Factors associated with self-reported, pesticide-related visits to health care providers in the agricultural health study

To investigate factors associated with pesticide-related visits to health care providers (i.e., doctor or hospital visits), responses to self-administered questionnaires received from 35,879 licensed restricted-use pesticide applicators participating in the Agricultural Health Study were analyzed. (In Iowa, applicators are actually certified, whereas in North Carolina they are licensed; for ease of reference, the term license will be used for both states in this paper.) The cohort reported a total of more than 10.9 million pesticide-application days. These applications were associated with one or more pesticide-related health care visits by 2,214 applicators (7.0% of the applicator cohort for whom health care visit data were available). The odds of a pesticide-related health care visit were increased for commercial applicators compared to private applicators [odds ratio (OR = 1.77; 95% confidence interval (CI), 1.52-2.06) and for applicators who used insecticides 70 times or more in their lifetime compared to those who used insecticides less frequently (OR = 1.43; CI, 1.26-1.63). After adjusting for the number of applications in a logistic regression model, significantly higher odds of health care visits were observed among North Carolina applicators compared to Iowa applicators (OR = 1.35; CI, 1.17-1.52), among applicators who mixed their own pesticides (OR = 1.65; CI, 1. 22-2.23), and among applicators who personally repaired their pesticide application equipment at least once per year (OR = 1.12; CI, 1.06-1.25). Significantly lower odds were found among female versus male applicators (OR = 0.68; CI, 0.46-0.99) and among applicators who graduated from high school versus those who did not (OR = 0.82; CI, 0.71-0.94 for high school graduates and OR = 0.79; CI, 0.68-0.91 for those with at least some college). Several methods of pesticide application to crops, seed, or stored grain were also associated with significantly elevated odds ratios of health care visits. These observations suggest that several steps can be taken to reduce the number of health care visits resulting from occupational exposure to pesticides. The implications of this pattern of pesticide-related health care visits may have etiologic implications for cancer and other chronic diseases.     

Breast-feeding in Egypt

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Development, behaviour and temperament: a prospective study of infants conceived through in-vitro fertilization

The development, behaviour and temperament of 65 singleton infants conceived through in-vitro fertilization (IVF) and 63 matched controls were compared at 1 year postpartum. Primiparous women were recruited during pregnancy and their infants' development was assessed at 1 year. In addition, test-taking behaviour was evaluated by an examiner using the Bayley behaviour rating scale and mothers completed a behaviour problem checklist and temperament scale. Mental, motor, speech and social development were appropriate for age, with no significant group differences. While receptive language development was in the normal range, IVF infants scored lower than control infants. Across both groups, mothers reported low levels of behaviour difficulty and mean temperament ratings were in the general population range. There were no group differences in observed test-taking behaviour. However, IVF mothers rated their children at a higher level of behaviour difficulty and more reactive than the ratings given by control mothers. Overall, singleton children conceived through IVF demonstrate appropriate general development at 1 year of age. The higher reported behaviour difficulty experienced by IVF mothers may reflect their concerns about the well-being and adjustment of their child during the first year.     

1988 National Maternal and Infant Health Survey: methods and response characteristics

OBJECTIVES: The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. METHODS: The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. RESULTS: The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more. CONCLUSIONS: The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.     

The outcome of twin pregnancies after IVF

It has been suggested that the high rates of prematurity, low birth weight, perinatal morbidity and mortality in in-vitro fertilization (IVF) infants are due to the increased frequency of multiple gestations in this population. The aim of our study was to test this hypothesis by comparing the outcome of IVF twins with that of twins born after spontaneously conceived pregnancies. The perinatal outcome of 40 IVF twins was compared with that of 80 control twins, matched for maternal age, parity and ethnic origin. IVF twins had a higher rate of prematurity (P = 0.03), their mean birth weight was significantly lower (P < 0.01) and the frequency of very low birth weight infants was much higher (P < 0.003). There was no neonatal mortality in the control group, whereas four IVF twins died (P < 0.01). Neonatal morbidity was significantly greater in IVF twins (P < 0.05). Oxygen therapy and mechanical ventilation were administered more frequently to IVF twins (P < 0.007 and P < 0.05). We conclude that twins conceived by IVF are at a significantly higher risk for prematurity and associated neonatal morbidity and mortality than spontaneously conceived twins.     

Access and outcomes of elderly patients enrolled in managed care

OBJECTIVE: To determine differences in access to care and medical outcomes for Medicare patients with an acute or a chronic symptom who were enrolled in health maintenance organizations (HMOs) compared with similar fee-for-service (FFS) nonenrollees. DESIGN: A 1990 household telephone survey of Medicare beneficiaries who reported joint pain or chest pain during the previous 12 months. SAMPLE: Stratified random sample of HMO enrollees (n = 6476) and comparable sample of FFS Medicare beneficiaries (n = 6381). ACCESS AND OUTCOME MEASURES: Care-seeking behavior, physician visits, diagnostic procedures performed, therapeutic interventions prescribed, follow-up recommended by a physician, and symptom response to treatment. RESULTS: After controlling for demographic factors, health and functional status, and health behavior characteristics, HMO enrollees with joint pain (n = 2243) were more likely than nonenrollees (n = 2009) to have a physician visit (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.03 to 1.38) and medication prescribed (OR, 1.35; 95% CI, 1.14 to 1.60). Patients with chest pain who were enrolled in HMOs (n = 556) were less likely than nonenrollees (n = 524) to have a physician visit (OR, 0.50; 95% CI, 0.30 to 0.82). For both joint and chest pain, HMO enrollees were less likely to see a specialist for care, have follow-up recommended, or have their progress monitored. There were no differences in complete elimination of symptoms, but HMO enrollees with continued joint pain reported less symptomatic improvement than nonenrollees (OR, 0.72; 95% CI, 0.59 to 0.86). CONCLUSIONS: Reduced utilization of services for patients with specific ambulatory conditions was observed in HMOs with Medicare risk contracts, with less symptomatic improvement in one of the four outcomes studied.     

Evaluation of long-term follow-up of glomerular function in renal transplant recipients

The determinants and outcomes of unwanted pregnancies were explored in a prospective study of 1454 women who delivered in Moscow, Russia, during 1984-85. Mothers were interviewed during their postpartum hospital stay and again 3 years later. 131 women (9%) demonstrated a negative attitude toward their pregnancy. Another 72 women (5%) had a negative attitude initially, but developed positive feelings over the course of the pregnancy. The percentage of unwanted pregnancies was 2.9 times greater among unmarried women (14.9%) than married women (5.1%). Poor marital relationships, inadequate living conditions, tobacco/alcohol use, and low per capita income were found significantly more often among women with unwanted pregnancies. Significantly more infants of mothers with unwanted than wanted pregnancies had infants who were premature (28.3% vs. 9.5%) and low birth weight, but there was no significant difference in neonatal complications. Mothers of unwanted infants also were more likely to delay prenatal care and attend infrequently and, once the child was born, made fewer visits to the pediatrician. Even if unwanted pregnancy has no adverse medical sequelae, being unwanted should be considered a psychosocial risk factor with implications for a child's development.     

Rapid depletion of plasma tryptophan: a review of studies and experimental methodology

The body mass is one of the major indicators which determine the clinical condition of newborns, influence the rate of neonatal mortality and further development of newborns. In order to prevent malformations it is necessary to identify factors which impair the fetus development and cause fetal hypotrophy. The main objective of the study was to find out whether mothers' occupational work affected the body mass of infants born at term. The study covered a group of 1015 women randomly sampled among those who had delivered their babies in the Polish Mother Memorial Hospital in Lód?, during the years 1992-94. In this group the percentage of working women accounted for 69%. The comparison of the body mass in infants born to women employed and not employed during pregnancy did not indicate differences. However, it was found that male infants born to employed mothers showed a lower body mass than those born to not employed mothers. The effect of some factors modifying infants' body mass was different in the case of not employed women than in those employed. In the group of not employed women a significantly lower body mass in infants was observed in the following subgroups: mothers under 24 years of age, spontaneous abortion of one of previous pregnancies, consumption of large quantity of caffeine (equivalent of > two cups of coffee), and poor economic status. Smoking during pregnancy decreased the body mass of infants in both groups of women. In the group of working women, chronic diseases before pregnancy and diseases involving fever during pregnancy proved to be factors affecting the body mass of infants. The indicators of perinatal medical care (the beginning of medical care and the number of visits during pregnancy) in working women were better than in those not working. None of factors characterizing occupational work affected significantly the body mass of infants. Slightly lower infants' body mass was observed only in those born to mothers working overtime (> 9 hrs daily), involved in hard physical work or working in the environment with harmful chemical and physical factors. According to the data obtained, a negative effect of occupational work on the fetus development should not be overestimated. Nevertheless, the performance of occupational work may aggravate a negative effect of woman's bad health condition on the fetus development.     

Meningiomas in the region of the cavernous sinus: a review of 21 patients

OBJECTIVE: To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; > or = 2500 g) Malaysian infants during the first year of life. METHODOLOGY: Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity. RESULTS: Compared with NBW infants (n = 106), VLBW infants (n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [CI]: 1.1 to 354.3), wheezing (OR = 3.7, 95% CI: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% CI: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% CI: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% CI: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI 89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% CI for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life. CONCLUSIONS: Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neuro-developmental morbidities.     

Does excessive adenosine 5''-triphosphate formation in cells lead to malignancy? A hypothesis on cancer

PROBLEM: Neonatal outcome of in vitro fertilization (IVF) pregnancies has been described by different authors, but several issues have yet to be resolved. The aim of the present study was to evaluate neonates conceived in vitro and to direct special attention to neonatal morbidity and prevalence of minor abnormalities. The information that has been accumulated so far is scant. METHOD: The first 100 babies conceived in vitro, and subsequently born in our institute, were investigated and compared with the general, spontaneously conceived newborn population. All infants were examined by a senior neonatologist, and the data that were recorded included gestational age at delivery, birth weight, gender, major malformations, minor congenital abnormalities, neonatal mortality, and neonatal morbidity (including asphyxia, jaundice, meconium aspiration, hypoglycemia, and hypocalcemia). RESULTS AND CONCLUSIONS: The data indicate that the IVF neonates assessed had a higher rate of low birth weight (37%), twinning (30%), and preterm birth (20%) in comparison with the general reference population (p < 0.05). However, no differences were encountered either in the rate of small for gestational age infants or the incidence of major malformations and minor abnormalities between these groups of newborns. The overall neonatal morbidity in IVF babies was found to exceed that of the general population. Nevertheless, at birth, there were no clinical pathognomonic signs typical of IVF babies, although more detailed metabolic, endocrine, and neurobehavioral studies are still required to confirm that newborns conceived in vitro do not differ from those conceived spontaneously in any of these respects.     

Ambulatory health care use by patients in a public hospital emergency department

OBJECTIVE: To describe primary care clinic use and emergency department (ED) use for a cohort of public hospital patients seen in the ED, identify predictors of frequent ED use, and ascertain the clinical diagnoses of those with high rates of ED use. DESIGN: Cohort observational study. SETTING: A public hospital in Atlanta, Georgia. PATIENTS: Random sample of 351 adults initially surveyed in the ED in May 1992 and followed for 2 years. MEASUREMENTS AND MAIN RESULTS: Of the 351 patients from the initial survey, 319 (91%) had at least one ambulatory visit in the public hospital system during the following 2 years and one third of the cohort was hospitalized. The median number of subsequent ED visits was 2 (mean 6.4), while the median number of visits to a primary care appointment clinic was O (mean 1.1) with only 90 (26%) of the patients having any primary care clinic visits. The 58 patients (16.6%) who had more than 10 subsequent ED visits accounted for 65.6% of all subsequent ED visits. Overall, patients received 55% of their subsequent ambulatory care in the ED, with only 7.5% in a primary care clinic. In multivariate regression, only access to a telephone (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.39, 0.60), hospital admission (OR 5.90; 95% CI 4.01, 8.76), and primary care visits (OR 1.68; 95% CI 1.34, 2.12) were associated with higher ED visit rates. Regular source of care, insurance coverage, and health status were not associated with ED use. From clinical record review, 74.1% of those with high rates of use had multiple chronic medical conditions, or a chronic medical condition complicated by a psychiatric diagnosis, or substance abuse. CONCLUSIONS: All subgroups of patients in this study relied heavily on the ED for ambulatory care, and high ED use was positively correlated with appointment clinic visits and inpatient hospitalization rates, suggesting that high resource utilization was related to a higher burden of illness among those patients. The prevalence of chronic medical conditions and substance abuse among these most frequent emergency department users points to a need for comprehensive primary care. Multidisciplinary case management strategies to identify frequent ED users and facilitate their use of alternative care sites will be particularly important as managed care strategies are applied to indigent populations who have traditionally received care in public hospital EDs.     

Use of formal and informal sources of mental health care among older African-American public-housing residents

BACKGROUND: Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents. METHOD: Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care. RESULTS: Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07). CONCLUSIONS: Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.     

Maternal flu, fever, and the risk of neural tube defects: a population-based case-control study

Results of clinical and epidemiologic studies have shown an increased risk for neural tube defects (NTD) in infants whose mothers were exposed to heat during pregnancy. However, the risk for NTD in infants whose mothers had influenza during pregnancy has not been well studied. This population-based case-control study of infants born in metropolitan Atlanta, Georgia, from 1968 through 1980 included 385 infants with NTD, 3,647 infants with other birth defects, and 2,676 infants without birth defects. Of the 385 mothers of case infants, 31 reported having a 2-day or longer episode of flu with fever from 1 month before through 3 months after conception (odds ratio (OR) = 3.0; 95% confidence interval (CI) 1.9-4.7). Infants of mothers who took medications for their episodes of flu with fever had an even higher risk for NTD (OR = 4.3, 95% CI 2.6-7.1). When mothers of infants with birth defects other than NTD were used as controls, an increased risk of NTD remained for flu with fever (OR = 1.7, 95% CI 1.1-2.5). There was no increased risk for NTD among the infants of mothers who reported fever from causes other than flu. Because of the heterogeneity of maternal flu, the individual contributions of infection, fever, and medications remain difficult to disentangle.     

Delayed childbearing--are there any risks?

OBJECTIVE: To determine whether women delivering their first child at age 35 years or older are at increased risk of adverse (non-genetic) pregnancy outcomes. DESIGN AND SETTING: A cross-sectional analytic study of singleton deliveries in Northern Sydney Area Health Service (NSAHS) hospitals. PARTICIPANTS: All women aged > or = 20 years delivering their first child between 1 January 1990 and 31 December 1991. MAIN OUTCOME MEASURES: Obstetric complications and procedures, type of delivery and neonatal outcomes. RESULTS: Compared with women aged 20-29 years, women delivering their first child at > or = 35 years were at increased risk of pre-existing maternal hypertension (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.0), antepartum haemorrhage (adjusted OR, 2.4; 95% CI, 1.6-3.7), preterm delivery (33-36 weeks) (adjusted OR, 2.0; 95% CI, 1.5-2.8) and breech presentation (adjusted OR, 1.8; 95% CI, 1.3-2.4). Women aged > or = 35 years were also substantially more likely to have an operative delivery, induced labour and/or epidural anaesthesia. Neither these women nor their infants were at increased risk of pregnancy-induced hypertension, gestational diabetes, threatened premature labour, postpartum haemorrhage, very preterm delivery (< or = 32 weeks), perinatal death, low Apgar scores or the need for neonatal resuscitation. CONCLUSIONS: Women who delay the birth of their first child face some increased risks, but these risks, for the most part, are manageable in the context of modern obstetric care.     

Postdischarge utilization of medical services by high-risk infants: experience in a large managed care organization

BACKGROUND: Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants. OBJECTIVES: Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both controls using computerized files in a managed care organization. METHODS: Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality. RESULTS: The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population. CONCLUSION: Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.     

Elevated heart rate variability in physically active young and older adult women

OBJECTIVE: To determine if participation in group sessions as part of health supervision visits for infants improves outcomes compared with individual visits in high-risk mothers. STUDY DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Mothers of young infants who had at least 1 of the following risk factors: aged younger than 20 years at delivery, participation in Medicaid, less than a high school education, previous or ongoing substance abuse, or history of abuse as a child. SETTING: Two urban university pediatric clinics in Seattle, Wash. INTERVENTIONS: Mother-infant dyads were randomized to receive group well-child care (GWCC) or individual well-child care (IWCC) before the infant was 4 months old; the intervention continued until the child was 15 months old. Mothers completed the Sense of Competence and Social Isolation subscales from the Parenting Stress Index and Sarason's Social Support Questionnaire at enrollment and again on completion of the study. During the 11-month study period, 7 health supervision visits were scheduled for each mother-infant dyad. Social workers met periodically with mothers during the study and assessed the following functional outcomes: return to school, return to work, enrollment in a substance abuse treatment program, and becoming pregnant. In addition, data on study children were collected from Child Protective Services to assess referrals because of suspected abuse and/or neglect. RESULTS: Data were collected on 213 mother-infant dyads, including 108 who received GWCC and 105 who received IWCC. At the conclusion of the study period, similar proportions of GWCC and IWCC mothers scored in the high-risk range on the Sense of Competence subscale, Social Isolation subscale, and the Social Support Questionnaire (P=.57, .32, and .59, respectively). For more than 50% of the mothers, scores on the Sense of Competence and Social Isolation subscales deteriorated during the study period from the not-high-risk range to the high-risk range, regardless of assignment to GWCC or IWCC. No differences were noted between GWCC and IWCC mothers for any functional outcome. During the study period, 8.8% of children receiving GWCC were referred to Child Protective Services vs 8.3% of those receiving IWCC (P=.85). CONCLUSION: The format of well-child care may not be an important determinant of outcomes among high-risk mothers.     

Gorham massive osteolysis

The training of health workers in breastfeeding and lactation management is to enable them make correct breastfeeding recommendations to mothers. This study aims to provide answers to two research questions: what components of breastfeeding training are easily achieved with extension health workers, and what health worker variables affect these outcomes. Multivariable analysis of the outcomes of a controlled breastfeeding training programme for community health workers (CHW) in rural communities of Osun State, Nigeria, was performed by logistic regression. The results show that the training was the most powerful predictor of correct CHW recommendations on breastfeeding (OR = 60.25, p-0.0000), and of 'perfect' breastfeeding knowledge (OR = 192.49, p = 0.0000). Younger CHWs (in the age bracket 20 to 29 years) were significantly more likely to make correct recommendations on exclusive breastfeeding (OR = 3.02, p = 0.0304). Other CHW variables such as sex, experience, job status, and marital status did not make consistently significant independent contributions to the outcomes. The results suggest that breastfeeding education can enhance CHW professional recommendations on breastfeeding and should be extended to all categories of health workers.     

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births

PURPOSE: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies. METHODS: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy. RESULTS: The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth. CONCLUSIONS: Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.     

Use of emergency departments by elder patients: a five-year follow-up study

OBJECTIVE: To compare the use of emergency medical care by elders in the United States in 1995 with that previously described for 1990. METHODS: A computerized billing database of 88 EDs in 21 states was retrospectively reviewed for 1995, comparing elder and nonelder patients, estimating national use of emergency medical services by elders, and comparing the 1995 data with previously published results for 1990. RESULTS: From 1990 to 1995, the number of ED visits in the United States increased from 92 million to 100 million. The number of visits made by patients aged 65 years or older increased from 13,639,400 (15%) to 15,666,300 (15.7%), but this increase did not reach statistical significance (p = 0.17). The admission rate for elder ED patients increased from 32% to 46% over the five-year interval (p<0.01). This represents more than 7 million hospital admissions for elder patients in 1995. The rate of intensive care unit (ICU) admission for elders decreased from 7% to 6% over the five-year interval (p = 0.56), compared with 1.3% for nonelder patients for both years. Thirty percent of elder ED patients arrived by ambulance in 1990, compared with 33% in 1995 (p = 0.02). Based on 1995 data, elders comprised 39% of patients arriving by ambulance [odds ratio (OR) 4.75, 95% confidence interval (CI) = 4.71 to 4.79], 43% of all admissions (OR 6.59, 95% CI = 6.54 to 6.64), and 47% of ICU admissions (OR 5.00, 95% CI = 4.91 to 5.09). The comparable ORs in 1990 were 4.4, 5.6, and 5.5, respectively. CONCLUSIONS: From 1990 to 1995, the overall number of ED visits increased. The rate of increase was somewhat greater for elder patients. The use of ambulance services also disproportionately grew among elder patients, as did the rate of hospital admission. The overall rate of ICU admission was stable, but actually fell modestly for elder patients. Of these changes, only the increase in the rate of hospital admission for elders reached statistical significance.     

Effects of social, familial, and maternal state variables on neonatal and infant health.

The medical protocols of a Danish birth cohort of 5,036 infants were summarized into 5 infant outcome measures: birth weight, neonatal physical health, neonatal neurological status, 1-yr physical health, and 1-yr motor development. All Ss received uniform medical care during pregnancy. 17 indices representing both medical and environmental variables were used as predictors in hierarchical regression analyses. Consistent negative environmental influences on neonatal outcomes were not found, presumably due to the uniform medical care during pregnancy that each mother received. A stronger environmental influence was observable at 1 yr of age. Institutional daycare, mother's employment, family size, whether the child was planned, and SES all contributed significantly to the regression equation for 1-yr physical health. This effect was anticipated, since no uniform medical treatment was provided the cohort subsequent to birth. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)