Use of Medicare services by elderly residents of Puerto Rico

OBJECTIVES: We describe hospitalization rates among Medicare beneficiaries resident in Puerto Rico compared to beneficiaries in the mainland U.S., in 1999. METHODS: A cross-sectional analysis using Medicare Denominator and hospitalization files. RESULTS: The rate ratio (PR/U.S.) of age, gender-adjusted hospitalizations among elderly Medicare beneficiaries with Part A coverage was 0.78, compared with 0.92 among beneficiaries with both Part A and Part B coverage. Among the latter, the rate ratios were 0.78 for surgical admissions, 1.08 for low-variation medical conditions, and 0.97 for high variation medical conditions. They were higher for younger elderly beneficiaries. CONCLUSIONS: Rates of hospitalization in Puerto Rico may be lower, the same or exceed those of the mainland U.S. depending on the age of the beneficiary and the type of hospitalization.

Recruitment, retention and characteristics of women in a prospective study of preconceptional risks to reproductive outcomes: experience of the Diana Project.

Preterm delivery, low birthweight, and intrauterine growth retardation are common and recalcitrant problems in many countries. Although much remains to be learned, we know particularly little about the relationships between preconceptional and early pregnancy exposures and these and other reproductive outcomes. The study presented here was primarily designed to investigate the relationships between nutritional exposures measured before and during pregnancy and reproductive outcomes. This paper describes methods used to recruit the required 1000 preconceptional women from the collaborating health maintenance organisation (HMO) and the retention of participants in this time-intensive study. The results presented demonstrate that an adequate completion rate (66.3%), and a remarkably representative sample of women that poses few threats to the study's validity, can be obtained by population-based recruitment of women from an HMO.

Predictors of red cell folate level in women attempting pregnancy.

OBJECTIVE: To identify predictors of red cell folate level in women attempting to become pregnant. DESIGN: Cohort study. SETTING: A health maintenance organization serving the Minneapolis-St Paul, Minn, area. PARTICIPANTS: A total of 189 healthy, primarily white women aged 22 to 35 years enrolled in the Diana Project, a population-based prospective study of preconceptional and prenatal risks to reproductive outcomes. The sample represents 189 of 219 enrolled women who were sequentially selected from the total Diana Project sample to receive additional laboratory analyses. MAIN OUTCOME MEASURE: Red cell folate level. RESULTS: Folic acid supplements, folic acid intake from fortified cereals, vitamin C supplements, and serum zinc level (inverse) were found to predict red cell folate levels. Previous research has shown that red cell folate levels higher than 906 nmol/L (400 ng/mL) may be optimal for the prevention of folate-responsive neural tube defects. For folic acid supplement users, folate intakes of 450 microg per day and higher corresponded to these protective levels of red cell folate. In nonusers of supplements, intakes of more than 500 microg of folate per day from foods and folic acid-fortified cereals may be needed to attain red cell folate levels higher than 906 nmol/L (400 ng/mL). Red cell folate levels higher than 906 nmol/L (400 ng/mL) were primarily found in women who took folic acid supplements. Only 1 in 4 women had red cell folate levels higher than 906 nmol/L (400 ng/mL), while 1 in 8 had red cell folate levels indicative of a negative folate balance. Addition of a daily, 400-microg folic acid supplement to the usual diet would result in red cell folate levels over 906 nmol/L (400 ng/mL) in a majority of women in this study. CONCLUSIONS: Supplementation of diets of women of childbearing potential with 400 microg of folic acid per day would effectively raise red cell folate to levels associated with a low risk of folate-responsive neural tube defects. Protective levels of red cell folate may also be obtained by ample consumption of vegetables, fruits, and folic acid-fortified breakfast cereals. Efforts to increase folic acid supplement use and folate consumption among women of childbearing potential must go beyond fortification of refined cereal and grain products and reach women within all educational and income groups.

A food frequency questionnaire can detect pregnancy-related changes in diet.

OBJECTIVE: To determine whether a food frequency questionnaire (FFQ) can detect changes in dietary intake before pregnancy to mid-pregnancy relative to a 4-day food record. DESIGN: FFQs and 4-day, weighed food records (4DRs) were completed during similar time intervals before pregnancy and again near mid-pregnancy by women served by a large health maintenance organization in the Minneapolis-St Paul, Minn, area. The outcome of interest was change in the intake of energy and 16 nutrients. Participants were members of the Diana Project, a prospective study of relationships among prepregnancy and pregnancy nutritional and other exposures and reproductive outcomes. Fifty-six (51%) of the eligible women completed the study. SUBJECTS: Well-educated, healthy, white women. STATISTICAL ANALYSES PERFORMED: Spearman rank order correlations. RESULTS: Mean energy and nutrient intake levels estimated using the 4DR were generally higher than those estimated using the FFQ. Correlations between change in energy and nutrient intakes measured by the 4DR and FFQ ranged from .75 for vitamin C to .02 for cholesterol and averaged .48. APPLICATIONS: Comparisons with 4DRs indicate that the FFQ used in this study is appropriate for obtaining reliable estimates of prepregnancy to mid-pregnancy changes in intake of energy and a number of nutrients in similar groups of women.

Maternal waist-to-hip ratio as a predictor of newborn size: Results of the Diana Project.

Location of body fat stores, as indicated by waist-to-hip circumference ratio (WHR), affects a variety of metabolic processes in women, and some of these changes could affect fetal growth during pregnancy. We tested the hypothesis that WHR affects fetal growth among 702 participants of the Diana Project, a prospective study designed to identify preconceptual exposures related to reproductive outcomes. We tested the effect of maternal WHR on the outcomes of infant birthweight, length, and head circumference in regressional models that included 16 variables such as maternal body mass index, duration of gestation, and pregnancy weight gain previously related to birthweight. Maternal WHR was related to each measure of newborn size. A 0.1-unit increase in WHR predicts a 120-gm greater birthweight, a 0.2-inch greater length, and a 0.3-cm greater head circumference. We conclude that WHR is related to fetal growth and that the effect of WHR on fetal growth may be mediated by metabolic alterations associated with a preponderance of central body fat stores or to other factors closely aligned with WHR. The common finding of an independent effect of pregnancy BMI on birthweight may be largely attributable to maternal WHR.

Reduction of preterm birth in an HMO.

In 1984 a preterm birth prevention project was introduced into a large, well-established HMO. Five years of resultant experience and data are compared to metropolitan area and state data. The method described by Dr. Robert Creasy was followed. Some recommendations for change of the screening tool are made. The impact on the preterm birth rate in the HMO setting was substantial, with the rate of decline exceeding that of the metropolitan area and the state.