Effects of Maternal Pb2+ poisoning during pregnancy on the development of the jaw (Meckel´s Cartilage) of rat fetus

The purpose of this study was to investigate the effects of maternal lead poisoning during pregnancy on the development of the jaw (Meckel's cartilage) of rat fetuses by histologic and morphometric methods. Pregnant rats received a single intraperitoneal injection of 2.5 mg of lead acetate/100g body weight on the 10th day of pregnancy. Meckel's cartilage of fetuses of the lead-treated group showed smaller volume density and size of the lacunae, as well as modification of the lacunae shape. Moreover, the number density of lacunae and the volume density of the matrix increased significantly in the Meckel's cartilage in treated group fetuses. The results suggest that lead poisoning during the period of organogenesis can induce disturbances in the development and differentiation of the fetal stomatognathic system. Reducing the consumption of alcoholic beberages and smoking cessation by women in childbearing age, along with a strict policy of control of the environmental lead exposure can bring great benefits to the future generations of children.

A Fixed Netting System as a Means of Excluding Birds From a Domestic Waste Landfill

Many bird species are attracted to landfills which take domestic or putrescible waste. These sites provide a reliable, rich source of food which can attract large concentrations of birds. The birds may cause conflicts with human interest with respect to noise, birds carrying litter off site, possible transmission of pathogens in bird droppings and the potential for birdstrikes. In the UK there is an 8 mile safeguarding radius around an airfield, within which any planning applications must pass scrutiny from regulatory bodies to show they will not attract birds into the area and increase the birdstrike risk. Peckfield Landfill site near Leeds, West Yorkshire was chosen for a trial of a netting system designed to exclude birds from domestic waste landfills. The site was assessed for bird numbers before the trial, during the netting trial and after the net had been removed. A ScanCord net was installed for 6 weeks, during which time all household waste was tipped inside the net. Gull numbers decreased on the site from a mean of 1074 per hourly count to 29 per hourly count after two days. The gull numbers increased again after the net had been removed. Bird concentrations in the surroundings were also monitored to assess the effect of the net. Bird numbers in the immediate vicinity of the landfill site were higher than those further away. When the net was installed, the bird concentrations adjacent to the landfill site decreased. Corvids were not affected by the net as they fed on covered waste which was available outside the net throughout the trial. This shows that bird problems on a landfill site are complex, requiring a comprehensive policy of bird control. A supporting bird scaring system and clear operating policy for sites near to airports would be required.

THE CONTROL OF VERTEBRATE PROBLEM ANIMALS IN THE PROVINCE OF THE CAPE OF GOOD HOPE, REPUBLIC OF SOUTH AFRICA

The policy of the Cape Provincial Department of Nature Conservation is based on the concept of "wise management" of wildlife resources. Where crop damage is real, control measures are essential. These, however, must be adapted to the species concerned and applied only where the damage is taking place. Blanket measures which also kill many useful species must be avoided. For this reason, the control of problem animals should be vested in the agency concerned with wildlife conservation.

SIDE EFFECTS OF PERSISTENT TOXICANTS

As you can see from the general tenor of the printed program for this seminar, I am in the unenviable position of trying to discourage you from certain types of chemical control; but my assigned topic "Side Effects of Persistent Toxicants," implies that mission. However, my remarks may be somewhat anticlimax at this time, because it is now generally conceded that we need to reevaluate certain chemicals in control work and to restrict or severely curtail use of those that per¬sist for long periods in the environment. So let me detail my reasons for a somewhat negative attitude toward the use of the persistent hydrocarbons from my experience with the effects of these materials on birds. But first a few words of caution about control work in general, which so often disrupts natural processes and leads to new and unforseen difficulties. As an example, I think of the irruption of mice in the Klamath valley in northern California and southern Oregon in the late '50's. Intensive predator control, particularly of coyotes, but also of hawks and owls, was followed by a severe outbreak of mice in the spring of 1958. To combat the plague of mice, poisoned bait (1080 and zinc phosphide) was widely distributed in an area used by 500,000 waterfowl each spring. More than 3,000 geese were poisoned, so driv¬ing parties were organized to keep the geese off the treated fields. Here it seems conceivable that the whole chain of costly events--cost of the original and probably unnecessary predator control, economic loss to crops from the mouse outbreak, another poisoning campaign to combat the mice, loss of valuable waterfowl resources, and man-hours involved in flushing geese from the fields--might have been averted by a policy of not interfering with the original predator-prey relationship. This points to a dilemma we always face. (We create deplorable situations by clumsy interference with natural processes, then seek artificial cures to correct our mistakes.) For example, we spend millions of dollars in seeking cures for cancer, but do little or nothing about restricting the use of known or suspected carcinogens such as nicotine and DDT.

Corporate Governance and Dividend Policy in European Banking

This dissertation investigates corporate governance and dividend policy in banking. This topic has recently attracted the attention of numerous scholars all over the world and currently remains one of the most discussed topics in Banking. The core of the dissertation is constituted by three papers. The first paper generalizes the main achievements in the field of relevant study using the approach of meta-analysis. The second paper provides an empirical analysis of the effect of banking corporate governance on dividend payout. Finally, the third paper investigates empirically the effect of government bailout during 2007-2010 on corporate governance and dividend policy of banks. The dissertation uses a new hand-collected data set with information on corporate governance, ownership structure and compensation structure for a sample of listed banks from 15 European countries for the period 2005-2010. The empirical papers employ such econometric approaches as Within-Group model, difference-in-difference technique, and propensity score matching method based on the Nearest Neighbor Matching estimator. The main empirical results may be summarized as follows. First, we provide evidence that CEO power and connection to government are associated with lower dividend payout ratios. This result supports the view that banking regulators are prevalently concerned about the safety of the bank, and powerful bank CEOs can afford to distribute low payout ratios, at the expense of minority shareholders. Next, we find that government bailout during 2007-2010 changes the banks’ ownership structure and helps to keep lending by bailed bank at the pre-crisis level. Finally, we provide robust evidence for increased control over the banks that receive government money. These findings show the important role of government when overcoming the consequences of the banking crisis, and high quality of governance of public bailouts in European countries.

INTERNAL AUDIT AND GROWTH OF PUBLIC INSTITUTIONS

The ONATRACOM was established by the law number 08/2007 of 03/02/2007 determining the responsibilities, organization and functioning of Rwanda Public Transport Authority with function of promoting public transportation between Rwanda and other countries; participating in the implementation of the public transportation policy of Ministry in charge of transportation; perform any other activity that is directly or indirectly related to its objectives; and establish relations and collaborate with other regional and international agencies with similar attributions. In the recent days many public institutions have been listed by general auditor for being mismanaged and are on the course of deficit. This study aimed at examining internal audit growth of public institutions, case study of ONATRACOM – Rwanda. This research was conducted as a case study using ONATRACOM in NYARUGENGE District. The study was built at four specific objectives which are to determine if internal audit lead to the business growth of ONATRACOM, to find out if achieving internal audit increases the net profit and sales of ONATRACOM, to explore if there is internal sources of funds for pursuing growth opportunities in ONATRACOM, to assess whether ONATRACOM is able to obtain external sources of funds for pursuing growth opportunities as a result of internal audit impact or not. The findings were got from 27 respondents as the sample from the total target population of 96. Questionnaire was used as the technique to obtain primary data, while secondary data were obtained through examining the existing literature about the study. Chapter four presents the finding in form of descriptive statistical tables starting with the profile of the respondent and findings in line with the research objectives, It was found out that ONATRACOM was failure in its services because it was not achieve its targeted objectives and in this company, the internal audit was not effective in order to make performance of that company.

A Sociological Study of the Political Subsystem in Yugoslavia

In this critical analysis of sociological studies of the political subsystem in Yugoslavia since the fall of communism Mr. Ilic examined the work of the majority of leading researchers of politics in the country between 1990 and 1996. Where the question of continuity was important, he also looked at previous research by the writers in question. His aim was to demonstrate the overall extent of existing research and at the same time to identify its limits and the social conditions which defined it. Particular areas examined included the problems of defining basic concepts and selecting the theoretically most relevant indicators; the sources of data including the types of authentic materials exploited; problems of research work (contacts, field control, etc.); problems of analysisl and finally the problems arising from different relations with the people who commission the research. In the first stage of the research, looking at methods of defining key terms, special attention was paid to the analysis of the most frequently used terms such as democracy, totalitarianism, the political left and right, and populism. Numerous weaknesses were noted in the analytic application of these terms. In studies of the possibilities of creating a democratic political system in Serbia and its possible forms (democracy of the majority or consensual democracy), the profound social division of Serbian society was neglected. The left-right distinction tends to be identified with the government-opposition relation, in the way of practical politics. The idea of populism was used to pass responsibility for the policy of war from the manipulator to the manipulated, while the concept of totalitarianism is used in a rather old-fashioned way, with echoes of the cold war. In general, the terminology used in the majority of recent research on the political subsystem in Yugoslavia is characterised by a special ideological style and by practical political material, rather than by developed theoretical effort. The second section of analysis considered the wider theoretical background of the research and focused on studies of the processes of transformation and transition in Yugoslav society, particularly the work of Mladen Lazic and Silvano Bolcic, who he sees as representing the most important and influential contemporary Yugoslav sociologists. Here Mr. Ilic showed that the meaning of empirical data is closely connected with the stratification schemes towards which they are oriented, so that the same data can have different meanings in shown through different schemes. He went on to show the observed theoretical frames in the context of wider ideological understanding of the authors' ideas and research. Here the emphasis was on the formalistic character of such notions as command economy and command work which were used in analysing the functioning and the collapse of communist society, although Mr. Ilic passed favourable judgement on the Lazic's critique of political over-determination in its various attempts to explain the disintegration of the communist political (sub)system. The next stage of the analysis was devoted to the problem of empirical identification of the observed phenomena. Here again the notions of the political left and right were of key importance. He sees two specific problems in using these notion in talking about Yugoslavia, the first being that the process of transition in the FR Yugoslavia has hardly begun. The communist government has in effect remained in power continuously since 1945, despite the introduction of a multi-party system in 1990. The process of privatisation of public property was interrupted at a very early stage and the results of this are evident on the structural level in the continuous weakening of the social status of the middle class and on the political level because the social structure and dominant form of property direct the majority of votes towards to communists in power. This has been combined with strong chauvinist confusion associated with the wars in Croatia and Bosnia, and these ideas were incorporated by all the relevant Yugoslav political parties, making it more difficult to differentiate between them empirically. In this context he quotes the situation of the stream of political scientists who emerged in the Faculty of Political Science in Belgrade. During the time of the one-party regime, this faculty functioned as ideological support for official communist policy and its teachers were unable to develop views which differed from the official line, but rather treated all contrasting ideas in the same way, neglecting their differences. Following the introduction of a multi-party system, these authors changed their idea of a public enemy, but still retained an undifferentiated and theoretically undeveloped approach to the issue of the identification of political ideas. The fourth section of the work looked at problems of explanation in studying the political subsystem and the attempts at an adequate causal explanation of the triumph of Slobodan Milosevic's communists at four subsequent elections was identified as the key methodological problem. The main problem Mr. Ilic isolated here was the neglect of structural factors in explaining the voters' choice. He then went on to look at the way empirical evidence is collected and studied, pointing out many mistakes in planning and determining the samples used in surveys as well as in the scientifically incorrect use of results. He found these weaknesses particularly noticeable in the works of representatives of the so-called nationalistic orientation in Yugoslav sociology of politics, and he pointed out the practical political abuses which these methodological weaknesses made possible. He also identified similar types of mistakes in research by Serbian political parties made on the basis of party documentation and using methods of content analysis. He found various none-sided applications of survey data and looked at attempts to apply other sources of data (statistics, official party documents, various research results). Mr. Ilic concluded that there are two main sets of characteristics in modern Yugoslav sociological studies of political subsystems. There are a considerable number of surveys with ambitious aspirations to explain political phenomena, but at the same time there is a clear lack of a developed sociological theory of political (sub)systems. He feels that, in the absence of such theory, most researcher are over-ready to accept the theoretical solutions found for interpretation of political phenomena in other countries. He sees a need for a stronger methodological bases for future research, either 1) in complementary usage of different sources and ways of collecting data, or 2) in including more of a historical dimension in different attempts to explain the political subsystem in Yugoslavia.

Central Europeans towards Integration with the European Union: A Study of Public Opinion, Social Attitudes and National Identities

Since the turbulence of 1989, the countries of Central and Eastern Europe have striven to "return to Europe". Agreements have been signed with ten post-communist countries, beginning in 1991 with Czechoslovakia (before its division), Hungary and Poland. Since that time several countries have expressed a desire to become members of the EU. In 1997 the European Commission announced its opinion on the applications for EU membership of the Czech Republic, Hungary, Poland, Slovakia, and seven other applicant countries. The Commission recommended the commencement of negotiations on accession with the Czech Republic, Estonia, Hungary, Poland, and Slovenia. Mr. Kucia's report, presented in the form of a series of manuscripts totalling 91 pages, written in English and Polish and including many pages of tables and graphs, presents the results of a study of public opinion on European integration in four countries of Central Europe (CE): the Czech Republic (CZ), Hungary (H), Poland (PL), and Slovakia (SK). The research results are primarily based on a public-opinion survey known as the Central and Eastern Eurobarometer (CEEB). CEEB has been conducted on behalf of the European Commission in the Central and Eastern European countries each year in autumn since 1990. Below is a very small selection of Mr. Kucia's research findings. Throughout the 90s people in the four countries increasingly saw their countries' future tied up with the EU, since economic and political connections to the EU were growing and prospects for EU membership were increasing. Regional co-operation within CE did not gain much popular recognition. However, initially high levels of enthusiasm for the EU were gradually superseded by a more realistic approach or even scepticism. Poland was the exception in this respect; its population was more positive about the EU in 1996 than ever before. Mr. Kucia concludes that, since the political "elites" in CE are more positive about the EU than the people they serve, they should do their best to bring people round to their beliefs, lest the project of European integration become purely the business of the elites, as Mr. Kucia claims it has been in the EU up till now. He accuses the governments of the region, the EU authorities and the media of failing to provide appropriate information, especially about the two subjects which most affect them, association with the EU and the PHARE assistance programme. Respondents were asked to rank in order the countries or regions they saw their country's future most closely tied up with. In the period 92-96 the EU received the highest ratings in all of CE. The ratings were highest in CZ in 92 and 93 (46%) and in Poland in 96 (46%). They were the lowest in Hungary (22% in 94). After the EU came "Other Western European countries (non EU)", that is Austria, Sweden and Finland (before they joined the EU in 1995), Switzerland and Norway. Mr. Kucia puts the high ratings of these countries down to historical connections and geographical proximity, particularly in the case of Austria. The USA always came second in Poland, and in Hungary too its standing has always been higher than in CZ or SK. Indeed Mr. Kucia suggests that the USA's standing is disproportionately low in especially the CZ. Germany was nominated frequently by Hungarians, though in the CZ and SK, figures have been consistently low (1-2%). "Other CE/EE countries" increased their ratings in all of CE except Poland between 92 and 96. With regard to these last figures, Mr. Kucia makes an interesting note. Assuming that for the respondents in the four countries this category covered the Visegrad 4, least support was found in Poland, whose government was the most in favour of close political co-operation within the V4, while most support was in evidence in CZ and SK, for whose governments V4 was simply not a priority. Again, there is evidence of a divide between the political elites and the people. Russia has occupied a consistently modest rank. It was the highest in PL, fairly low in H and SK and the lowest in CZ. The Slovak government's policy of closer ties with Russia is reflected in a growth in the figures from 2% in 93 to 6% in 95. Every year the spontaneous answer "we should depend on ourselves" appeared, which Mr. Kucia interprets as either a sign of isolationism and disillusionment or as a call for self-reliance. Unfortunately he regards both these tendencies as unfeasible in the uniting Europe. Moving to more general conclusions, Mr. Kucia finds that the concept "Central Europe" does not have much meaning for Central Europeans. He believes that this is probably due to the failure to establish a viable regional co-operation network. Group discussions also revealed that people thought themselves European as a consequence of being Czech or Polish etc. Thus European identity is based on national identities. Generally within the surveyed period, the numbers of those who said they often think themselves European decreased, while the numbers of those who said they never think themselves European increased from 41% in PL, 36% in CZ, and 30% in H in 1990, to 67% in CZ, 58% in PL, and 51% in H in 1995.

Central Europe in the Process of European Integration. A Comparative Study of the Strategies of the Czech Republic, Hungary, Poland and Slovakia towards the Deepening and Widening of the European Union

Membership of the European Union U is usually seen as a strategic goal of the associated states of central and eastern Europe. At the beginning of the 1990s central European countries, where the economic and political transformation was relatively advanced, received preferential treatment from the European Community, which was starting to evolve a policy of differentiation. Podraza studied the strategies of four central European countries towards changes under way in the European Union, analysing several aspects for each case: (1) the process of political transformation (2) decision-making structures in the field of foreign policy and European integration (3) integration strategies: (a) main foreign policy priorities (b) application for membership of the European Union (c) the Commission option on each country (d) accession partnership, including a National Programme for the Adoption of the Acquis (NPAA) (e) regular Commission reports (f) accession negotiations

Rhetorics and Practices of Modernisation in Russian Industry: a Reflective Analysis of Organisational Cultures in Transition

This research was based on the results of a case study of a large confectionery factory in the Russian city of Samara. The concept of paternalism is clear in many features of the life of Russian enterprises, including the rhetoric and strategy of the management, relationships within the labour force and the stereotypical expectations of workers. The concept also has a much wider bearing, embracing the spheres of state policy, the social, and family relationships, that is every sphere of social life in which the patriarchal, communal, stereotyped way of thinking of the Soviet people is reproduced. A substantial proportion of the state's role in providing social protection for the population is carried out through enterprises. In spite of low salaries and the absence of career opportunities, female workers were as strongly attached to the enterprise as to their homes. Romanov's research showed how the development of capitalism in industries in Russia is destroying the cultural and social identities of female workers and is contributing to gender inequality. Interpersonal relations are becoming increasingly utilitarian and distant and the basic features of the patriarchal type of administrative control are becoming blurred. This control is becoming more subtle, but gender segregation is preserved in the new framework and indeed becoming more obvious, being reproduced both at the departmental level and in the hiring policy of the enterprise as a whole.

The Social Desintegration of an Ethnical German Group from Romanian Village Community Comparative with a Romanian Group and Hungarian Group from some Village Their Integration into the German Society

Zarna is witness to the disappearance of the Swabian community in Santana, a process which seems to date back to before the major changes in Central and Eastern Europe. His project showed how a strong German ethnic community, formed more than 250 years ago, has virtually disappeared from the village of Santana (Romania). Zarna presents the causes leading to the loss of their ethnic identity, of their culture, traditions and of the collective reproduction of their ethnicity, although the last Swabians remaining in the village have preserved their individual identity and not let themselves be assimilated. The policy of the former communist regime is not sufficient to explain the decline of the German ethnic group, nor is the present international context with its varying effects on the form and reproduction of their ethnic identity. Zarna has analysed the origins of the Swabian community, its development, historical changes (both desired and imposed) and the disappearance of elements that determined their German culture and their pride in being German. The Germans have demobilised more rapidly than other ethnic groups in Romania, partly because of Germany's pro-emigration policy over the last two decades. Many of the emigrants were however, poorly prepared for emigration and have not been able to recreate the prosperous financial situation which they left. The prevalent feeling among those interviewed was disappointment and this increases with age and education.

Simulating the impact of four control strategies on the population dynamics of Neospora caninum infection in Swiss dairy cattle

A dynamic deterministic simulation model was developed to assess the impact of different putative control strategies on the seroprevalence of Neospora caninum in female Swiss dairy cattle. The model structure comprised compartments of "susceptible" and "infected" animals (SI-model) and the cattle population was divided into 12 age classes. A reference model (Model 1) was developed to simulate the current (status quo) situation (present seroprevalence in Switzerland 12%), taking into account available demographic and seroprevalence data of Switzerland. Model 1 was modified to represent four putative control strategies: testing and culling of seropositive animals (Model 2), discontinued breeding with offspring from seropositive cows (Model 3), chemotherapeutic treatment of calves from seropositive cows (Model 4), and vaccination of susceptible and infected animals (Model 5). Models 2-4 considered different sub-scenarios with regard to the frequency of diagnostic testing. Multivariable Monte Carlo sensitivity analysis was used to assess the impact of uncertainty in input parameters. A policy of annual testing and culling of all seropositive cattle in the population reduced the seroprevalence effectively and rapidly from 12% to <1% in the first year of simulation. The control strategies with discontinued breeding with offspring from all seropositive cows, chemotherapy of calves and vaccination of all cattle reduced the prevalence more slowly than culling but were still very effective (reduction of prevalence below 2% within 11, 23 and 3 years of simulation, respectively). However, sensitivity analyses revealed that the effectiveness of these strategies depended strongly on the quality of the input parameters used, such as the horizontal and vertical transmission factors, the sensitivity of the diagnostic test and the efficacy of medication and vaccination. Finally, all models confirmed that it was not possible to completely eradicate N. caninum as long as the horizontal transmission process was not interrupted.

Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project

OBJECTIVE: To investigate the cost effectiveness of screening for Chlamydia trachomatis compared with a policy of no organised screening in the United Kingdom. DESIGN: Economic evaluation using a transmission dynamic mathematical model. SETTING: Central and southwest England. PARTICIPANTS: Hypothetical population of 50,000 men and women, in which all those aged 16-24 years were invited to be screened each year. MAIN OUTCOME MEASURES: Cost effectiveness based on major outcomes averted, defined as pelvic inflammatory disease, ectopic pregnancy, infertility, or neonatal complications. RESULTS: The incremental cost per major outcome averted for a programme of screening women only (assuming eight years of screening) was 22,300 pounds (33,000 euros; $45,000) compared with no organised screening. For a programme screening both men and women, the incremental cost effectiveness ratio was approximately 28,900 pounds. Pelvic inflammatory disease leading to hospital admission was the most frequently averted major outcome. The model was highly sensitive to the incidence of major outcomes and to uptake of screening. When both were increased the cost effectiveness ratio fell to 6200 pound per major outcome averted for screening women only. CONCLUSIONS: Proactive register based screening for chlamydia is not cost effective if the uptake of screening and incidence of complications are based on contemporary empirical studies, which show lower rates than commonly assumed. These data are relevant to discussions about the cost effectiveness of the opportunistic model of chlamydia screening being introduced in England.

Comparison between two caller groups of a medical call centre in Switzerland

OBJECTIVES: The incidence distribution of triage advice in the medical call centre Medi24 and the pattern of service utilisation were analysed with respect to two groups of callers with different insurance schemes. Individuals having contracted insurance of the Medi24 model could use the telephone consultation service of the medical call centre Medi24 (mainly part of the mandatory basic health insurance) voluntarily and free of charge whereas individuals holding an insurance policy of the Telmed model (special contract within the mandatory basic health insurance with a premium discount ranging from 8% to 12%) were obliged to have a telephone consultation before arranging an appointment with a medical doctor. METHODS: A cross-sectional study was carried out in the medical call centre Medi24 based on all triage datasets of the Medi24 and Telmed groups collected during the one year period from July 1st 2005 to June 30th 2006. The distribution of the six different urgency levels within the two groups and their respective pattern of service utilisation was determined. In a multivariable logistic regression model the Odds Ratio for every enquiry originating from the Telmed group versus those originating from the Medi24 group was calculated. RESULTS: During a one-year period 48 388 triage requests reached the medical call centre Medi24, 56% derived from the Telmed group and 44% from the Medi24 group. Within the Medi24 group more than 25% of the individuals received self-care advice, within the Telmed group, on the other hand, only about 18% received such advice. In contrast, 27% of the Telmed triage requests but only 18% of the Medi24 triage requests resulted in the advice to make a routine appointment with a medical doctor. The probability that an individual of the Telmed group obtained the advice to go to the accident and emergency department was lower than for an individual of the Medi24 group (OR 0.77, 95% CI 0.60-0.99). Likewise, the probability of self-care advice was decreased in regard to the Medi24 group (OR 0.80, 95% CI 0.75-0.85). However, regarding the advice to make a routine appointment with a medical doctor, the Telmed group was represented more frequently than the Medi24 group (OR 1.36, 95% CI 1.28-1.44). CONCLUSION: In respect of the triage advice, the Telmed group differed significantly from the Medi24 group within all urgency levels. The differences between the two groups in respect of the advice given were still less pronounced than expected against the background of their different contract conditions and the disparate temporal pattern of utilisation. We interprete this finding with the fact that appraising the urgency of health problems appropriately seems to be very difficult for the majority of people seeking advice.

Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off Campus Referral for Contraception at Two School-Based Clinics

PURPOSE: The purpose of this study was to assess the impact of different policies on access to hormonal contraception and pregnancy rates at two high school-based clinics. METHODS: Two clinics in high schools (Schools A and B), located in a large urban district in the southwest US, provide primary medical care to enrolled students with parental consent; the majority of whom have no health insurance coverage. The hormonal contraceptive dispensing policy of at School clinic A involves providing barrier, hormonal and emergency contraceptive services on site. School clinic B uses a referral policy that directs students to obtain contraception at an off-campus affiliated family planning clinic. Baseline data (age, race and history of prior pregnancy) on female students seeking hormonal contraception at the two clinics between 9/2008-12/2009 were extracted from an electronic administrative database (AHLERS Integrated System). Data on birth control use and pregnancy tests for each student was then tracked electronically through 3/31/2010. The outcomes measures were accessing hormonal contraception and positive pregnancy tests at any point during or after birth control use were started through 12/2009. The appointment keeping rate for contraceptive services and the overall pregnancy rates were compared between the two schools. In addition the pregnancy rates were compared between the two schools for students with and without a prior history of pregnancy. RESULTS: School clinic A: 79 students sought hormonal contraception; mean age 17.5 years; 68% were > 18 years; 77% were Hispanic; and 20% reported prior pregnancy. The mean duration of the observation period was 13 months (4-19 months). All 79 students received hormonal contraception (65% pill and 35% long acting progestin injection) onsite. During the observation period, the overall pregnancy rate was 6% (5/79); 4.7% (3/63) among students with no prior pregnancy. School clinic B: 40 students sought hormonal contraception; mean age 17.5 years; 52% > 18 years; 88 % were Hispanic; and 7.5% reported prior pregnancy. All 40 students were referred to the affiliated clinic. The mean duration of the observation period was 11.9 months (4-19 months). 50% (20) kept their appointment. Pills were dispensed to 85% (17/20) and 15% (3/20) received long acting progestin injection. The overall pregnancy rate was 20% (8/40); 21.6% (8/37) among students with no prior pregnancy. A significantly higher frequency of students seeking hormonal contraception kept their initial appointment for birth control at the school dispensing onsite contraception compared to the school with a referral policy for contraception (p<0.05). The pregnancy rate was significantly higher for the school with a referral policy for contraception compared to the school with onsite contraceptive services (p< 0.05). The pregnancy rate was also significantly higher for students without a prior history of pregnancy in the school with a referral policy for contraception (21.6%) versus the school with onsite contraceptive services (4.7%) (p< 0.05). CONCLUSION: This preliminary study showed that School clinic B with a referral policy had a lower appointment keeping rate for contraceptive services and a higher pregnancy rate than School clinic A with on-site contraceptive services. An on-site dispensing policy for hormonal contraceptives at high school-based health clinics may be a convenient and effective approach to prevent unintended first and repeat pregnancies among adolescents who seek hormonal contraception. This study has strong implications for reproductive health policy, especially as directed toward high-risk teenage populations.