Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans.

As socioeconomic status (SES) increases, the incidence of low birthweight and preterm birth decreases irrespective of social class. However, low birthweight remains twice as high for African-American women as for white women even when SES is controlled. This study examines to what extent second generation high SES African-American women experience improvement in birthweight and gestational age. One hundred eighty-nine former Meharry students were surveyed. Identified were 934 births that are the children and grandchildren of these students who matriculated at Meharry. These infants are compared with a cohort of white mothers from a study in the School of Public Health at Yale University. Low birthweight was reduced in the third generation high SES African-American children (6.9%) from the second generation (11.4%) but remained higher than white children (3.3%). Results showed that African-American third generation children remained at higher risk for low birthweight than were white children (relative risk [RR], 1.78; 95% confidence interval [CI], 1.03, 3.09). Similar results were observed for preterm delivery where the increased risk to third generation African-American children was 3.16 (1.89, 5.27). Persistent strong ethnic differences in birthweight in this high SES cohort (OR = 3.16, 95% CI, 1.89-5.27) support a conclusion that African-American women have birthweight distributions that are somewhat lighter than white women. This may explain a portion of current ethnic differences in birthweight. It is also possible that persistent psychosocial and behavioral factors continue to negatively influence birthweight, even in second generation high SES African-American mothers. This explanation will require identification of powerful risk factors, which are largely unrelated to those presently under investigation.

Women's health care for the coming millennium.

In examining ways to improve female health care access and utilization, the magnitude of health problems must be examined before the design of solutions. Two types of barriers interfere with health care: attitudinal barriers blocking motivation to seek health care services and organizational barriers which block actual use of needed services. The major health problems of women in the United States are heart disease, cancer, stroke, lung-related diseases, intentional injuries, diabetes and HIV/AIDS. Public health has had a greater impact than high technology on the health of our nation. Balancing health care reform, changes in legislation and funding for medical education should help the United States be responsive to the challenge to move from substandard health for many women to superlative health care for all women and their family members.

Reaching parity for minority medical students: a possibility or a pipe dream?

This article assesses the extent to which under-represented minorities are entering medical school and whether the gap between them and other ethnic groups is narrowing. The issues of genesis of the problem, rationale for redress, assessment of current status, and mechanisms for reaching parity are examined. The current status of underrepresented minority applicants to medical school is made and mechanisms for catalyzing the effort to reach parity with other ethnic groups in the United States are presented.

Low birthweight in African Americans: does intergenerational well-being improve outcome?

The primary antecedent of infant mortality is low birthweight. Vital statistics data have shown that women of low socioeconomic status, regardless of race, are at greater risk for delivering low birthweight infants; however, prevailing data show that black women of the same socioeconomic status as white women have a twofold higher risk of giving birth to an infant weighing < 2500 g and a threefold risk of delivering a very low birthweight infant weighing < 1500 g. There is also evidence that intergenerational effects on birth outcome exist. However, virtually all studies of the effect of socioeconomic status on perinatal outcome have been cross-sectional; the effect of sustained intergenerational well-being has not been measured. To address this gap, this study was designed to demonstrate that in an African-American population with sustained high socioeconomic status and equal risk factors, the birthweight distribution and other reproductive outcomes are the same as those for comparable US white populations. Preliminary findings are reported here.

Resident scheduling: night float programs.

Obstetrics and gynecology residency programs have traditionally involved long hours in the hospital. In recent years, in an attempt to determine whether work hours could be reduced while at least maintaining resident education and patient care, many program directors have instituted night float systems. In New York State, these systems must adhere to rigid hospital code requirements (limiting total hours worked and with specific mandates regarding time away from the hospital); in other areas, these requirements are not as limiting. At the request of the Council on Resident Education in Obstetrics and Gynecology, residency program directors and residents in the United States and Canada were sent a survey regarding whether they had a night float program, how it was structured, and what changes it was perceived to have caused. Responses were received from 193 program directors (65%) and 302 residents. Major differences were noted in the structure of the programs within New York state compared with those outside the state. In New York, 63% of the programs had residents in all 4 years participating in the night float; this was true for only 10% of the programs outside New York. In New York state, the programs were required to adhere to state hospital code requirements limiting hours on duty and mandating the specifics of time off, whereas the programs outside New York did not necessarily adhere to these restrictive requirements. Twelve characteristics were evaluated regarding changes that were perceived to have occurred as a result of the night float program.(ABSTRACT TRUNCATED AT 250 WORDS)

Accommodating to restrictions on residents' working hours.

In 1988, New York became the first state to implement regulatory measures limiting housestaff work hours. Because restrictions on residents' work hours will have such profound and far-reaching implications for how obstetrics and gynecology residencies are conducted, the Council on Resident Education in Obstetrics and Gynecology (CREOG) requested that a survey be conducted to solicit information from program directors of U.S. obstetrics and gynecology residencies who had already begun to alter their call schedules. Two hundred and ninety-six programs were contacted, and representatives of those that had implemented changes were requested to respond. Eighty-two responses were received; 26 of these contained information that could be collated. From these 26 responses the authors have structured a prototypic call schedule and presented its application. A key feature necessary to implement the new type of schedule is the use of a night float system. It is concluded that changes can and will be made by obstetrics and gynecology residencies. Creative scheduling, as described in this article, is essential and will facilitate the task; however, the current standards of education and patient care will be difficult to maintain without additional economic and human resources.

The High-Risk Young People's Program. A summing up.

For over five years, 21 teaching hospitals and 54 community cosponsors provided health services to young people at risk for sociomedical problems, i.e., to young people living in communities characterized by high rates of teen pregnancy, sexually transmitted disease, drug abuse, alcohol abuse, accidents, homicide, suicide, and mental illness. With support from The Robert Wood Johnson Foundation, the 20 grantees of the High-Risk Young People's Program developed projects whose collective goal was to expand services to high-risk youth and improve their health. This goal was to be achieved by a direct provision of medical services, training health providers in the care of high-risk youth, consolidating categorical youth services into single, comprehensive care sites, and securing long-term support for these new services and training activities. During the grant period, 114 fellows, 974 residents, 453 medical students, and 126 graduate nurses trained at project sites. Patient visits, which totaled 47,203 the first year, reached 84,754 the second year, and were reported at 89,024 in the fourth year. Sixteen of the 20 projects secured 117 grants worth nearly $7 million. We conclude that the projects were successful in training health care providers and in securing additional support for Program purposes, but were less successful in expanding services beyond the initial pilot for clinical care.

Development of community-based health services for adolescents at risk for sociomedical problems.

Community-based service and training programs have been advocated as important for improving access to medical care for the poor as well as enhancing the ambulatory training setting for residents and medical students. In 1981 the Robert Wood Johnson Foundation provided funds to 20 teaching hospitals to support community-based, comprehensive health services to high-risk young people, that is, young people living in communities with high rates of sociomedical problems, such as adolescent pregnancy, drug abuse, alcohol abuse, accidents, homicide, suicide, and depression. In this article, the authors describe the experiences of these institutions in establishing off-campus clinics, concluding that high-risk adolescents need additional services and that teaching hospitals and communities can collaborate to provide these comprehensive services. They discuss issues of maintaining services after foundation grants end and the impact of recent financial restraints on continued support from teaching hospitals for off-campus activities.

Postconception menses induction using prostaglandin vaginal suppositories.

Vaginal suppositories containing 15 methyl prostaglandin F2 alpha methyl ester in a high-melt base were administered to 60 women desiring early pregnancy interruption who were no more than 56 days' (eight weeks) pregnant as calculated from the first day of the last regular menstrual period (LMP). The purpose of this study was to evaluate the safety, efficacy, and patient acceptability of this mode of noninvasive early abortion. Some factors evaluated during the study included the time interval from insertion of the suppository to the onset of cramping and bleeding. Also measured were immediate and delayed blood loss, nausea, vomiting, and diarrhea. Of the 60 patients entered into the study, 55 procedures have been judged as successful by the prospective criteria set forth in the protocol. There were no deaths or serious complications. Four patients required hospitalization and follow-up dilatation and curettage (D&C). One patient withdrew from the study after receiving a suppository and subsequently delivered a preterm infant.

Study of lipids in human amnion and chorion.

Most previous fetal membrane studies have focused primarily on their phospholipids as the precursors of arachidonic acid and the obligate precursors of prostaglandins E2 and F2 alpha, with little attention being afforded nonpolar lipids as another possible source. In this presentation, a special emphasis is placed on nonpolar lipids and their acyl group makeup. A substantial amount of acyl group (20:4) lipids was found. The implication of this finding could be that a nonpolar lipid source is necessary for the production of prostaglandins E2 and F2 alpha.

Obstetrics and gynecology-important advances in clinical medicine: exchange transfusion in pregnant women with sickle cell disease.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in obstetrics and gynecology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers or scholars to stay abreast of these items of progress in obstetrics and gynecology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Obstetrics and Gynecology of the California Medical Association and the summaries were prepared under its direction.