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Biomedical subjects

A Handler

Publications and source records attributed to A Handler.

14 recordsLinked to original sources
PubMed1992

Improving pregnancy outcomes: public versus private care for urban, low-income women.

This study describes the characteristics of women who received maternity care from the Chicago Department of Health or from private practitioners in 1988 and the first half of 1989, and who delivered at the University of Illinois Hospital or Cook County Hospital. The risk of preterm low birthweight for the infants of these women was compared according to source of prenatal care. The likelihood of giving birth to a preterm, low-birthweight infant was significantly greater (odds ratio 3.1, 95% confidence interval 2.3-4.0) for women who received care only from private physicians (n = 530) compared with those who received care entirely from the Chicago Department of Health (n = 2465). This relationship remained after adjustment for race, age, parity, history of adverse pregnancy outcomes, smoking, and use of drugs during pregnancy. We examined alternative explanations for these findings, and concluded that although the role of urban public health departments in the direct delivery of maternity care services continues to be a source of controversy, these institutions remain an important provider of such care for low-income women.

Chicago↗
PubMed1992

Mortality of American Indian and Alaska native infants.

Accurate determination of infant mortality rates among Indians in seriously hampered by variations in the identification of Indian persons and use of different subsets of the Indian population for various purposes. Lack of consistency in the reporting of racial origin on birth and death records is a source of substantial error. Because of these factors, more than the usual care must attend comparisons and inferences drawn from data in which these differences are present. At present, it would seem prudent to regard all data about American Indians as provisional. Even though Indian infant mortality remains higher than that for US all races, regardless of techniques used for estimates, the decline of Indian infant mortality by more than 80% since the establishment of the IHS is a truly remarkable achievement. This success has been ascribed to a combination of activities, including the provision of safe drinking water, especially as an integral part of the IHS program; the nearly universal immunization of Indian children; and emphasis upon comprehensive, community-oriented programs focused on maternal and child care. These successes have contributed to changes in the distribution of the leading causes of Indian infant mortality, so that the most prominent causes now are SIDS, congenital anomalies, injuries, and various infections. Because of these changes and advances in knowledge, the IHS has recently revised its five-year plan for dealing with infant mortality to provide greater attention to injuries and infections and has embarked upon a series of discussions with the American Academy of Pediatrics to address postneonatal deaths and the difficult problem of SIDS. Low socioeconomic conditions, so important in influencing mortality rates (7, 14, 29), have thus far proved to be intractable. In the meantime, success will depend upon ensuring optimal prenatal care, reducing those risk factors amenable to correction, and solving the problem of SIDS.

Alaska↗
PubMed1991

Cocaine use during pregnancy: perinatal outcomes.

The relation between maternal cocaine use and perinatal outcomes was investigated among 17,466 non-Asian singleton deliveries in 1988 from the University of Illinois Perinatal Network data base in the metropolitan Chicago area. Elevated adjusted relative risks (RR) of low birth weight (RR = 2.8, 95% confidence interval (CI) 2.2-3.7), prematurity (RR = 2.4, 95% CI 1.9-3.1), abruptio placentae (RR = 4.5, 95% CI 2.4-8.5), and perinatal death (RR = 2.1, 95% CI 1.1-4.0) were observed for "any" cocaine users (n = 408) compared with women who did not use cocaine or any other drugs or alcohol (n = 17,058). There was an increased (although unstable) risk of intrapartum placenta previa not previously reported (RR = 2.3, 95% CI 1.0-5.1). The relative risk of small-for-gestational-age births for cocaine users who did not smoke (RR = 3.4, 95% CI 1.8-6.5) was greater than that for cocaine users who did (RR = 2.1, 95% CI 1.1-4.1). Irrespective of smoking status, cocaine use during pregnancy increased the risk of small-for-gestational-age births.

Abruptio Placentae↗
PubMed1991

Regional perinatal care in crisis: a case study of an urban public hospital.

Regionalized perinatal care is intended to guarantee pregnant women and neonates access to appropriate care regardless of ability to pay. Its effectiveness depends on the willingness of hospitals to transfer high-risk patients according to established protocols and affiliations. This study examines maternal transfers (n = 896) to Cook County Hospital (CCH), a public facility and a designated perinatal center in Chicago. In 1987 and 1988, the majority (68%) of maternal transfers to CCH came from out-of-network hospitals, and 52% of these came directly from another perinatal center. The data indicate that 62% of the out-of-network transfers who delivered were medically high-risk. The study also documents the transfer of women in active labor, a violation of federal law. The term "perinatal dumping" is introduced to mean the transfer of high-risk pregnant women between hospitals for economic rather than medical reasons. Strategies for safeguarding the integrity of regionalized perinatal care are discussed.

Adolescent↗
PubMed1990

A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal data base.

In one regional perinatal network between 1982-1987, 101,506 women delivered infants greater than 500 g, of which 1253 were twin pregnancies (1.2%). This latter group was compared statistically with a 5% random sample of the singletons (N = 5119). The results showed that the women with twin pregnancies were slightly older, had a higher parity, gained more weight during the gestation, and had a heavier body weight at delivery. Twin pregnancies were complicated by increases in hypertension (odds ratio 2.5; 95% confidence interval 2.1-3.1), abruption (odds ratio 3.0; 95% confidence interval 1.9-4.7), and anemia (odds ratio 2.4; 95% confidence interval 1.9-3.0). There was no increased risk of pyelonephritis, placenta previa, or diabetes mellitus in mothers with twins. The twin pregnancies delivered earlier and the infants were smaller, had lower Apgar scores, and were at increased risk for congenital anomalies. Fetal and neonatal mortality rates were significantly increased in the twin infants; the perinatal mortality rates for twin A and twin B were 48.8 and 64.1, respectively, compared with 10.4 per 1000 births for the singleton controls. When the twin infants A and B were of similar weight, they had a similar perinatal mortality (odds ratio 1.0; 95% confidence interval 0.6-1.8). For infants less than 2500 g, twins A and B had lower fetal and neonatal mortality rates than did singletons, but twins heavier than 2500 g were at increased risk of perinatal death.

Adult↗
PubMed1989

The relationship of smoking and ectopic pregnancy.

A case-control study, using data abstracted between 1983 and 1987 from a large perinatal registry, was conducted to explore the relationship between smoking and ectopic pregnancy. Women with ectopic pregnancy (n = 634) seen at University of Illinois Perinatal Network Hospitals were compared to women who were delivered of a single live-born infant (n = 4287). Adjusted for age and race, women who reported smoking during pregnancy had a greater than twofold risk of ectopic pregnancy (Odds Ratio = 2.5, 95% confidence interval = 1.9, 3.2) compared to women who never smoked. The estimated relative risk rose from 1.4 (95% CI = 0.8, 2.5) for a woman smoking fewer than 10 cigarettes a day to 5.0 (95% CI = 2.9, 8.7) at one and a half or more packs of cigarettes per day (p-value for trend less than 0.001). Although further basic and epidemiologic research is necessary, the observed dose-response relation strengthens the argument that smoking may be a causal factor in the development of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1988

Changes in discrimination learning and brain activity (ERP's) due to combined exposure to NO and CO in rats.

Carbon monoxide (CO) and nitric oxide (NO) are air pollutants frequently appearing in combination. Information available on the mechanisms of NO intoxication suggests that in mixtures with CO additive effects should be assumed. In this study CO and NO-induced changes and their interaction were investigated at different levels of integration: carboxyhemoglobin (COHb) and methemoglobin (met-Hb) formation as well as centrally mediated effects were analyzed using evoked potential techniques and behavioral data from a complex discrimination learning experiment. Slight enhancements of COHb and met-Hb concentrations were seen for the combined CO + NO exposure conditions at low and high exposure levels when compared to isolated exposure conditions. The performance decrease was clearly higher under NO exposure than under CO exposure. Decrements were overadditive when simultaneous CO + NO exposure was used in higher concentration. Both gases affected early evoked potential components (P10, N30) in the same way: latencies were prolonged and amplitudes increased. Later potential components were differently influenced by CO and NO. Mainly the N150 amplitude was decreased in NO exposure and increased in CO conditions. N150 amplitude was also decreased after combined CO + NO exposure. At high levels this effect was overadditive indicating a dominant role of NO in the CO + NO combinations used in this experiment.

Animals↗