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Biomedical subjects

K G Keppel

Publications and source records attributed to K G Keppel.

17 recordsLinked to original sources
PubMed2000

Healthy People 2000: an assessment based on the Health Status Indicators for the United States and each state.

The Health Status Indicators (HSIs) were developed as part of the Healthy People 2000 process to facilitate the comparison of health status measures at national, State and local levels. In this report, the number of HSIs where the national target has been attained and the number of HSIs that have improved significantly are enumerated for the United States, the District of Columbia, and each State. Based on data for 1998, the United States had attained targets for 6 of the 17 HSIs with national targets. Twenty-three States had attained targets for 9 or more of the HSIs and 37 States had either attained the target for, or had made significant progress on, at least 12 of the indicators. Substantial progress has therefore been made since the Healthy People 2000 National Health Promotion and Disease Prevention Objectives were published in 1991.

Forecasting↗
PubMed1996

Preconceptional and prenatal multivitamin-mineral supplement use in the 1988 National Maternal and Infant Health Survey.

This paper examines the prevalence of multivitamin-mineral supplement use before and during pregnancy, as well as predictors of nonuse, in 9953 women who delivered live infants in the 1988 National Maternal and Infant Health Survey. Ninety-seven percent of the women were advised to take multivitamin-mineral supplements in prenatal care. Sixty-seven percent of Black mothers took supplements during pregnancy, as compared with 84% of White mothers. Multivariate analysis revealed that Black mothers; mothers who are less educated, younger, unmarried, and non-smokers; and mothers who participate in Women, Infants, and Children programs are at elevated risk for nonuse. These data help identify groups in need of supplementation guidance.

Adult↗
PubMed1995

What is assessment?

The Institute of Medicine's report on The Future of Public Health identified assessment, policy development, and assurance as core functions of public health. Assessment is a process whereby public health agencies identify health problems, identify health resources and evaluate their effectiveness, and present the results of these analyses to decision makers. These efforts are carried out through a division of labor among local, state, and federal agencies. The responsibility for assessment extends to all areas of the country and to every area of public health: from infectious diseases to chronic conditions, from behavioral risks to environmental hazards, and from motor vehicles to hand guns.

Health Planning↗
PubMed1993

Medical advice on maternal weight gain and actual weight gain. Results from the 1988 National Maternal and Infant Health Survey.

Weight gain advice showed a notable shift for white married mothers during the 1980s, with a large decline in reported advice of less than 22 pounds concomitant with a substantial increase in reported advice of 28 pounds or more. For black married mothers, there was little change in reported advice, except in the proportion of mothers who said they were advised to gain at least 35 pounds, which increased from 2 to 11%. It should be noted that it is not possible to corroborate the information on weight gain advice reported by mothers in 1980 or 1988 because of the lack of similar information from the providers of prenatal care. However, for the 1996 NMIHS, the feasibility of collecting such information from prenatal care providers will be examined. In view of the strong, positive relationship between maternal weight gain and birth weight, optimum weight gain advice for white and black mothers is critical. A recent nationwide survey of practicing dieticians found that 26% of the pregnant mothers they counseled believed that one shouldn't gain more than 20 pounds during pregnancy and that obese women didn't need to gain any weight at all. These beliefs were often culturally transmitted. Although only 12% of white mothers reported advice that did not meet the minimum standard in effect in 1988 and 19% reported advice that did not meet the minimum 1990 IOM guideline for their weight and height, a significantly higher proportion of black mothers reported advice of less than 22 pounds (33%) or the IOM minimum (34%). The far more frequent inappropriate advice reported by black than white mothers cannot be explained by differences in body mass index, age, education, parity, marital status, or site of care. Nevertheless, compliance with advice was almost the same for black and white mothers: More than 70% gained at least 22 pounds when this was the reported weight gain advice. It is thus entirely feasible that more appropriate advice for black women will result in significantly higher weight gains and improvement in infant birth weight and health.

Adolescent↗
PubMed1993

Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines.

OBJECTIVES: Guidelines from the Institute of Medicine's 1990 report call for weight gains during pregnancy that are higher than those previously recommended. This study examines the potential implications of compliance with these guidelines for postpartum weight retention. METHODS: Weight retention 10 to 18 months following delivery was examined for selected women who had live births in the 1988 National Maternal and Infant Health Survey. Women's actual weight gains during pregnancy were retrospectively classified according to the Institute of Medicine's guidelines. RESULTS: Weight retention following delivery increased as weight gain increased, and Black women retained more weight than White women with comparable weight gain. The median retained weight for White women who gained the amount now being recommended was 1.6 lb whereas that for Black women was 7.2 lb. CONCLUSIONS: If pregnant White women gain weight according to the institute's guidelines, they need not be concerned about retaining a substantial amount of weight postpartum. Our findings suggest, however, that Black women are in need of advice about how to lose weight following delivery.

Female↗
PubMed1991

The 1988 National Maternal and Infant Health Survey: design, content, and data availability.

The 1988 National Maternal and Infant Health Survey was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. The survey is a nationally representative sample of 11,000 women who had live births, 4000 who had late fetal deaths, and 6000 who had infant deaths in 1988. Mothers were mailed questionnaires based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. Data collection from the Longitudinal Followup of mothers in the survey began in January 1991. It provides information on health and development of low- and very low-birthweight babies, child care and safety, maternal health, maternal depression, and plans for adoption and foster care. Both surveys will provide useful data for clinicians in maternal and child health.

Data Collection↗
PubMed1989

X-ray examinations during pregnancy: National Natality Surveys, 1963 and 1980.

Based on 1963 and 1980 National Natality Surveys, the rate of medical x-ray examinations during pregnancy per 100 mothers fell 34.2 percent. A decrease in chest x-ray examinations accounted for almost all of the decline in total x-ray examinations. The reductions were greater for older mothers and those who were not White. While the number of births fell from 4,071,000 in 1963 to 3,612,000 in 1980, the number of pelvimetry examinations actually increased by 45,000.

Adult↗
PubMed1986

Advice about weight gain during pregnancy and actual weight gain.

In the 1980 National Natality Survey, married mothers were asked whether their doctors had suggested a weight gain limit during pregnancy and, if so, what limit was suggested. Current obstetric recommendations call for 22-27 pound weight gain. Previous research indicates that gaining less than 16 pounds greatly increases the likelihood of a poor pregnancy outcome. Reported advice varied by mother's race, education, parity, and prepregnancy weight. Mothers given no advice or advised to gain less than 22 pounds were far more likely than others to have an inadequate gain. The findings suggest that many more women should be told that it is appropriate to gain at least 22 pounds.

Adult↗
PubMed1979

Differentials in survivorship of the older populations among areas within a state. The case of Pennsylvania.

It has often been assumed when making estimates or projections of populations of sub-state areas that survival ratios of the state, region, or even the nation may be used since significant differentials are not expected within the state. The validity of this assumption is questioned, employing single-year-of-age survival ratios estimated for each planning and service area in Pennsylvania. Regression analysis estimations were made to determine whether the survival functions of the areas were statistically the same as the survival functions of the state. The survival functions were partitioned into two groups by age; a 10 to 49 year age group and a 50 to 84+ year age group. Briefly, the results indicated that, at least for Pennsylvania significant differences existed and that these differences are more likely to occur among the older group.

Adolescent↗
PubMedDate not supplied

Uses of the 1980 National Natality and Fetal Mortality Surveys for the assessment of obstetric technologies.

Because of the multipurpose utility of followback surveys, six Public Health Service (PHS) agencies including the Bureau of Health Care and Delivery Assistance (BHCDA) financially assisted the National Center for Health Statistics (NCHS), which conducted the 1980 National Natality Survey (NNS) and 1980 National Fetal Mortality Survey (NFMS). These are called "followback" surveys because NCHS uses mail questionnaires and telephone to follow back informants (mothers, hospitals, and attendants at delivery) and medical sources of radiation named by informants, identified on Certificates of Live Birth and Reports of Fetal Death from all 52 state and independent registration areas of the United States. Ten basic data applications have emerged from the 1980 NNS/NFMS, and this paper addresses these 10 purposes simultaneously, in relation to NNS/NFMS uses in assessing obstetric technologies. The five obstetric technologies that are the focus of this paper are: cesarean delivery, electronic fetal monitoring, ultrasound, X-ray, and amniocentesis--and are often examined in relation to maternal complications and conditions. Data on these technologies are highlighted with reference to each of the following 10 data applications of followback surveys: produce national estimates of unique information; establish trends; facilitate analytic and epidemiologic research; use followback surveys as anchor data bases; undertake parallel studies; link followback surveys together to calculate new vital rates; conduct comparative studies vis-à-vis other data sets; assess volume of medical care; evaluate quality of information on vital records; and generate synthetic estimates and need assessments. Finally, this paper discusses NCHS plans to measure obstetric technologies in the 1988 National Maternal and Infant Health Survey, which will include natality, fetal mortality, and infant mortality components.

Female↗
PubMedDate not supplied

Social and clinical correlates of postpartum sterilization in the United States, 1972 and 1980.

This analysis is based on the 1972 and 1980 National Natality Surveys, conducted by the National Center for Health Statistics. About 10.6 percent (381,000) of women in the United States who delivered live infants in 1980 were sterilized postpartum. About 93 percent of these postpartum sterilizations were tubal operations; only 1.4 percent were hysterectomies. Because the literature on the health correlates of sterilization is sparse, this analysis was exploratory. In both 1972 and 1980, married mothers were more likely to be sterilized postpartum if they had previous fetal losses, underlying medical conditions, complications of pregnancy, or a cesarean delivery. Inspection of more detailed tabulations reveals that repeat cesarean delivery, multiparity, diabetes and at the higher birth orders, excess weight gain, and toxemia preeclampsia were associated with postpartum sterilization. An apparent association with varicosity may be due to misreporting. The degree to which each of these associations is causal or spurious awaits further research, but preliminary analysis suggests that some maternal health factors may influence some sterilization decisions. Beyond these specific maternal health conditions and complications, the evidence for a connection between poor maternal health and sterilization is equivocal.

Adult↗
PubMedDate not supplied

Radiation procedures performed on U.S. women during pregnancy: findings from two 1980 surveys.

The 1980 National Natality Survey (NNS) and 1980 National Fetal Mortality Survey (NFMS) provide a unique opportunity to examine variation in exposure to radiation during pregnancy for mothers of live-born and stillborn infants. Maternal race, age, education, and marital status in both surveys and low birth weight in the 1980 NNS are characteristics used to examine exposure rates for X-ray, ultrasound, nuclear medicine, shortwave, and microwave radiation examinations and treatments. About 15 percent of mothers of live infants and 23 percent of mothers who experienced stillbirths (fetal deaths of 28 weeks or more gestation) had a medical X-ray procedure during pregnancy. The 15 percent exposed in 1980 was a reduction from 22.5 percent of mothers exposed according to the results of the 1963 NNS; this reduction occurred in all race and age groups. About 34 percent of 1980 NNS mothers and 53 percent of 1980 NFMS mothers had ultrasound exposure during pregnancy. Radiation exposure rates were higher for 1980 NNS mothers who had low birth weight infants (under 2,500 g, or 5 lb, 8 oz) than for those who had normal weight infants.

Adult↗
PubMedDate not supplied

Electronic fetal monitoring in relation to cesarean section delivery, for live births and stillbirths in the U.S., 1980.

In the 1980 National Natality and Fetal Mortality Surveys, information about fetal monitoring and type of delivery was obtained from hospitals for a sample of 9,941 live births and 6,386 fetal deaths of 28 weeks' gestation or more. Data in this analysis are weighted to provide national estimates of live births and late fetal deaths that occurred in U.S. hospitals during 1980. Electronic fetal monitoring (EFM) was used for 47.7 percent of live births; 27.2 percent were monitored by Doppler ultrasound only, 10.2 percent by scalp electrode only, 6.3 percent by Doppler ultrasound and scalp electrode only, and 4.0 percent by other methods and combinations. The distribution by type of EFM used was similar for the 42.7 percent of late fetal deaths (also called stillbirths) that were monitored. Variation in the use of EFM for live births and stillbirths is examined according to maternal age, parity, education, race, marital status, income, previous fetal loss, underlying medical conditions, complications of pregnancy, complications of labor, duration of labor, infant birth weight, and length of gestation. Among live births, 17.1 percent were delivered by cesarean section, as were 16.8 percent of stillbirths. The association between fetal monitoring and the primary cesarean section rate (the probability of cesarean section for women who had never had one) for all birth orders and for first births is examined according to characteristics of the mothers and the infants. Factors involved in the consistent association found between fetal monitoring and the primary cesarean section rate are discussed.

Adult↗