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Biomedical subjects

A A Herman

Publications and source records attributed to A A Herman.

33 records · Page 2Linked to original sources
PubMed1988

Infant feeding in an urban community.

Two hundred randomly selected mothers were interviewed approximately 1 year post-partum to establish how they had fed their babies and the number of attacks of gastro-enteritis these infants had had; 129 of the babies were examined, primarily for their nutritional status. The majority of mothers (97%) began by breast-feeding and 50% were still doing so at 20 weeks. By 4 weeks 20% had introduced formula feeds. Although some mothers introduced solids very early, the overall pattern was very similar to UK data. The infants' mean weight and length compared well with the 50th centile on the Boston Growth Chart. Infants on prolonged breast-feeding were no better off nutritionally than those in whom breast-feeding was stopped before 12 weeks. It could not be demonstrated that prolonged breast-feeding in this community protected infants against gastro-enteritis, probably because few babies were exclusively breast-fed.

Breast Feeding↗
PubMed1988

Evaluating obstetric risk scores by receiver operating characteristic curves.

The purpose of obstetric risk scoring systems is to identify pregnancies that will end in poor perinatal outcomes such as perinatal death. The proportion of such pregnancies identified by a risk scoring system can be increased by choosing a more lenient threshold criterion for the score beyond which the pregnancy is regarded as being at risk. This increase in sensitivity is gained at the expense of a decrease in specificity. Thresholds differ between published risk scoring systems, making it difficult to assess their relative merits using the measures of sensitivity and specificity. However, risk scores can be compared by constructing receiver operating characteristic curves, i.e., plotting the true positive rate against the false positive rate for multiple thresholds and calculating the area under the receiver operating characteristic curve (theta). In published systems used in this paper, values of theta, used to rank published obstetric risk scoring systems, ranged from 0.49-0.95. All scores used prepregnancy and early antenatal information. The risk scores with the highest predictive accuracy tended to include factors representing past reproductive experience and those from the late antenatal and intrapartum periods. Studies with statistical weighting of risk factors tended to use fewer late prenatal and intrapartum risk factors.

Female↗
PubMed1987

C-reactive protein as a predictor of fetal and maternal infective morbidity and fetal mortality.

The value of maternal C-reactive protein (CRP) levels as predictors of fetal and maternal infective morbidity and fetal mortality was assessed prospectively over a 6-month period in all cases of premature rupture of the fetal membranes or suspected premature labour. Statistical analysis of results showed that CRP at a level of 1.32 mg/dl is a sensitive marker of infective morbidity in mother and neonate. Furthermore, there was a significant association between raised CRP levels and low-birth-weight babies, suggesting that intra-uterine infection is a major cause of prematurity in the study population.

C-Reactive Protein↗
PubMed1987

Needs for special-care beds for the newborn in the Witwatersrand area.

The requirements for different levels of neonatal care in the Witwatersrand area were estimated from a review of neonatal unit records of all infants born at Johannesburg Hospital during 1983 and 1984. When extrapolating these figures to the greater population of the Witwatersrand and referral areas, adjustments were made for the increased number of low-birth-weight and complicated deliveries at Johannesburg Hospital. Given the low-birth-weight rate of 8% for this population, it was calculated that 3.3 intermediate-care beds and 1.2 intensive-care beds were justified per 1,000 annual live births. A total of 25 beds for mechanical ventilation of neonates were required over this study period, approximately double the number available. Facilities for other population groups, who have higher rates for low birth weight, were even less adequate. For the country as a whole it is recognised that postneonatal mortality is a greater problem amenable to less costly intervention than neonatal mortality; nevertheless, existing facilities for neonatal care should be used more efficiently, and a co-ordinated regional service for all population groups in the area should be established.

Bed Occupancy↗
PubMed1987

Systolic blood pressure differences in black, colored, and white infants.

Systolic blood pressure was measured in a random cluster sample of three-month-old black (n = 532), colored (n = 496), and white (n = 637) infants in Johannesburg, South Africa, by means of a Parks Doppler ultrasound device with a random zero sphygmomanometer. The study was conducted during a nine-month period in 1981. Major predictors of systolic pressure measurements were which fieldworker had taken the measurement and whether the child was quiet or agitated. After adjustment for predictors as necessary, the mean systolic blood pressure of black infants was about 2 mmHg higher than that of coloreds, which was statistically significant, with suggestive evidence that coloreds have a systolic pressure about 1 mmHg higher than that of whites. Findings at age three months may represent ethnic differences in blood pressure distributions of genetic origin.

Black People↗
PubMed1985

Changes in infant mortality rates among whites, coloureds and urban blacks in the RSA over the period 1970-1983.

Using national mortality statistics, we found that infant mortality rates (IMRs) declined among whites and coloureds in the RSA over the period 1970-1983, the decrease in coloured IMR being from 134,8 to 50,7/1 000 and that in white IMR from 21,6 to 12,6/1 000. The decrease in the IMR among coloureds was mainly due to the decline in post-neonatal mortality rates (PNMRs). Since post-neonatal deaths are generally due to gastro-enteritis, pneumonia, malnutrition and measles, the decline in mortality is probably due to a decrease in these causes. The decrease in early neonatal mortality made only a small contribution to the decline in the IMR among coloureds. In the case of whites the decrease in the IMR was largely due to the decline in the early neonatal mortality rate (ENMR); these deaths usually result from low birth weight, the respiratory distress syndrome, asphyxia and infections. The decline in the PNMR played a minor role. National IMRs for blacks are not reported annually, but IMRs can be calculated for the two census years 1970 and 1980 for blacks in 34 'selected' (urban) magisterial districts, and were 124,4 and 85,9/1 000 respectively. A valid IMR for 'rural' Transkei from a well-conducted epidemiological study was 130/1 000 in 1980. The components of the IMRs for blacks can only be determined for certain urban areas with large black populations such as Soweto (adjacent to Johannesburg), where the IMR fell from 81,4/1 000 in 1970 to 25,5/1 000 in 1983. The decline in the IMR was due to decreases in both the ENMR and the PNMR.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗
PubMed1984

Screening for liver metastases from ovarian cancer with serum carcinoembryonic antigen and radionuclide hepatic scintiphotography.

The association between pre-operative serum carcinoembryonic antigen (CEA) and liver scanning employing technetium (99mTc)-tin colloid was investigated in 30 women subsequently proven to have primary epithelial ovarian carcinoma to determine whether these two investigations improve the detection of hepatic metastases. The upper limit of normal for CEA (greater than or equal to 5 ng/ml) did not represent the optimal levels for use in predicting ovarian carcinoma nor the presence of liver metastases. But with CEA levels greater than 10 ng/ml sensitivity for liver metastases was 57%. Liver scanning alone demonstrated metastases in five out of seven patients (71%) with parenchymal liver metastases. The combination of CEA and liver scan was positive in six out of these seven patients (86%).

Adult↗
PubMedDate not supplied

Liver morphology in southern African blacks with hepatocellular carcinoma: a study within the urban environment.

Hepatocellular carcinoma has a lower prevalence and presents at a later age in urban Blacks than in rural Blacks. These differences have previously been shown not to be attributable to differences in serum hepatitis B virus markers. In the present study, the average age of patients with hepatocellular carcinoma in a developing urban Black population is shown to have risen from 38.9 to 56.5 years (p less than 0.0001) over a 20-year interval, while the prevalence of co-existing cirrhosis has declined from 66 to 44% (p less than 0.05) and tissue HBsAg positivity has fallen from 44 to 17.7% (p = 0.002). The lower prevalence of tissue HBsAg in the recent patients may be explained by their older age. Macronodular cirrhosis was present in 56% of cases in the earlier period but declined to 18.9% in the later period, with micronodular cirrhosis becoming the dominant nontumor pathology (p = 0.002). Liver damage attributable to the abuse of alcohol is now found in more than half of the cases (48/90) of hepatocellular carcinoma occurring in this population. The remainder show no changes (12 cases) or show macronodular or incomplete septal cirrhosis (30 cases), presumed to be of viral origin. The latter cases are more likely to have serum markers of current hepatitis B virus infection than those with evidence of alcohol abuse. We conclude that alcohol is increasing in importance as an etiologic association of hepatocellular carcinoma in urban South African Blacks. At the same time, the prevalence of macronodular cirrhosis (and of cirrhosis as a whole) in urban patients with this tumor has declined. The reason for this decline is not known.

Adult↗
PubMedDate not supplied

Pooled pasteurized breast milk and untreated own mother's milk in the feeding of very low birth weight babies: a randomized controlled trial.

It has been shown that milk derived from mothers with term infants is not optimal for premature babies. There is also concern about the effect of heat sterilizing breast milk. At Baragwanath Hospital, the majority of mothers remain with and care for their premature babies. Over many years, pooled pasteurized breast milk has been fed to these babies before direct breast feeding is instituted. A study was done to compare feeding pooled pasteurized breast milk and untreated own mother's milk to very low birth weight babies. There was a significantly more rapid weight gain both in terms of regaining birth weight and, from this point, to reaching a weight of 1,800 g when using untreated own mother's milk. This occurred in spite of the fact that there was little difference, especially in terms of energy content, between the two types of breast milk. This was due to the fact that the pooled pasteurized milk was also largely obtained from mothers of premature babies. It is suggested from our data that slower weight gain in the group receiving the pooled pasteurized milk could be due to the pasteurization, which probably destroys heat-labile milk lipase.

Body Weight↗
PubMedDate not supplied

Analysis of neonatal and infant mortality data for the white population of the Witwatersrand.

Statistics of population size, number of births, and neonatal and infant mortality for the White populations of 10 Witwatersrand municipalities were studied. Sources of data were: (i) national statistics from the Central Statistical Services; and (ii) annual reports from the local authorities. The two sources correlated well for population size and number of births (r = 0,99), less so for infant deaths (r = 0,71), and not at all for neonatal deaths (r = 0,43). Causes of infant mortality were also studied, using national and local reports. Comparison of hospital records with those of the local Department of Health revealed significant coding errors in the recording of causes of death. The mechanisms for reporting births and deaths are discussed and suggestions for improvements in the system are made.

Death Certificates↗
PubMedDate not supplied

Toward a conceptualization of race in epidemiologic research.

This paper is a review of the prevailing conceptual basis of the use of race in health research. The author explores the current definitions of race in health research, and describes some of the history of race fabrication. In the examination of the association between race and disease the author describes black/white differences in age-adjusted mortality, infant mortality rates and birthweight. The analysis of race and disease is frustrated by incomplete theoretical constructs. Race, as used in health research, tends to be a unidimensional construct and the complex interplay between race and other social status variables is simplified. These problems are illustrated, and the author suggests a multidimensional construct of race.

Black or African American↗
PubMedDate not supplied

Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status.

The relationship between pregnancy wantedness and adverse pregnancy outcomes was studied using data from 2,828 mothers who participated in the Missouri Maternal and Infant Health Survey. The wantedness of a pregnancy was measured using traditional classifications of mistimed and unwanted, as well as additional measures gauging how the woman felt about the pregnancy while she was pregnant. Fifty-eight percent of the very low birth weight infants and 59% of the moderately low birth weight infants resulted from unintended pregnancies, as did 62% of the normal-birth-weight infants. Logistic regression showed that mothers of very low birth weight infants were significantly more likely than those who had a normal-weight baby to report that they had felt unhappy about the pregnancy (odds ratio of 1.53). Very low birth weight was also associated with early denial of the pregnancy (1.54). Odds ratios associating these two unwantedness categories with low-birth-weight babies were higher among Medicaid recipients than among women not receiving Medicaid. Associations between very low birth weight and the denial variable were also significant among white women when very low birth weight outcomes were compared with normal outcomes, but there was no significant association among black women. There were no significant associations between low birth weight and the traditional unwantedness variables.

Adolescent↗
PubMedDate not supplied

The relationship between prenatal health behavior advice and low birth weight.

OBJECTIVES: The purposes of the study were (a) to examine the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight and (b) to describe the type and frequency of health behavior advice offered to a group of pregnant women. METHODS: The authors used data from the National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey, a follow-back survey of women who had delivered very low birth weight infants and of matched control subjects who had delivered moderately low birth weight and normal birth weight infants. Frequency distributions for different types of prenatal health behavior advice were examined for the 2205 participants, and logistic regression analyses were used to determine whether there was a relationship between birth weight and receiving the advice recommended by the Expert Panel. RESULTS: Only 10.4% of mothers reported receiving all seven types of health behavior advice recommended by the Expert Panel. Women who did not receive all seven types of advice were 1.5 times more likely to deliver a very low birth weight infant than a normal birth weight infant. CONCLUSIONS: Further research is needed to better understand the relationship between health education and birth weight.

Adult↗