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Biomedical subjects

J W Buehler

Publications and source records attributed to J W Buehler.

At least 73 records · Page 4Linked to original sources
PubMed1986

Maternal mortality in women aged 35 years or older: United States.

To examine maternal mortality among women aged 35 years or older, we used death certificates from the United States for 1974 through 1978. There were 425 maternal deaths, corresponding to a mortality rate of 58.3 deaths per 100,000 live births. This rate was higher than the rate for women 20 through 34 years of age (race-adjusted relative risk [RR] = 4.0; 95% confidence interval [CI], 3.6 to 4.4). The leading causes of death were obstetric hemorrhage and embolism. Black women had higher mortality rates than white women for deaths without abortive outcomes (RR = 3.3; CI, 2.7 to 4.1) and with abortive outcomes (RR = 9.4; 95% CI, 5.8 to 15.3), and the latter difference was largely due to a higher rate of deaths associated with ectopic pregnancy among black women. From 1974 through 1978, compared with 1982, maternal mortality rates for women aged 35 years or older reported by the National Center for Health Statistics declined approximately 50%. Among white women, changes in age and parity accounted for less than half of this decrease, suggesting that improvements have occurred in age- and parity-specific mortality for women aged 35 years or older.

Abortion, Spontaneous↗
PubMed1986

Motorcycle-associated fatalities in Georgia, 1980-1981.

In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent of motorcycle-associated fatalities did not involve another vehicle, and head injuries alone or in combination with other injuries were responsible for death in approximately half. Helmet use, an effective measure for preventing motorcycle-associated fatalities, is required in Georgia; additional injury prevention strategies are discussed.

Accidents, Traffic↗
PubMed1986

Infant mortality in a rural health district in Georgia, 1974 to 1981.

In 1979 the infant mortality rate (IMR) dropped nearly 50% in a rural health district in southeast Georgia, and this lower rate continued during the next two years. For infants born during 1979 to 1981, the IMR was 12.4 as compared with 21.6 for those born from 1974 to 1978. Using linked birth and infant death records to identify shifts in the components of infant mortality in this district, we found that the change in IMR primarily reflected a decrease in neonatal and postneonatal deaths among infants with birth weight greater than or equal to 2,500 gm, rather than a change in the distribution of birth weights. Although the IMR was approximately twofold higher in white than in black infants, a similar relative decline in mortality was observed in both racial groups. For infants weighing greater than or equal to 2,500 gm, approximately half of the lower death rate was due to fewer deaths caused by infections. The decline in mortality in this district was greater than declines in neighboring districts and accompanied efforts to improve services for medically indigent mothers and infants. The findings suggest that in areas with high infant mortality, initial efforts to lower mortality should focus on primary care programs rather than more specialized interventions.

Black or African American↗
PubMed1985

The risk of serious complications from induced abortion: do personal characteristics make a difference?

We examined the age, gestational age, parity, race, and number of previous spontaneous and induced abortions of 82,030 women who obtained abortions at less than or equal to 24 weeks' gestation. Among these women, 342 (0.4%) had serious complications, including 130 (0.2%) with fever greater than or equal to 38 degrees C for 3 or more days, 172 (0.2%) who required transfusions, 67 (0.1%) who required unintended surgery, and three who died. Factors significantly (p less than 0.05) associated with serious complications varied by period of gestation, including previous induced abortions (adjusted relative risk = 1.57, 95% confidence interval = 1.03 to 2.40) for procedures done at less than or equal to 12 weeks' gestation, advancing age (relative risk for a 5-year increment = 1.12, 95% confidence interval = 1.01 to 1.24), and advancing gestational age (relative risk for a 2-week increment = 1.50, 95% confidence interval = 1.43 to 1.57) for procedures done at greater than 12 weeks, and greater than or equal to 1 previous delivery (relative risk = 1.34, 95% confidence interval = 1.03 to 1.75) for all gestational ages. Although Hispanic women had higher rates of complications compared with white women, data were not available to control for socioeconomic status in comparing race groups. There was no significant association between previous spontaneous abortions and serious complications. Risk patterns were similar, but not identical, when fever, operation, and transfusion were considered separately.

Abortion, Induced↗
PubMed1985

Unexplained deaths in a children's hospital. An epidemiologic assessment.

During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33 infant deaths during this nine-month period occurred between midnight and 6:00 a.m., as compared with 1 of 10 infant deaths during a separate 27-month period (P less than 0.001). Although nearly all deaths occurred in patients with serious congenital heart disease, epidemic-period deaths were more likely to have an unexpected timing and a clinical pattern consistent with digoxin toxicity. In four patients, forensic and clinical digoxin measurements suggested that an intravenous overdose of digoxin had been administered shortly before death. Although a review of nursing schedules revealed a strong association (relative risk, 64.6) between infant deaths and the duty times of a particular nurse, the cause of the epidemic remains unclear. The study led to suggestions that the hospital strengthen central control over procedures for dispensing medicines and implement a system for monitoring the occurrence of deaths by time and place within the hospital.

Digoxin↗
PubMed1985

Postponing or preventing deaths? Trends in infant survival, Georgia, 1974 through 1981.

Trends in survival were examined for infants in five birth-weight groups (500 to 999 g, 1,000 to 1,499 g, 1,500 to 1,999 g, 2,000 to 2,499 g, and greater than or equal to 2,500 g). The study population consisted of infants born in Georgia from 1974 through 1981. Survival to the first birthday increased for all birthweight groups. Improvements in postneonatal survival occurred concurrently with improvements in neonatal survival, except for infants with birth weights of 500 to 999 g. Between 1974-1975 and 1980-1981, the proportion of deaths that were attributed to perinatal conditions but occurred during the postneonatal period increased from 1.1% to 4.7%. These observations suggest that advances in perinatal care have led to postponement rather than prevention of a few infant deaths, although overall many more deaths were prevented. For infants with birth weights of less than 1,500 g, lower mortality among those admitted to newborn intensive care units was the major contributor to improved survival. Our findings indicate that both neonatal and postneonatal mortality should be examined in evaluating the effects of perinatal care.

Georgia↗
PubMed1984

Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention.

In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.

Adenoviridae Infections↗
PubMed1983

Gnat sore eyes: seasonal, acute conjunctivitis in a southern state.

In late summer 1981, a widespread outbreak of acute bacterial conjunctivitis occurred in southeast Georgia, affecting primarily grade-school children. This outbreak was similar to previously described seasonal conjunctivitis in the South. As suggested in previous studies, the eye gnat, Hippelates pusio, may serve as a mechanical vehicle in the transmission of the suspected causative agent, a possible Haemophilus species. The 1981 Georgia outbreak illustrates that "gnat sore eyes" is not obsolete and apparently can occur unpredictably during warm months in the southern states. Physicians and other health-care workers should be aware of the unique clinical and epidemiologic features of acute seasonal conjunctivitis.

Acute Disease↗
PubMedDate not supplied

Trends in transfusion-associated acquired immune deficiency syndrome in the United States, 1982 through 1991.

To evaluate the efficacy of measures for preventing the transmission of human immunodeficiency virus (HIV) by blood transfusion, trends in transfusion-associated cases of acquired immune deficiency syndrome (AIDS) reported through June 1992 were analyzed. By year of transfusion, cases rose from 56 in 1978 to 714 in 1984, dropped sharply to 288 in 1985 when screening of donated blood for HIV antibody began, and fell below 20 per year from 1986 through 1991. Reinvestigation of a sample of cases suggested that only one-fourth of those attributed in the trends analysis to post-1985 United States transfusions actually were due to that source. By year of AIDS diagnosis, cases climbed from 14 in 1982 to 824 in 1987 and subsequently remained relatively level. Of cases diagnosed in 1991 with known transfusion dates, almost all resulted from transfusions received before 1986. Cases in persons aged > or = 65 years at diagnosis fell steeply after 1987, while those in persons aged 45 to 64 years leveled and those in persons aged 25 to 44 years continued to increase; this caused the median age to decrease from 59 in 1986 to 47 in 1991. Thus, screening and other measures have almost completely prevented transmission, but, because of infections acquired before screening began, many cases continue to be diagnosed among increasingly younger persons.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Norwalk gastroenteritis associated with a water system in a rural Georgia community.

An outbreak of acute gastroenteritis occurred during January 4-9, 1982, in a rural community in north Georgia. A systematic telephone survey revealed that 63% of persons living in homes served by the community water system had symptoms of acute gastroenteritis in contrast to 9% of persons in homes served by private wells or other sources (P less than .001). A fourfold rise in antibody titer to the Norwalk virus occurred in 20 of 22 serum pairs obtained from ill persons. Fecal coliforms (greater than 16 MPN/100 ml) were detected in a spring which served as one water source for the community system. Surface runoff from a heavy rainfall, which preceded the outbreak, may have contaminated the system. Outbreaks of gastroenteritis should be promptly reported and investigated to facilitate corrective measures and to identify causative agents such as Norwalk virus.

Disease Outbreaks↗
PubMedDate not supplied

Prevalence of antibodies to Legionella pneumophila among workers exposed to a contaminated cooling tower.

A serosurvey for antibodies to Legionella pneumophila was conducted among 206 employees of a power-generating plant. L. pneumophila serotype 6 and a non-typable L. pneumophila organism were isolated from cooling-tower water specimens at the plant, and antibody titers in workers were measured using homologous antigens prepared from these isolates. For the serotype 6 water isolate, none of workers with low cooling tower exposure, 4.6% with intermediate exposure, and 7.6% with high exposure levels had titers equal to or greater than 1:128 (P less than .05, Kruskal-Wallis test). For the non-typable L. pneumophila isolate, a similar trend was observed, but differences among workers in the three exposure groups were not statistically significant. No association was observed between antibodies to L. pneumophila serotypes isolated from cooling water and workers' age, race, smoking status, or duration of job assignment. None of the study employees had findings suggesting the occurrence of L. pneumophila pneumonia since the plant had been in operation. Use of respiratory protection devices by workers exposed to aerosols from cooling towers was not recommended.

Adult↗
PubMedDate not supplied

The reporting of race and ethnicity in the National Notifiable Diseases Surveillance System.

The authors used 1987 data from the Epidemiologic Surveillance Project (ESP) of the Centers for Disease Control to examine the completeness of race-ethnicity reporting in the National Notifiable Diseases Surveillance System. And, to the extent possible, they used ESP to assess racial and ethnic disparities in the occurrence of selected notifiable infectious diseases. For the 30 reporting areas (29 States and the District of Columbia) that provided data to ESP for all of calendar year 1987, approximately 60 percent of case reports were accompanied by specified race-ethnicity for affected persons. This percentage varied widely by disease and State. In general, non-Hispanic whites had morbidity rates (cases per 100,000 population per year) that were among the lowest compared with rates for other groups, and Native Americans commonly had rates that were among the highest. The ranking of morbidity rates among blacks, Hispanics, and Asians and Pacific Islanders varied by disease, although the last group had strikingly higher rates for malaria and tuberculosis. The age distribution of persons with cases was often lower among minority groups than among non-Hispanic whites, but the authors were unable to calculate age-specific or age-adjusted rates. Potential biases that limit interpretation of the findings are reviewed. Efforts to eliminate racial-ethnic disparities in the occurrence of infectious diseases would be aided by effective surveillance data. For the ESP to meet its potential in this regard, however, substantial improvements in the reporting of race-ethnicity for notifiable diseases are needed.

Adolescent↗
PubMedDate not supplied

Mortality in infants discharged from neonatal intensive care units in Georgia.

Although neonatal intensive care units (NICUs) have contributed to advances in neonatal survival, little is known about the epidemiology of deaths that occur after NICU discharge. To determine mortality rates following NICU discharge, we used linked birth, death, and NICU records for infants born to Georgia residents from 1980 through 1982 and who were admitted to NICUs participating in the state's perinatal care network. Infants who died after discharge (n = 120) had a median duration of NICU hospitalization of 20 days (range, 1 to 148 days) and a median birth weight of 1983 g (range, 793 to 5159 g). The postdischarge mortality rate was 22.7 per 1000 NICU discharges. This rate is more than five times the overall postneonatal mortality rate for Georgia from 1980 to 1982. The most common causes of death were congenital heart disease (23%), sudden infant death syndrome (21%), and infection (13%). Demographic characteristics commonly associated with infant mortality were not strongly associated with the mortality following NICU discharge.

Black or African American↗
PubMedDate not supplied

Overview of the National Infant Mortality Surveillance (NIMS) project--design, methods, results.

The recent slowdown in the decline of infant mortality in the United States and the continued high risk of death among black infants (twice that of white infants) prompted a consortium of Public Health Service agencies to collaborate with all States in the development of a national data base from linked birth and infant death certificates. This National Infant Mortality Surveillance (NIMS) project for the 1980 U.S. birth cohort provides neonatal, postneonatal, and infant mortality risks for blacks, whites, and all races in 12 categories of birth weights. (Note: Neonatal mortality risk = number of deaths to infants less than 28 days of life per 1,000 live births; postneonatal mortality risk = number of deaths to infants 28 days to less than 1 year of life per 1,000 neonatal survivors; and infant mortality risk = number of deaths to infants less than 1 year of life per 1,000 live births.) Separate tabulations were requested for infants born in single and multiple deliveries. For single-delivery births, tabulations included birth weight, age at death, race of infant, and each of these characteristics: infant's live-birth order, sex, gestation, type of delivery, and cause of death; and mother's age, education, prenatal care history, and number of prior fetal losses at 20 weeks' or more gestation. An estimated 95 percent of eligible deaths were included in the NIMS tabulations. The analyses focus on three components of infant mortality: birth weight distribution of live births, neonatal mortality, and postneonatal mortality. The most important predictor for infant survival was birth weight, with an exponential improvement in survival by increasing birth weight to its optimum level. The nearly twofold higher risk of infant mortality among blacks was related to a higher prevalence of low birth weights and to higher mortality risks in the neonatal period for infants weighing 3,000 grams or more, and in the postneonatal period for all infants, regardless of birth weight. Regardless of other infant or maternal risk factors, the black-white gap persisted for infants weighing 2,500 grams or more.

Birth Certificates↗
PubMedDate not supplied

Regional differences in birth weight-specific infant mortality, United States, 1980.

To describe regional differences in birth weight-specific infant mortality in the United States, we used data from the National Infant Mortality Surveillance project. The infant mortality risk (IMR) for the nation was 11.0 deaths per 1,000 live births. The risk (with 95 percent confidence intervals [CI]) for the four U.S. Census regions were West 9.9 (9.7 to 10.1), Northeast 10.4 (10.1 to 10.6), North Central 10.8 (10.6 to 11.0), and South 12.1 (11.9 to 12.3). In all regions, the IMR for blacks was approximately twice that of whites. Seventy-two percent of the higher IMR in the South was due to a higher proportion of black births compared with the remainder of the nation, reflecting the higher mortality rates suffered by black infants, and 28 percent to higher mortality among southern whites. The IMR for whites in the South was significantly higher than in the remainder of the nation: 9.8 versus 9.1 (relative risk = 1.09, CI = 1.06 to 1.11). Thirty-six percent of this excess in IMR was due to a higher frequency of low birth weight (less than 2,500 grams), 18 percent was due to higher IMR in infants with birth weight less than 2,500 grams, and 46 percent due to higher IMR in infants with birth weights of 2,500 g or more. Black infants born in the West had a lower risk of death than black infants in the other regions. When compared with the Northeast and South, 36 percent of the lower risk in the West among black infants was due to a lower frequency of low birth weight, 38 percent due to lower IMR in infants w'ith birth weight less than 2,500 g, and 26 percent to lower IMR in infants with birth weight of 2,500 g or more.

Birth Weight↗