Quantifying risks of preterm birth in the Arkansas Medicaid population, 2001-2005.

OBJECTIVE: The objective of this study was to examine risks of preterm births, quantify the explanatory power achieved by adding medical and obstetric risk factors to the models and to examine temporal changes in preterm birth due to changes in Medicaid eligibility and the establishment of a maternal-fetal medicine referral system. STUDY DESIGN: The study used data from the 2001 to 2005-linked Arkansas (AR) Medicaid claims and birth certificates of preterm and term singleton deliveries (N=89 459). Logistic regression modeled the association among gestational age, demographic characteristics and risk factors, pooled and separately by year. RESULT: Physiological risk factors were additive with demographic factors and explained more of the preterm birth ≤32 weeks than later preterm birth. Changing eligibility requirements for Medicaid recipients and increasing the financial threshold from 133 to 200% of federal poverty level had an impact on temporal changes. The proportion of births ≤32 weeks declined to 33%, from 3.0 to 2.0. However, later preterm births declined and then increased in the last year. CONCLUSION: Physiological conditions are strongly associated with early preterm birth. Maternal behaviors and other stressors are predictive of later preterm birth. Unmeasured effects of poverty continue to have a role in preterm birth. Further examination of the referral system is needed.

Birth outcomes of Asian-Indian-Americans.

OBJECTIVE: This study examines the maternal characteristics and birth outcomes of infants of U.S. resident Asian-Indian-American (AIA) mothers and compares those to infants of U.S. resident Whites and African-American (AA) mothers. METHODS: Single live births to U.S. resident mothers with race/ethnicity coded on birth certificate as AIA, non-Hispanic White, or non-Hispanic AA were drawn from NCHS 1995 to 2000 U.S. Linked Live Birth/Infant Death files. RESULTS: Compared to AAs or Whites, AIAs have the lowest percentage of births to teen or unmarried mothers and mothers with high parity for age or with low educational attainment. After taking these factors into account, AIA had the highest risk of LBW, small-for-gestational age and term SGA births but a risk of infant death only slightly higher than Whites and far less than AAs. CONCLUSIONS: The birth outcomes of AIAs do not follow the paradigm that more impoverished minority populations should have greater proportions of low birth weight and preterm births and accordingly greater infant mortality rates.

Organizing emergency preparedness within United States public health departments.

OBJECTIVES: We examined the manner in which state public health agencies have organized their operations to accomplish the goals associated with emergency preparedness (EP) funds. We also examined the leadership challenges associated with the effective utilization of preparedness funds. METHODS: The websites of all 50 state public health organizations in the USA were examined in order to determine the different approaches that states have used to organize for preparedness. Thirty-eight states provided sufficient information to allow for classification of their organizational approach to EP. Telephone interviews were conducted with representatives in three model states to obtain deeper insights into the organizational approach. RESULTS: Three predominant organizational models were identified as a means to address the challenge of organizing for preparedness. The results confirmed the equifinality principle of organization (there may be more than one equally effective way to organize) and demonstrated that, contrary to the prescription of early management thought, there is no 'one best way' to organize. Leadership rather than formal management emerged as the primary contributor to perceived EP. Specifically, interviews with preparedness professionals indicated that they believed expert power was more important than position power and the ability to negotiate and influence through persuasion was more important than formal authority. CONCLUSIONS: All three models contained, to a greater or lesser degree, elements of matrix management with the associated leadership challenges for emergency preparedness (EP) directors. Recommendations were provided for successful leadership in the context of EP directors in state departments of public health.

High-precision lattice QCD confronts experiment.

The recently developed Symanzik-improved staggered-quark discretization allows unquenched lattice-QCD simulations with much smaller (and more realistic) quark masses than previously possible. To test this formalism, we compare experiment with a variety of nonperturbative calculations in QCD drawn from a restricted set of "gold-plated" quantities. We find agreement to within statistical and systematic errors of 3% or less. We discuss the implications for phenomenology and, in particular, for heavy-quark physics.

Transgenic mice overexpressing the neurotrophic factor S-100 beta show neuronal cytoskeletal and behavioral signs of altered aging processes: implications for Alzheimer's disease and Down's syndrome.

S-100 beta is a neurotrophic factor released by astroglial cells and localized to chromosome 21, within the region which is considered obligate for Down's syndrome (DS). S-100 beta is increased in the postmortem brains of both DS and Alzheimer's disease. Transgenic mice, produced by insertion of the human gene for S-100 beta, were examined for dendritic development at two ages, using an antibody against microtubule associated protein-2 (MAP-2). At the earliest stages, the density of dendrites within the hippocampus of transgenic animals exceeded that of controls. Also, MAP-2 immunostaining was evident in the region of the cell body. By 1 year of age, the transgenic animals had significant loss of dendrites compared to controls and the number of cells showing cell body staining was further increased. These pathological changes could be indicative of the presence of neurofibrillary tangles and cytoskeletal collapse. Behaviorally, younger transgenic animals could not perform in a learning task as well as controls. Together, these findings suggest that increased S-100 beta in brain may lead to accelerated development, followed by increased aging. The pathological changes may prove useful as an animal model of Down's syndrome and Alzheimer's disease.

Midtrimester uterine rupture. A case report.

BACKGROUND: Uterine rupture during the second trimester is a rare obstetric emergency. There have been 31 reported cases since 1968, with 25 occurring during elective termination of pregnancy. Four cases occurred in patients with transverse lower uterine segment cesarean scars. CASE: In this case, uterine rupture of a classical cesarean scar occurred during second-trimester termination. CONCLUSION: This is the first reported case of rupture of a classical cesarean scar during second-trimester pregnancy termination.

Vulvar dystrophies in geriatric patients.

The term vulvar dystrophies has received international acceptance and replaces the confusing terminology formerly used to describe vulvar epithelial disorders. The classification is based on histopathologic features and has provided a more rational foundation for the use of specific therapies. The risk of malignant change is small and depends on the presence or absence of atypical cells. Biopsies are mandatory for diagnosis and therapy. Vulvar dystrophies without atypia are benign lesions whose primary treatment is medical.

Reactivity of monoclonal antibody F36/22 with human ovarian adenocarcinomas.

Monoclonal antibody F36/22 recognizes high-molecular-weight glycoprotein components associated with neoplastic development of the ovary. Indirect immunoperoxidase staining techniques were performed on a panel of nonmalignant ovarian tissues, primary ovarian tumors, exfoliated ascitic tumor cells, and metastatic lesions. Normal ovarian tissue components (n = 20) failed to exhibit detectable levels of antigen, whereas benign ovarian tissues show a low incidence of immunostaining (three of 26) restricted to some ductal elements. One hundred % (19 of 19) of the immunopositive primary malignant tumors were histologically classified as adenocarcinomas. Each of the predominant adenocarcinoma histotypes consistently showed expression of the antigen with 30 to 100% of the tumor cells scored as immunopositive. Ascitic tumor cells obtained from all of the ovarian adenocarcinoma patients examined (47 of 47) displayed immunopositive reactions, whereas normal mesothelial cells in these specimens exhibited undetectable staining. In addition, ovarian adenocarcinoma metastases (12 of 12) exhibited very intense immunoreaction products. No detectable antigen was expressed by nonadenocarcinoma ovarian tumor cells.

Postmenopausal osteoporosis: concerns and costs in clinical management.

There are a number of social, political and medical concerns for the clinician dealing with female patients who are postmenopausal and at risk for the development of osteoporosis which may lead to chronic disability and possibly death. A brief overview of the role of current therapies is given together with their potential for adverse effects. Further research into etiology, diagnosis and optimum management is obviously necessary.

Geriatric gynecology.

The quality of life of the postmenopausal woman can be significantly improved by active investigation and treatment of gynecologic disorders, such as postmenopausal osteoporosis, in this age group. Surgical intervention should never be excluded simply on the basis of chronologic age.

The first three words.

The regularly reported influence on stuttering of early sentence position, particularly the first three words, evidently is confounded with the influence of grammatical class, another variable consistently found to correlate with stuttering frequency. Representative samples of English prose are found to contain, in early sentence positions, words of grammatical classes known to be associated with high stuttering frequency. Use of a specially constructed passage, which markedly altered the grammatical class composition of the first three words of sentences, resulted in significant changes in the typical patterns of stuttering frequency associated with word position and grammatical class. The findings lead to an analysis which identifies linguistics stress as the essential feature responsible for the effect on stuttering of both grammatical class and sentence position.

The loci of stuttering: grammar or prosody?

Much of the research dealing with linguistic dimensions in stuttering has emphasized the various aspects of grammar, particularly as these aspects contribute to the meaning of utterances. However, data from several sources indicate that meaning and grammatical features are not likely to be the important language variables related to stuttering, but that stuttering occurrence is linked more closely to the prosodic dimension. The published literature in this area reports work done with English-speaking subjects; comparable material from other languages would be of considerable value to our understanding of linguistic determinants in stuttering.