PubMed Health⌕ Search

Biomedical subjects

G C Cunningham

Publications and source records attributed to G C Cunningham.

53 records · Page 3Linked to original sources
PubMed1982

Fetal growth and perinatal viability in California.

To produce more appropriate information for evaluating fetal growth and viability, vital records data were used to compute percentile curves and perinatal, neonatal, and fetal mortality rates at specific birth weights and gestational ages. Percentile values were in good agreement with previous studies, and the large number of births (2,288,806) allowed for a more precise determination of fetal viability at various weight-age combinations than has been previously available. Mortality rates were found to be much more sensitive to birth weight than to gestational age, especially for small-for-gestational age fetuses. Optimal weight-age combinations were found to be up to 500 g and 2 weeks greater than the average combination. The results consistently emphasize the importance of rapid and sustained fetal growth at all gestational ages.

Birth Weight↗
PubMed1980

Monitoring perinatal mortality rates: California, 1970 to 1976.

Recent developments have emphasized the need to monitor perinatal mortality statistics by small geographic areas. A method is presented which separates county-specific perinatal mortality rates into a component reflective of socioeconomic, behavioral, and environmental variables, and a component that relates more directly to hospital-based intra- and postpartum care. Major differences in geographic variations were observed between the crude rate and the two components. An arbitrary index of the need for perinatal health services was created by combining the two components with the number of perinatal deaths in each county. Although there are some obvious limitations, the index serves as a useful guidepost for monitoring perinatal mortality on a statewide basis.

Bayes Theorem↗
PubMed1971

Therapeutic abortions in California.

Therapeutic abortions in California have increased from 5,030 in 1968 to 15,339 in 1969, and over 60,000 are estimated for 1970. Also, there are pronounced regional differences in therapeutic abortions relative to live births. In 1969 the San Francisco Bay Area had six times as many abortions (115 per 1000 births) as did the Los Angeles Metropolitan Area (19). Preliminary figures for 1970 indicate this difference may be narrowed to a two-fold difference by the end of the year. Experience in other countries indicates morbidity and mortality risks are high in procedures done after the twelfth week, and in California one abortion in four is done after this period. Planning is needed to assure access to abortion services in all areas of the State and to meet the obligations of law and equity implicit in the Therapeutic Abortion Act. This should include counseling, follow-up, and referral services and not just the abortion procedure alone. Extension and more effective use of family planning services could substantially reduce unwanted pregnancies and the consequent demand for abortion. Efforts are also indicated to reduce the proportion of women terminating pregnancy after the twelfth week of gestation.Deaths associated with illegal abortions have decreased from 35 in 1966-1967 to 22 in 1968-1969. This is consistent with the view that the number of illegal abortions is decreasing.

Abortion, Therapeutic↗
PubMed1969

Two years of PKU testing in California. The role of the laboratory.

A cooperative phenylketonuria screening program involving private nongovernmental laboratories, individual physicians and local and state health departments has been in operation for two years. The system has evolved to the point where practically all newborns are tested. The accuracy of laboratory work has been verified by an ongoing evaluation program which has resulted in continual improvement in level of performance. There are two areas in which some beneficial changes might be considered. One is the reduction of costs of the testing and follow-up by increasing volume and centralization of work. The other is greater cooperation of the medical community in collecting the data necessary to evaluate the program and expedite the final diagnosis.

California↗
PubMed1966

Phenylketonuria. Early detection, diagnosis and treatment.

Phenylketonuria can now be detected during the first few days of life by two reliable mass screening techniques; and its major consequence, severe mental retardation, can be prevented by the early institution of a low phenylalanine diet. Case finding, based on determination of phenylalanine serum levels in newborns before discharge from the hospital, appears to yield an acceptable number of new cases without excessive numbers of false positive or false negative tests at the 4 mg per 100 ml reporting level. Feeding history does not appear to be a major factor in influencing test results. In addition to finding cases of phenylketonuria, newborn blood screening has called attention to another group of infants with hyperphenylalaninemia of other causes. The differential diagnosis in such cases is important because the restrictive diet necessary for patients with phenylketonuria might be harmful to others. Such factors as enzymatic immaturity, heterozygote carriers, maternal enzymatic capacities and other amino-acidemic states must be ruled out by thorough examination. Careful observation, investigation and reporting of experience with these patients will help to eliminate some of the present deficiencies in the knowledge of normal and abnormal amino acid metabolism.

Diagnosis, Differential↗
PubMedDate not supplied

Issues in implementing prenatal screening for cystic fibrosis: results of a working conference.

PURPOSE: To summarize a conference convened to examine how cystic fibrosis screening might appropriately be introduced into routine prenatal practice. METHODS: Participants included experts from various relevant disciplines. Systematic reviews and data from individual trials were presented; issues were identified and discussed. RESULTS: Judged by published criteria, prenatal cystic fibrosis screening is suitable for introduction. Screening can be performed cost-effectively by identifying racial/ethnic groups at sufficient risk and then using either of two models for delivering laboratory services. Validated educational materials exist. Ethical issues are not unique. CONCLUSIONS: Once adequate facilities for patient and provider education, testing, counseling, quality control, and monitoring are in place, individual programs can begin prenatal screening for cystic fibrosis.

Clinical Trials as Topic↗
PubMedDate not supplied

Cost and effectiveness of the California triple marker prenatal screening program.

PURPOSE: To report the utilization of services offered and pregnancy outcomes for a unique statewide prenatal triple marker screening program and to present a cost-benefit analysis. A state population of 32 million with considerable ethnic and age distribution and with a wide variety of delivery systems providing prenatal care was considered. The entire pregnant population who appeared for care before 20 weeks gestation, approximately one-half million per year during the years of 1995 to 1997, was included in the study. METHODS: Mandatory offering of serum testing, using alpha-fetoprotein from 1986 to 1995, and the addition of human chorionic gonadotropin and unconjugated estriol in 1995, with systematic follow-up of serum screen positives with ultrasound and amniocentesis. This study collected and analyzed the program data and reports of outcomes and collected similar information from the birth defects registry. RESULTS: Triple marker serum screening was accepted by 67.4% of the women eligible and yielded an initial positive rate of 7.3%. More than 90% of the initially screen positive pregnancies were seen at a prenatal diagnostic center. After correction of gestational age, 71.3% had amniocentesis. The overall amniocentesis rate among women screened was 2.6%. The Program's detection rate was predicted to be 85% for neural tube defects, and, based on Monte Carlo modeling, was theoretically calculated to be 62% for Down syndrome. In practice, detection rates were 75% for neural tube defects and 41% for Down syndrome due to lower than expected amniocentesis acceptance rate. Nevertheless, at a 5% discount rate, the screening program was cost beneficial at a ratio of 2.69:1. The cost per case detected was $35,365 and per case prevented was $110,741. CONCLUSION: It is possible to implement a cost-effective population-based screening in compliance with quality standards in a diverse ethnic population with a variety of health-care providers. Triple marker screening in the second trimester is a cost beneficial program even if utilization of all services is less than ideal.

Biomarkers↗