Objective
Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health ...centres in resource‐limited countries.
Design
Cluster randomised trial.
Setting
Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia)
Methods
Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.
Main outcome measures
The primary outcome was a composite of maternal mortality, maternal near‐miss mortality, stillbirth, and neonatal mortality.
Results
During the 24‐month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound‐diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components.
Conclusions
Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced.
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Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
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Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
Research on the impacts of climate change on soil organic carbon (SOC) stocks has focused on the effects of changes in average climate, but the potential effects of increased climate variability, ...including more frequent extreme events, remain under-examined. In this study, set in a semiarid agricultural landscape in southeastern Australia, we used the Rothamsted carbon (RothC) model to isolate the effects of interannual rainfall variability on SOC stocks over a 50 yr period. We modelled SOC trends in response to 3 scenarios that had the same 50 yr average climate but different interannual rainfall distributions: non-changing average climate, historic variability (H), and increased variability due to more frequent extreme rainfall years (XH). Relative to the non-changing average climate, RothC simulations predicted net decreases in mean SOC stocks to 50 yr of 11% under the H scenario and 13% under the XH scenario. These decreases were the result of predicted SOC decreases (and increased CO₂ emissions) in extreme wet years (ca. 0.26 Mg ha⁻¹ yr⁻¹) that were not counterbalanced by SOC increases in extreme dry years (ca. 0.11 Mg ha⁻¹ yr⁻¹). No significant difference in mean SOC stocks at 50 yr between the H and XH scenarios was likely due to an increase in both extreme wet and counterbalancing extreme dry years in the latter. Strong negative correlations were found between annual changes in SOC stocks and rainfall. Our modelled predictions indicate the potential for extreme rainfall years to influence SOC gains and losses in semiarid environments and highlight the importance of maintaining plant inputs in these environments, particularly during extreme wet years.
Objectives. This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as ...identified possible determinants of weight change. Methods. In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. Results. Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811)in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg(SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. Conclusions. The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern.
To follow the 1995 birth cohort of infants, born in the State of Missouri, through their first birthday to: 1) examine their rates of visits to emergency departments (EDs), 2) identify predictors of ...any ED visit, 3) examine rates of nonurgent ED visits, and 4) identify predictors of nonurgent visits.
This was a retrospective population cohort study. Using deterministic linkage procedures, 2 databases at the Missouri Department of Health (DOH; (the patient abstract database and the birth registry database) were linked by DOH personnel. International Classification of Diseases, Ninth Revision-Clinical Modification codes for ED visits were classified as emergent, urgent, or nonurgent by 2 researchers. Eight newborn characteristics were chosen for analysis. Negative binomial regression was used to examine the rates and predictors of both total and nonurgent ED visits.
There were 935 total ED visits and 153 nonurgent ED visits per 1000 infant years. The average number of visits was.94, with 59% of infants having no visits, 21% having 1 ED visit, and 20% having 2 or more visits. Factors associated with increases in both total and nonurgent ED visits were Medicaid, self-pay, black race, rural region, presence of birth defects, and a nursery stay of >2 days. Significant interactions were found between Medicaid and race and Medicaid and rural regions on rates of ED use and nonurgent use. The highest rate of ED use, 1.8 per person year, was seen in white, rural infants on Medicaid, and the lowest rate (.4 per person year) was seen in urban white infants not on Medicaid. The highest rates of nonurgent use,.3 per person year, were among urban and rural Medicaid infants of both races and among black infants on commercial insurance. The lowest nonurgent rate,.04 per person year, was seen in white urban infants on commercial insurance.
Infants in the State of Missouri have high rates of ED visits. Nonurgent visits are only a small portion of ED visits and cannot explain large variations in ED usage. Increased ED use by Medicaid patients may reflect continuing difficulties in accessing primary care.
Smoking Status as a Vital Sign Ahluwalia, Jasjit S.; Gibson, Cheryl A.; Kenney, R. Emmet ...
Journal of general internal medicine : JGIM,
July 1999, Letnik:
14, Številka:
7
Journal Article
Recenzirano
Odprti dostop
OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow‐up for African‐American ...patients about smoking‐related issues.
DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1‐month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period.
SETTING: An adult walk‐in clinic in a large inner‐city hospital.
PARTICIPANTS: We consecutively enrolled into the study 2,595 African‐American patients (1,229 intervention and 1,366 control subjects) seen by a housestaff physician.
INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period.
MAIN RESULTS: Forty‐five housestaff rotated through the clinic in 1‐month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio OR 4.28; 95% confidence interval CI 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow‐up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38).
CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow‐up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.
Objective: To determine the effect of different bladder management methods on long-term renal function in persons with spinal cord injury (SCI).
Design: Cohort study.
Setting: Model SCI care system ...within a large teaching hospital.
Patients: Consecutive sample of 1, 114 persons with SCI who were injured between 1969 and 1994.
Main Outcome Measure: Total and individual kidney effective renal plasma flow (ERPF).
Results: ERPF was generally lower in persons with cervical injuries or kidneys that had a renal stone, older persons, and women. Overall, there was very little change in renal function as time postinjury increased, and there were no clinically meaningful differences in the change in renal function over time among persons using different bladder management methods.
Conclusion: Renal function was adequately preserved in the great majority of persons and did not appear to be influenced to any great extent by method of bladder management.
Background. In an effort to learn more about the smoking behavior of hospital employees, a study was conducted at the University of Kansas Medical Center (KUMC) regarding tobacco usage and secondhand ...smoke exposure.
Methods. An anonymous voluntary survey was distributed to 4177 full-time employees in Kansas City and Wichita during June and July of 1998. Questions included tobacco usage and exposure to secondhand smoke. The survey results were assimilated in a data base, which was analyzed in a variety of ways to arrive at several conclusive findings.
Results. Of the 1187 respondents (28.4%), 35.1% had smoked at least 100 cigarettes in their life (41% of those had at least a 10 pack-year history), and 11.8% currently smoked. The groups with the highest percentage of current smokers were females (12%), blacks (17%), Kansas City campus employees (12%), and nonfaculty (13%). Sixty-seven percent of respondents were exposed to secondhand smoke in the previous week, and 25% were exposed at KUMC.
Conclusions. After arriving at the results of this study, recommendations include starting an educational campaign against smoking, promoting cessation programs, moving the current smoking area to a less populated area on campus, and investigating a total campus ban on smoking.
Oxidative stress is thought to be an important pathogenic mechanism in many diseases of the retina. The purpose of this study was to investigate the chemical changes that are present in the ...photoreceptor outer segments of the retina following exposure to oxidative stress. Fourier transform infrared (FT-IR) microspectroscopy enables the characterization and semi-quantitation of chemical functional groups in microscopic regions of tissue sections. This technique was used to evaluate the chemical changes in the outer segments following exposure to ferrous sulfate, which promotes oxidative tissue damage. A reduction of C=C-H and C=O functional groups was observed in the outer segments of iron-injected eyes compared to vehicle-injected eyes at 3 days following injection, which is prior to major histological changes that occur by 7 days. These functional groups are found in docosahexaenoic acid (DHA), which is present at a high concentration in the outer segments. DHA contains a series of six cis-conjugated double bonds, which are vulnerable to free radical attack, and the reduction of these unsaturation group absorptions suggests that DHA was degraded and/or removed from the outer segments. An unexpected finding was that several other chemical functional groups increased in concentration over time in the outer segments of vehicle-injected eyes compared to non-injected eyes. These increases generally did not include C=C-H or C=O, which suggests that either DHA was being degraded while other organic molecules were being concentrated, or that production of DHA failed to be upregulated in vehicle-injected eyes. In summary, there was a loss of both C=C-H and C=O functional group concentrations in the outer segments of iron-injected eyes, and there was an increased concentration of several other chemical functional groups following trauma induced by vehicle injection.
We examined the role of added macronutrients (N, P, and K) and prevention of damage to inflorescences (ovule/seed predation and rachis damage) by insects in determining levels of fruit-set in Banksia ...spinulosa at two sites in southeastern Australia. Insecticide application eliminated damage to developing inflorescences (primarily by the lepidopteran, Arotrophora canthelias) and application of macronutrient fertilizer significantly increased nutrient concentrations in leaves at both sites. Only joint application of nutrients and insecticide increased fruit-set per infructescence significantly above that of the control, indicating that the effect of nutrients on fruit-set depends on the intensity of insect damage to inflorescences. The proportion of inflorescences that developed fruits differed between sites and higher levels of rachis damage at one site may partially explain the lower proportion of inflorescences that fruited. Neither nutrient addition or inflorescence damage influenced the position of fruit-set within an infructescence. Our results suggest that (1) macronutrient availability and inflorescence damage interact in determining levels of fruit-set in B. spinulosa, and (2) other factors, such as pollen or micronutrient availability, may limit it at some sites. These results highlight site-specific variation and interaction in the factors that limit plant reproduction.
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