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Biomedical subjects

A L Franks

Publications and source records attributed to A L Franks.

33 records · Page 2Linked to original sources
PubMed1990

Contraception and ectopic pregnancy risk.

Studies of the association of ectopic pregnancy with contraception have generated a conflicting array of results because of methodologic differences between studies. We estimated the absolute incidence rates of ectopic pregnancy for various contraceptives by multiplying the pregnancy rate by the proportion of pregnancies with ectopic implantation for each method. Our results indicated a more than 500-fold difference in ectopic pregnancy incidence, from a low of 0.005 ectopic pregnancies per 1000 women years of oral contraception or vasectomy to a high of 2.6 per 1000 women years of no contraception. These estimated incidence rates should be useful for clinicians and patients seeking to better understand the risks and benefits of contraceptives.

Adult↗
PubMed1990

Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986.

Preeclampsia and eclampsia continue to be among the leading causes of maternal death. However, national estimates of the occurrence of these conditions have not been available. To derive national rates of preeclampsia and eclampsia and to characterize the women at highest risk of the development of these conditions, we analyzed data from the National Hospital Discharge Survey for the years 1979 through 1986. We found that 26 per 1000 births during this period were complicated by preeclampsia and 0.56 per 1000 births were complicated by eclampsia. The rate of mild or unspecified preeclampsia remained constant over the study period. In contrast, the rate of severe preeclampsia increased sharply and the rate of eclampsia declined by 36%. Maternal age less than 20 years old was the strongest risk factor for both preeclampsia and eclampsia. These data indicate a need for improved prenatal care among teenagers.

Adolescent↗
PubMed1990

Fatal pulmonary embolism during legal induced abortion in the United States from 1972 to 1985.

To determine the risk factors for abortion-related deaths caused by pulmonary embolism, we investigated all deaths from legal abortions in the United States from 1972 through 1985. Of 213 deaths, 45 (21%) were due to air, blood clot, or amniotic fluid embolism. The risk of embolism death was higher among minority women and older women (34 to 44 years). Our analysis revealed that curettage at less than or equal to 21 weeks and abortions at less than or equal to 12 weeks, regardless of method, were both associated with the least risk of embolism death. In comparing 1972 to 1978 and 1979 to 1985, we found that the embolism mortality rate decreased 79%. During 1979 to 1985, the number of abortions performed by noncurettage methods decreased 58%, possibly as a result of earlier abortion morbidity studies, which showed that these methods carried a greater risk of complications. Although a decrease in mortality rates may be partially attributable to the declining use of these methods, our analysis suggests that changes in methods over time have not been universally applied to all racial groups.

Abortion, Induced↗
PubMed1990

Obstetrical pulmonary embolism mortality, United States, 1970-85.

To investigate pulmonary embolism as a cause of obstetrical death, vital records data from 1970 through 1985 were analyzed. Results showed that the number of obstetrical pulmonary embolism deaths per 100,000 live births declined by 50 percent for both Whites and Blacks. However, Black women maintained more than a 2.5-fold higher risk, and women over age 40 had a ten-fold higher risk of embolism mortality. Thus, although the risk of obstetrical pulmonary embolism death has declined, some subgroups of women remain at higher risk.

Adolescent↗
PubMed1990

Maternal mortality in the United States, 1979-1986.

To understand better the epidemiology and to describe the causes of maternal death, we reviewed all identified maternal deaths in the United States and Puerto Rico for 1979-1986. The overall maternal mortality ratio for the period was 9.1 deaths per 100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death after a live birth. Unmarried women had a higher risk of death than married women. The risk of death increased with increasing live-birth order, except for primiparas. In order to develop strategies to reduce the risk of maternal death in the United States, future studies should include expanded information about each death, which will allow better understanding of factors associated with maternal mortality.

Abortion, Spontaneous↗
PubMed1989

Hepatitis B virus infection among children born in the United States to Southeast Asian refugees.

Since 1975 nearly 1 million persons have entered the United States from Southeast Asia, where infection with hepatitis B virus (HBV) is hyperendemic. To evaluate the prevalence and patterns of transmission of HBV infection among the children of refugees from Southeast Asia, we studied 196 refugee families with 257 children born in the United States. Of 31 children born in the United States to mothers with infectious disease, 17 (55 percent) had been infected with HBV. Of 226 children whose mothers did not have infectious disease, 15 had HBV infection--a prevalence of 6.6 percent (95 percent confidence interval, 4.1 to 10.7). The risk of infection was greatest (26 percent) among children living in households with children with infectious disease (relative risk, 5.5; confidence interval, 2.3 to 13.4). Exposure to fathers or other adults with infectious disease was not significantly associated with infection. Of children from households with no persons with infectious disease, 3.9 percent (confidence interval, 1.7 to 8.8) were infected. Nearly half (46 percent) the cases of HBV infection among the U.S.-born children of refugees were not attributable to perinatal transmission from a mother with infectious disease. We conclude that child-to-child transmission may be occurring within and between households. Current recommendations to immunize the newborns of mothers with infectious disease are not sufficient to protect all U.S.-born children of Southeast Asian refugees from HBV infection early in life, when the risk of chronic sequelae and premature death is highest. We recommend that the HBV vaccination policy be expanded to include all newborns of Southeast Asian immigrants.

Asia, Southeastern↗
PubMed1989

Case-fatality rates for tubal sterilization in U.S. hospitals, 1979 to 1980.

To update a 1977 to 1978 case-fatality estimate for tubal sterilization in U.S. hospitals, we reviewed the medical records of women reported by the Commission on Professional and Hospital Activities to have died after tubal sterilization procedures in 1979 or 1980. We project that the most reasonable case-fatality rate estimate is slightly greater than 9 per 100,000 sterilizations if all deaths associated with the procedure are considered. Rate estimates that assume minimum and maximum numbers of all associated deaths in our sample are approximately 6 per 100,000 and 10 per 100,000 sterilizations, respectively. However, when only deaths that can be attributed to sterilization per se are considered, the most reasonable case-fatality rate is estimated at between 1 and 2 per 100,000 procedures, a lower rate than previously reported. Rate estimates that assume minimum and maximum numbers of attributable deaths in our sample are approximately 1 per 100,000 and 5 per 100,000 sterilizations, respectively. These results further indicate that death attributable to tubal sterilization is rare.

Female↗
PubMed1988

Ectopic pregnancy surveillance, United States, 1970-1985.

Ectopic pregnancy is now one of the leading causes of maternal death in the United States. In 1984 and 1985, both the numbers and rates of ectopic pregnancy increased. Since the rate of ectopic pregnancy remained unchanged for white women, the rate increase appears to be driven by the increasing rate among women of black and other races. Although ectopic pregnancies accounted for only 1.5% of the total pregnancies in 1984 and 1985, they accounted for 14% of the total maternal deaths in 1984 and for 11% of those deaths in 1985. However, the case-fatality rate for 1985 decreased to 4.2/10,000 ectopic pregnancies, down from the 35.5 deaths/10,000 ectopic pregnancies reported in 1970. Several factors may contribute to the increase in ectopic pregnancies, including heightened awareness of the condition, improved diagnostic technology, and possibly the higher prevalence of risk factors (e.g., acute and chronic salpingitis and sexually transmitted diseases) and the lower prevalence of protective factors (e.g., decreased use of oral contraceptives). Heightened awareness of the condition and improved technology may also be factors resulting in the decreased case-fatality rate.

Adolescent↗
PubMed1987

Postmenopausal smoking, estrogen replacement therapy, and the risk of endometrial cancer.

Previous studies of the association between cigarette smoking and endometrial cancer have yielded inconsistent results. There is some evidence that this discrepancy may be explained by differences in menopausal status between the groups of women studied. We addressed the issue of the effects of postmenopausal smoking on endometrial cancer risk using data from the Cancer and Steroid Hormone Study, a multicenter, population-based, case-control study of gynecologic cancers in the United States. We found that smoking after natural menopause is associated with a 70% reduced risk of endometrial cancer among estrogen users and a 50% reduced risk among nonusers of estrogen. These findings are consistent with previously proposed biologic effects of smoking on estrogen metabolism, which may have important clinical implications.

Adult↗
PubMed1987

Unintended laparotomy associated with laparoscopic tubal sterilization.

Although the complication rate for laparoscopic tubal sterilization is generally low, laparotomy is sometimes necessary to complete the sterilization or manage complications. To better characterize factors that predispose women to unintended laparotomy, we analyzed data from the Collaborative Review of Sterilization. Of the 5027 women undergoing laparoscopic tubal sterilization, 12 had unintended laparotomies to manage complications, whereas 39 women had unintended laparotomies because of technical inability to complete the laparoscopic procedure. Women with prior abdominal or pelvic surgery had an increased risk of unintended laparotomy (relative risk = 10.2, 95% confidence interval = 5.3 to 19.7). Women with a history of intrauterine device use or pelvic inflammatory disease had elevated risks that were not statistically significant (relative risk = 2.2 and 1.5, respectively). Comparative studies of alternative surgical approaches for tubal sterilization are needed to formulate recommendations for women who may be at increased risk of unintended laparotomy associated with the laparoscopic approach.

Adult↗
PubMed1987

Cigarette smoking and the risk of epithelial ovarian cancer.

Cigarette smoking may affect each of the currently proposed mechanisms of ovarian carcinogenesis. Whether cigarette smoking has any effect on the development of ovarian cancer has not been adequately evaluated. To study this issue, the authors examined data from the Cancer and Steroid Hormone Study, a multicenter, case-control study of gynecologic cancers conducted between December 1, 1980, and December 31, 1982, in eight geographic areas of the United States. This analysis utilized data on 494 women with newly diagnosed epithelial ovarian cancer and 4,238 population-based control women 20-54 years of age. There was no association of epithelial ovarian cancer with dose of cigarette smoking, age smoking started, time since smoking started, or time since smoking last occurred. Simultaneous adjustment for age, parity, history of oral contraceptive use, and other potentially confounding factors did not alter these results.

Adult↗
PubMedDate not supplied

A sitting/companionship service for palliative care patients: Leicestershire, England.

Volunteers are vital to most UK hospices, performing wide-ranging duties. In our unit a carefully selected and trained group provides a professionally coordinated setting/companionship service for housebound patients. In this study we questioned their reasons for volunteering to "sit" and their evaluations of the training course. Six (of eight) completing the most recent course returned questionnaires. Five already were engaged in voluntary work, three within Leicestershire Hospice. They wanted to be "sitters" primarily to support the carers and to use their time constructively. They were aware of potential difficulties in "sitting" and considered the course had realistically acknowledged these and highlighted others that the volunteers had not contemplated, preparing them appropriately. Overall the course was valuable; all enthusiastically welcomed ongoing support and training.

Career Choice↗
PubMedDate not supplied

Isoniazid hepatitis among pregnant and postpartum Hispanic patients.

On request of local health officials, the authors investigated isoniazid (INH) hepatitis morbidity and mortality among patients attending an Hispanic prenatal clinic. Among 3,681 women treated with INH during and after pregnancy to prevent tuberculosis (TB), 5 developed INH hepatitis, and 2 of the 5 women died. Comparison with previously collected Public Health Service data concerning 3,948 nonpregnant women, using the Cox proportional hazards model, revealed a 2.5-fold increased risk of INH hepatitis in the prenatal clinic group. The mortality rate was four times higher in the prenatal clinic group. However, statistical power was low because of the small number of cases, and neither of these findings was statistically significant (P greater than 0.05). In the absence of controlled studies, the issue of INH safety during the perinatal period remains unresolved. Nevertheless, current American Thoracic Society-Centers for Disease Control recommendations regarding TB screening, implementation of INH chemoprophylaxis programs, and adequate monitoring of individuals on INH should be adhered to. The results of this investigation raise concern that deviations from existing policy may contribute to unnecessary morbidity and mortality.

Adolescent↗