 486 urine specimens were collected, 32 (6.6%) of which were C. trachomatis positive. Rates were higher for subjects screened in the field than in facility settings (11.9% vs. 4.4%, P < 0.05). Subjects with chlamydial infection were more likely to have had vaginal intercourse in the previous 30 days (adjusted odds ratio: 2.9) and to have been recruited in field settings (adjusted odds ratio: 2.5). Of subjects with chlamydial infection, 31/32 (97%) were treated within a median of 8 days after urine collection. CONCLUSIONS: Urine chlamydial screening by polymerase chain reaction of sexually active male youth in nontraditional settings appears to be feasible and to provide yields similar to those reported in standard clinic settings. Evaluation of samples easily collected in nonclinic locations holds great promise as an additional strategy for the control of chlamydial infection and other STD among difficult-to-reach populations.

Adolescent pregnancy: effects of family support, education, and religion on the decision to carry or terminate among Puerto Rican teenagers.

Why do some pregnant teenagers decide to carry to term while others terminate their pregnancy? This study examined the influence of family relationships and support, religion, and education on the decision to carry or to abort. A nonrandom sample of 43 pregnant Puerto Rican teenagers (21 who carried and 22 who aborted) were interviewed in 1982 using a 34-item interview schedule. It was found that girls in the carry group were more significantly influenced and supported by family and friends than were those in the abort group. Fathers were the least influential persons in both carry and abort groups, while mothers were the most influential in the carry group, and sisters in the abort group. Brothers, boyfriends, and best friends were more influential for carry girls than for abort girls. Contrary to expectations, girls in the abort group reported a greater degree of religiosity than did those in the carry group. Further, girls who received strong support from family and friends reported a higher degree of satisfaction with their decision than did those who received less support. Finally, girls in the abort group were more likely to continue their education than were those in the carry group. Overall, the findings of this study have immediate implications for research and counseling services. Practitioners should focus on the girls in conjunction with their families in order to achieve better results in both treatment and preventive services.

PIP: Why do some pregnant teenagers decide to carry to term while others terminate their pregnancy? This study examined the influence of family relationships and support, religion, and education on the decision to carry or to abort. A nonrandom sample of 43 pregnant Puerto Rican teenagers living in a large eastern US city (21 who carried and 22 who aborted) were interviewed in 1982 using a 34-item interview schedule. It was found that girls in the carry group were more significantly influenced and supported by family and friends than were those in the abort group. Fathers were the least influential persons in both carry and abort groups, while mothers were the most influential in the carry group, and sisters in the abort group. Brothers, boyfriends, and best friends were more influential for carry girls than for abort girls. Contrary to expectations, girls in the abort group reported a greater degree of religiosity than did those in the carry group. Further, girls who received strong support from family and friends reported a higher degree of satisfaction with their decision than did those who received less support. Finally, girls in the abort group were more likely to continue their education than were those in the carry group. Overall, the findings of this study have immediate implications for research and counseling services. Practitioners should focus on the girls in conjunction with their families in order to achieve better results in both treatment and preventive services.