Maternal hypertension and associated pregnancy complications among African-American and other women in the United States.

OBJECTIVE: To characterize maternal hypertension and related pregnancy complications among African-American and other women in the United States. METHODS: Using data from the National Hospital Discharge Survey, we analyzed the incidence and clinical spectrum of maternal hypertension among African-American women who delivered in hospital during 1988-1992. Maternal hypertension consisted of pregnancy-induced hypertension and chronic hypertension preceding pregnancy, including pregnancy-aggravated hypertension. Pregnancy-induced hypertension included preeclampsia, eclampsia, and transient hypertension. Incidence rates (per 1000 deliveries) and 95% confidence intervals (CI) were calculated by type of hypertension and demographic characteristics. Risk ratios and 95% CIs for adverse pregnancy outcomes among women with hypertension were also calculated. RESULTS: The overall incidence of all causes of maternal hypertension was 64.2, and of chronic hypertension preceding pregnancy it was 25.0 per 1000 deliveries among African-American women, an excess of 15.6 and 14.5 cases per 1000 deliveries, respectively, compared with rates for other women. The risks of preterm delivery and inadequate fetal growth were similarly increased for all hypertensive women, regardless of race. However, hypertensive African-American women were at a threefold greater risk of pregnancies complicated by antepartum hemorrhage, an association that was not observed, in other women. Development of preeclampsia and eclampsia irrespective of race was about four times higher among women with chronic hypertension preceding pregnancy than among those without chronic hypertension. CONCLUSION: The excess incidence of maternal hypertension, particularly chronic hypertension, may contribute to adverse maternal and fetal pregnancy outcomes and the disparity in outcomes observed between African-American and other women in the U.S. These findings provide a specific focus for further clinical outcomes research and assessment of prenatal management in African-American women.

Reducing the self-stimulatory behavior of a profoundly retarded female through sensory awareness training.

Sensory awareness training procedures were used to reduce the self-stimulatory behavior of a profoundly retarded female. Self-stimulatory behaviors were directly observed and recorded using a 15-second momentary time sample procedure for 10-minute recording periods. An alternating treatment design was used to compare the effects of treatment and nontreatment. Tactile, olfactory, and gustatory materials were used to stimulate the person's senses. Generalization was assessed across noncompliant behaviors. The results indicate that sensory awareness training reduced self-stimulatory behaviors, but that these behaviors were still being emitted at a high rate. Suggestions for further research are made, and the use of "traditional" sensory awareness training procedures is questioned.

Reversible activation-inactivation of renin in human plasma.

Renin, an aspartate protease, cleaves the alpha-globulin angiotensinogen to produce the decapeptide angiotensin I, which is then converted to the vasoactive hormone angiotensin II by the action of a peptidase 'converting enzyme'. An inactive form of renin sometimes termed prorenin is present in normal human plasma. Its enzymatic activity is increased by exposure to a pH of 3.0 or 3.3 followed by dialysis towards neutral pH. Only a small proportion of the inactive renin is activated during the acid stage of dialysis, most of the activation apparently taking place during the subsequent dialysis to pH 5.7 (ref. 4) or 7.5 (ref. 5). Furthermore, if inhibitors of serine proteases are added to the plasma, the amount of inactive renin activated by this dialysis procedure is reduced. These results suggest that acid-activation is mediated by serine proteases. The role of enzymes such as plasma kallikrein, plasmin and renal kallikrein as physiological activators of inactive renin has recently been discussed. In our study of the activation of plasma inactive renin we have no found that, contrary to previous reports, complete activation of inactive renin takes place during the acid stage of dialysis. This activation can be reversed if plasma is rapidly adjusted to pH 7.4 and warmed. The next step in the acid-activation procedure, that is, dialysis to neutral pH, renders the initial acid-activation irreversible. These results were completely unexpected, and we offer an explanation that reassesses the nature of inactive renin and the activation process.

Shift from predominantly white to predominantly black staff: a retrospective study relating to surgical care.

This nine-year study on hysterectomy patients at Southwest Community Hospital in Atlanta, Georgia, indicates that a shift in hospital staff from predominantly white to predominantly black had no detrimental effect on quality of care. The study also shows that the number of consultations increased with the influx of obstetrical/gynecological (ob/gyn) physicians. At the same time, there was an approximately 90 percent positive correlation between clinical and pathological diagnoses with the influx of black ob/gyn physicians to the staff.