Biomedical subjects

E F Mitchel

Publications and source records attributed to E F Mitchel.

26 records · Page 2Linked to original sources

PubMed1993

Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records.

In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.

Birth Certificates↗

PubMed1993

Prenatal use of metronidazole and birth defects: no association.

OBJECTIVE: To determine whether the use of metronidazole by pregnant women increases the risk of birth defects in the offspring. METHODS: Two cohorts of pregnant women who delivered live-born or stillborn infants between January 1, 1983 and December 31, 1988 were identified from the Tennessee Medicaid enrollment files. The exposed cohort consisted of 1387 women who filled a prescription for metronidazole between 30 days before and 120 days after the onset of their last normal menstrual period. The unexposed cohort consisted of 1387 comparable women who did not fill a prescription for metronidazole during the same time. Medical records for 94% of the offspring of both study cohorts were then reviewed to ascertain the occurrence of birth defects. RESULTS: Pregnancy outcomes were similar for the exposed and unexposed cohort members. There was no excess of overall birth defect occurrence in the offspring of exposed women (risk ratio 1.2, 95% confidence interval 0.9-1.6), nor could an excess risk be detected for any category of birth defects. CONCLUSION: This study provides no evidence that prenatal use of metronidazole increases the risk of overall birth defect occurrence.

Abnormalities, Drug-Induced↗

PubMed1991

Prenatal exposure to prescribed drugs in Tennessee Medicaid, 1983-1988.

This report describes the prenatal exposure histories of 107,804 women to prescribed drugs other than vitamins, iron and other minerals. The data were obtained from Tennessee Medicaid pharmacy files linked to birth and fetal death certificates for 1983-1988. The utility of these data to other investigators in predicting power or estimating sample size for studies of drug exposure in pregnancy associated with adverse birth outcomes is discussed.

Abnormalities, Drug-Induced↗

PubMedDate not supplied

ENDO-LAB: an integrated, portable endocrinology laboratory software system.

ENDO-LAB is an IBM PC-based system which performs calculations and record-keeping for the Vanderbilt University Medical Center Endocrinology Laboratory. It manages maintenance and quality control, and prints reports for regulatory agencies. The system was designed to minimize paperwork without changing laboratory procedures in any way. Key features of ENDO-LAB include a uniform user interface, and error detection mechanisms. The system is designed to detect data which has been incorrectly entered. In addition, where the efficacy of a test can be determined on the basis of limited data, preliminary graphs are screened as soon as possible, so that the user can terminate lengthy calculations whose outcome would be invalid or inconclusive. ENDO-LAB is an integrated system in that the same statistical and calibration programs can be applied to all of the analyses. The system is both extensible and portable; it has been successfully implemented outside Vanderbilt.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

Monitoring maternal mortality using vital records linkage.

We developed a method to identify maternal deaths (deaths to women within 365 days of delivery) by linking Tennessee vital records. A computerized algorithm compared personal identifiers from the death certificates of reproductive-aged women to maternal identifiers on birth and fetal death certificates. For each decedent record which met the study criteria, the algorithm calculated a "match score" by comparing common elements in both files. The algorithm awarded full credit for data elements that agree exactly, partial credit for elements in partial agreement, and subtracted credit for information that mismatched. Match scores ranged from 0 to 35 for the 9,009 deaths in women 10-55 years of age during the three study years, with the majority of scores (96.3%) being 0 for "no match." Match scores of 1 to 8 were obtained by 153 (1.7%) of decedent records, while scores greater than 9 were obtained by 184 (2.0%) of decedent records. We used nurse-abstracted hospital, autopsy, and coroner records as our standard to verify the linkages. Manual review of personal identifiers showed that scores of 12 or less were not a match while scores of 13 or more indicated "true" matches. Based on this cutoff, the linkage algorithm yielded 130 maternal deaths. Of these, 32 (25%) were classified as truly pregnancy-related upon medical record review by an obstetrician. The remaining 98 deaths were associated only temporally with pregnancy. During the same time period, 16 individuals were identified to the State Health Department on their death certificates as dying from pregnancy-related causes, including one not identified by the linkage process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Expanded Medicaid coverage for pregnant women to 100 percent of the federal poverty level.

Our objective was (1) to identify the subgroup of women most affected by the regulatory change expanding Tennessee Medicaid eligibility for pregnant women from 45% of the federal poverty level to 100% and (2) to examine whether increased enrollment correlated with greater use of prenatal care and improved reproductive outcomes. We linked Tennessee birth and fetal death certificates to Medicaid enrollment files. We compare outcome rates in the 12-month period before the change in the Medicaid regulations with similar rates for the 10-month period after the change had been in effect nine months. We found the increase in Medicaid enrollment that occurred after the expansion was greatest for teenage mothers. Among teens, Medicaid enrollment increased 18%, and the odds of receiving no prenatal care or only late (third-trimester) care were reduced 16% (95% confidence interval = 8%, 24%) after we controlled for potential confounders. However, there was no improvement in first-trimester use of prenatal care or in birth outcomes. This finding suggests the need to evaluate carefully subsequent regulatory changes, which sought to promote early prenatal care by removing barriers to early Medicaid enrollment in pregnancy.

Adolescent↗

PubMedDate not supplied

Evaluation of a program for prenatal care case management.

A prenatal care case-management program in Tennessee was evaluated to determine its effectiveness in improving the adequacy of prenatal care reducing the odds of preterm birth (gestation less than 37 weeks) and very low birth weight births (less than 1,500 g). The case-management program, Project HUG, included care provider referrals, visit scheduling, assistance with transportation and nutritional and health education. In a cohort of 66,051 Medicaid women with a birth during the period July 1989 through December 1991, 6% received HUG services. HUG participants had improved utilization of prenatal care, significantly decreased odds of inadequate perinatal care (an odds ratio of 0.71) and significantly increased odds of obtaining prenatal vitamins within 120 days of the last menstrual period (1.79). The apparent benefit of Project HUG was greater among blacks than among whites. However, there was no significant reduction in the incidence of preterm births or very low birth weight births among program participants

Black People↗

PubMedDate not supplied

Effect of Medicaid expansions on preterm birth.

OBJECTIVES: Inadequate prenatal care is thought to be a major modifiable risk factor for preterm birth, the leading cause of neonatal mortality. To improve high-risk women's financial access to prenatal care, the U.S. Medicaid program underwent major expansions during the 1980s. We evaluated these expansions over the nine-year period 1983 to 1991 in Tennessee to determine their effects on Medicaid enrollment, use of prenatal care, and preterm birth. METHODS: We used linked birth certificates, Medicaid data, and U.S. Census files to identify 610,056 singleton births to African-American or Caucasian women in Tennessee whose last menstrual period was between 1983 and 1991. These were classified by maternal characteristics to identify groups with the greatest postexpansion increases in Medicaid enrollment, which should have benefited most from the policy changes. Study outcomes were Medicaid enrollment by delivery, enrollment in the first trimester, inadequate prenatal care (modified Kessner index), and preterm (< 37 weeks) birth. We calculated the changes (delta expressed as births per 100) between 1983 and 1991 in percentages of births with each of these outcomes. RESULTS: The expansions led to pronounced increases in maternal Medicaid enrollment by delivery (21% of births in 1983 to 51% by 1991) and in the first trimester (from 10% to 37%). Married women with < 12 years of education, < 25 years of age, and < $12,500 mean neighborhood incomes (group 1) had the greatest increase, where enrollment and first-trimester enrollment increased from 24% to 86% and 7% to 68%, respectively. In group 1, the percentages of births with inadequate maternal use of prenatal care decreased substantially, from 12.8% in 1983 to 6.4% in 1991, a reduction of 6.4 births per 100 (95% confidence intervals [CI] = -7.6, -5.3). However, the preterm birth rate did not decrease (9.1% in 1983, 9.4% in 1991, change of 0.3[-0.7 to 1.2] births per 100). For other births, there were lesser increases in Medicaid enrollment, correspondingly lesser decreases in inadequate use of prenatal care, but no reductions in preterm birth rates. CONCLUSIONS: In Tennessee, the Medicaid expansions materially increased enrollment and use of prenatal care among high-risk women, but did not reduce the likelihood of preterm birth.

Adult↗