Trends in cesarean section rates for the United States, 1970--78

With National Hospital Discharge Survey data collected by the National Center for Health Statistics as a basis, rates of cesarean section deliveries were computed for the United States and its regions for 1970 through 1978. For each year and within each region, trends were examined according to variations in the mother's color, age, and marital status and in the hospital size (number of beds), the form of hospital ownership, and the length of the mother's hospital stay. Within each region and for each variable considered, cesarean section deliveries rose fairly uniformly. Nationally, C-sections comprised 5.5 percent of all deliveries in 1970, but rose steadily to comprise 15.2 percent of all deliveries in 1978. Overall, 1978 rates were highest in the Northeast, among whites, among women age 30 and over, among married women, in hospitals with 500 beds or more, and in proprietary hospitals. The mean length of the mother's hospital stay in 1978 was 6.7 days for cesarean section deliveries and 3.2 days for other deliveries, down from the mean hospital stay of 7.8 days for C-sections and 3.9 days for other deliveries observed in 1970.     

Health impact of peptic ulcer in the United States

OBJECTIVES: To assess the general outcome and impact of current and previous peptic ulcer disease on health status in the United States. METHODS: During the National Health Interview Survey of 1989, a special questionnaire on digestive diseases was administered to 41,457 randomly selected individuals. Various measures of impaired health in ulcer patients were expressed by their age- and sex-standardized prevalence rates. RESULTS: Ten to 15% of all subjects with a recent ulcer reported that they had been in poor health, incapable of major activity, or unable to work for some time during the 12 months preceding the interview. Twenty to 25% of the subjects with recent ulcers complained about restricted activity and had spent 7 or more days per year in bed. About 40% of all ulcer subjects had seen a physician five or more times within 12 months before the interview. These percentages were significantly lower in patients with previous ulcer histories but no active ulcer within 12 months, but they were still significantly higher than in subjects with no ulcer history at all. In the United States, expenditures attributed to recent ulcers amounted to $5.65 billion per year. CONCLUSIONS: In the United States, peptic ulcer disease is associated with major morbidity. Ulcer cure would result in large economic and medical savings.     

Trends in rates of occupational fatal injuries in the United States (1983-92)

Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.     

Cesarean delivery rates in 1995 continue to decline in the United States

The anaesthesia management of a 10-year old girl with a fracture to her distal arm is presented, using inhalational anaesthesia with a laryngeal mask and a supplementary axillary plexus block. Due to light anaesthesia the patient vomited during the course of surgery resulting in a severe pulmonary aspiration necessitating four days of mechanical ventilation in the ICU. The safety of the laryngeal mask airway for emergency surgery is discussed.     

Revision rates after knee replacement in the United States

We present a force plate system which measures low-magnitude vertical reaction forces generated by small laboratory animals. The force plate mechanical design minimizes radiated transverse waves, acoustic reverberation, and standing waves caused by impacts on the force plate surface. A secondary force plate and PC-based software algorithm minimize floor vibrational artifact. The force plate was used to measure function of rats during two tests: forelimb/hindlimb hopping reaction and surface righting reaction. In control rats, forelimb hopping rate exceeded hindlimb hopping rate during 16 weeks of repeated testing. Subchronic intraperitoneal (i.p.) dosing of 10 mg/kg/day acrylamide produced a selective impairment of hindlimb hopping. In contrast, single doses of haloperidol (1-5 mg/kg, i.p.) slowed the righting reaction and produced a relatively selective impairment of forelimb hopping. The force plate system presents new opportunities for performing quantitative neurological assessments of small laboratory animals when previously such tests had been performed subjectively and qualitatively.     

Severity measurement methods and judging hospital death rates for pneumonia

Payers and policymakers are increasingly examining hospital mortality rates as indicators of hospital quality. To be meaningful, these death rates must be adjusted for patient severity. This research examined whether judgments about an individual hospital's risk-adjusted mortality is affected by the severity adjustment method. Data came from 105 acute care hospitals nationwide that use the Medis-Groups severity measure. The study population was 18,016 adults hospitalized in 1991 for pneumonia. Multivariable logistic models to predict in-hospital death were computed separately for 14 severity methods, controlling for patient age, sex, and diagnosis-related group (DRG). For each hospital, observed-to-expected death rates and z scores were calculated for each severity method. The overall in-hospital death rate was 9.6%. Unadjusted mortality rates for the 105 hospitals ranged from 1.4% to 19.6%. After adjusting for age, sex, DRG, and severity, 73 facilities had observed mortality rates that did not differ significantly from expected rates according to all 14 severity methods; two had rates significantly higher than expected for all 14 severity methods. For 30 hospitals, observed mortality rates differed significantly from expected rates when judged by one or more but not all 14 severity methods. Kappa analysis showed fair to excellent agreement between severity methods. The 14 severity methods agreed about relative hospital performance more often than expected by chance, but perceptions of individual hospitals' mortality rates varied using different severity adjustment methods for almost one third of facilities. Judgments about individual hospital performance using different severity adjustment approaches may reach different conclusions.     

Survival rates for four forms of cancer in the United States and Ontario

OBJECTIVES: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. METHODS: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. RESULTS: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. CONCLUSIONS: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors.     

The prevalence of cervical cancer screening iin the United States in 1970

Peripheral receptors signalling in both the 3 main divisions of the trigeminal nerves and in the glossopharyngeal nerves are most likely involved in the onset of the apnea in diving ducks. Since the response also takes place when ducks are submerged in mercury, these peripheral receptors are hardly specific to water. Neither any of the 3 main groups of trigeminal, nor the glossopharyngeal receptors are alone responsible for the initiation of the apnea. Most likely the apnea takes place when the total impact on the 'respiratory centre' in the brain exceeds a certain treshold value, due to activation of a certain number of both trigeminal and glossopharyngeal peripheral receptors. However, even very local stimulation of the glottal area invariably evoked apnea, indicating a higher density of receptors there than for example on the beak or in the nares. This idea is supported by the fact that not even heavy rain evokes any response at all. It is unlikely that the cardiovascular adjustments displayed by diving ducks are directly coupled to the apnea response (i.e. to stimulation of peripheral receptors). Rather they are supposed to be components in orienting and chemoreceptor reflexes.     

Trends in HIV incidence among young adults in the United States

CONTEXT: Behaviors that result in potential exposure to human immunodeficiency virus (HIV) usually begin in adolescence or young adulthood, but trends in HIV incidence in young people remain unclear. OBJECTIVE: To estimate trends in HIV incidence in teenagers and young adults. DESIGN AND SETTING: Back-calculation of past HIV incidence in persons born between 1960 and 1974 using US national acquired immunodeficiency syndrome (AIDS) incidence data and estimates of the distribution of times between HIV infection and AIDS. MAIN OUTCOME MEASURES: Incidence and prevalence of HIV in 1988 and 1993 in persons aged 20 and 25 years, respectively, in each of those years. RESULTS: As of January 1993, about 22000 men and 11000 women aged 18 to 22 years were living with HIV infection in the United States. Homosexual contact was the leading route of infection among young men. Heterosexual contact was the leading route of infection among young women. The HIV incidence attributed to homosexual contact or injection drug use decreased among persons aged 20 and 25 years between 1988 and 1993, but HIV incidence attributed to heterosexual contact was stable or increasing. Notably, in men aged 20 and 25 years, HIV prevalence declined by about 50% in white men but was relatively stable in black and Hispanic men. In contrast, HIV prevalence in women aged 20 and 25 years rose by 36% and 45%, respectively, because of increasing heterosexual transmission. Overall, HIV prevalence in persons aged 20 and 25 years declined by only 14% between 1988 and 1993. CONCLUSIONS: In young persons, HIV incidence in homosexual men and injection drug users was slowing by 1993; this favorable trend was offset by increasing heterosexual transmission, especially in minorities.     

The diffusion of new hospital technologies in the United States

Increases in the real resources used in hospital care have been an important cause behind rising hospital costs in the United States. Many of these resources have taken the form of new hospital technologies, and this paper begins by reviewing the trends in adoption of new hospital technologies over the years 1950-1974. The resource requirements, costs , and to the extent possible the patient benefits, of two of these technologies are then discussed in more detail: intensive care, a widespread facility with many variations, has been a major contributor to hospital costs; radiotherapy has been characterized by a succession of competing technologies. Regulatory efforts such as certificiate-of-need reviews would be more effective if they viewed hospitals as flexible collections of such technologies-with the costs and patient benefits of each to be weighed separately-rather than primarily in terms of numbers of beds. A national center to collect information on the separate technological functions of hospitals and make it available to interested groups would make a useful contribution to hospital regulation.     

Effect of genetic differences in omeprazole metabolism on cure rates for Helicobacter pylori infection and peptic ulcer

We report a 65-year-old woman with thyrotropin (TSH) secreting pituitary adenoma, who was diagnosed based on the lack of inhibition of serum TSH despite an increased serum free thyroxine (T4), a low response of serum TSH to thyrotropin releasing hormone, and a pituitary tumor as revealed by magnetic resonance imaging. The pituitary adenoma was, however, inoperable due to chronic respiratory failure. The treatment with octreotide in a dose of 100 microg b.i.d. resulted in inhibition of serum TSH and free T4 to euthyroid levels and considerable shrinkage of the pituitary tumor. These effects were continued over 8 months after the start of octreotide therapy without any adverse effects. These findings add further evidence that octreotide is useful for treating inoperable TSH secreting pituitary adenoma.     

Trends in contraceptive use in the United States: 1982-1995

CONTEXT: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS: Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS: The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS: The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women.