Biomedical subjects
Publications and source records attributed to R P Bernard.
The following points were made during the Discussion that followed the paper by Brian Martin.
Between 1973 and 1984, five patients underwent excision of a carotid body tumor without operative mortality, cranial nerve palsy, cerebrovascular accident, or recurrence when followed to the present or to death from unassociated causes. The importance of preoperative four-vessel extracranial cerebrovascular arteriography for both diagnosis and planning of the operative approach cannot be overemphasized. These operations were performed without preoperative tumor embolization or transfusion, by selectively utilizing arterial resection, replacement, or repair, based on intraoperative evaluation of the individual tumor. Given the propensity of carotid body tumors to progressively enlarge, locally invade, and occasionally metastasize, all patients who are not prohibitive operative risks should undergo resection of carotid body tumors.
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The risk of perinatal death is displayed for '56 growth combinations', then contracted into 16 gestational age/birthweight categories (GA/BW) with additional control for antenatal visits (AV;CARE) for 36 000 singleton birth deliveries monitored in Indonesia from 1978-1980. For virtually all GA/BW combinations, the risk of perinatal death (PD) drops impressively with pregnancy care (Care effect on PD). Fetal growth curves are then displayed by infant outcome, the BW difference being the deficit birthweight (DBW) that may serve as a specific life-death growth standard (LDGS)--a reference system in relation to which fetal growth curves, to be controlled for factors other than infant outcome, may be studied. By controlling for maternal education and pregnancy care, the fetal growth curve associated with high pregnancy care and low education (HIAV/LOED) is more favorable than that for low pregnancy care and high education (LOAV/HIED). In Indonesia then, pregnancy care is more important than formal education in the reduction of not only perinatal mortality but also low birthweight (Care effect on fetal growth).
Epidemiological study of maternal death in Indonesia and Sweden suggests a link between two unrelated data sets. Fifty years ago ('1930'), the Swedish maternal death risk exhibited a pronounced J-shaped pattern by maternal age; and a similar pronounced J-shaped pattern is observed 50 years later in Indonesia for women with prolonged/obstructed labor attended at the top referral and teaching institutions. Epidemiological documentation of 'North data sets' may possibly be used for teaching on factors affecting 'South mortality transition'. The documentation of a 'North-South transition' could accelerate the current dynamics of needed mortality decline by pointed programmatic intervention. The two figures are self-contained reference baselines.
Expansion of previous analytical work with MCM data in Indonesia focuses on antenatal visits (AV). AV is introduced as a systematic co-control of the risk of SB with either registration status, maternal morbidity, complication of labor/delivery or birth weight. 20 out of 22 control categories reveal risk profiles dependent on antenatal visits, the two exceptions being placenta abruptio and very low birth weight (less than 1500g). A systematic confrontation of relative risks obtained across antenatal visits with relative risks obtained within the four co-control variables highlights AV as being an important preventive determinant of late fetal death. In a second step, a clinical baseline of "NOCARE" shows a very strong association with education and a weak association with family planning within controlled education categories. A v-shaped pattern across maternal age is also noted. Two hypotheses are derived. Since FP precedes AV, the next analytical focus is on FP (CONUSE). If co-controlled with the five control factors used so far, the QUINTET will lead to a "closed six-variable control system" (SEXTET) of the risk of stillbirth.
The addition of contraception to five controls (1) of the risk of SB did not alter the previous finding: antenatal visits to emerge apparently as the main determinant of late fetal survival in Indonesian university obstetrics. Parts 1-4 are the basis for inquiring into the effects of parity and education, completing thus an OCTET control model of SB. The inquiry may also be expanded by computerized multivariate analysis; but the strongest determinants should then be used in a control system for 3D display of the SB risk for medical/paramedical education. The professional providers of both "Service and Data" (PSD) need early access to their data in order to apply implications to their service job (5).
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Debrecen is one of the original testing sites of MCM. This report focuses on all single births having occurred from January, 1978 to June, 1980 (N = 8818). Pregnancy outcome associated with maternal Hypertensive Disorders in Pregnancy (HDP) shall be set against pregnancy outcome among women with No Primary Antenatal Conditions (Control), the respective sample sizes being N = 540 (HDP) and N = 5, 472 women. The findings are given in four sections: (1) Occurrence of HDP; (2) Characteristics other than presence/absence of HDP; (3) Reproductive experience prior to current delivery; and (4) Maternal and infant outcome for the current delivery. A specific look is also given at smoking during current pregnancy. Special attention is called for the primordial importance of prenatal visits, preventive care and proper obstetrical management. The role of the MCM early warning system is emphasized and broader use of the system and rationale is suggested for objective international and intranational comparisons to improve pregnancy outcome for both the mother and infant.
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This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis which focused on education and parity/child desire, revealed that the counseling program produced contraceptive acceptance among 47.0% of those followed up. In spite of the counseling efforts, half of the women in this study did not accept contraception following the abortion-regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing to put themselves at risk again. Apparently, future efforts to increase the impact of counseling programs must also examine patients' motivation to accept (or not to accept) contraception.
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Studies of hospitalized "spontaneous" abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.
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In countries where induced abortion is permitted, national family planning programs are able to combine pre- and postconceptive fertility control methods to maximize success in achieving personally desired fertility levels and nationally desired growth levels. The proscription against induced abortion tends to produce criminal abortions and consequent morbidity and mortality which, in some countries, are often recognized as a national health problem. The International Fertility Research Program has undertaken this study of incomplete, inevitable, threatened and septic abortion cases, using a standard data collection instrument, to facilitate comparisons across institutions and countries. The data gather since 1971 in nine Asian, African and Middle Eastern hospitals includes 7,331 cases. Policies of the participating institutions with respect to what constitutes a therapeutic abortion affected the proportions of spontaneous abortions and of abortions induced outside the hospital and inside the hospital. Women treated for induced abortion tended to be of higher parity and more likely to have attained their desired family size than patients treated for spontaneous abortions. Morbidity rates were quite low for patients treated in centers where vacuum aspiration was mainly used, particularly in contrast to the morbidity rates for patients treated in centers where dilatation and curettage was used exclusively. High mortality rates in patients admitted with sepsis confirm the need not only for improvement of clinical procedures but also for reconsideration of the legal issues since many patients admitted with sepsis can be assumed to have had abortions induced.