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Biomedical subjects

A Macfarlane

Publications and source records attributed to A Macfarlane.

At least 37 records · Page 2Linked to original sources
PubMed1996

Recent trends in the incidence of multiple births and associated mortality in England and Wales.

AIM: To review trends in multiple births and associated mortality in England and Wales since 1975, in the light of trends for earlier years; to assess, within the limitations of the available data, the extent of any association between multiple birth rates and assisted conception and drugs used for subfertility. METHODS: Data collected routinely in England and Wales, between 1975 and 1994, were retrospectively reviewed. These comprised Office of Population Censuses and Surveys (OPCS) data collected at the registration of live and stillbirths and deaths occurring under the age of 1 year in England and Wales from 1975 onwards. Department of Health data about NHS prescriptions dispensed outside hospitals within England for drugs which could be used in the medical management of subfertility were also included. RESULTS: The proportion of pregnancies that resulted in a registered multiple birth increased from a low of 9.9 per thousand in 1975 to 13.6 per thousand in 1994. Up to 1992, the increase was seen in all age groups except for women under 20, with the most substantial increase being in women aged 35 to 39. The rise in the rate of triplet and other higher order births was much steeper than that for all multiple births, increasing from 0.13 sets of triplets per thousand maternities in 1975, to 0.41 in 1994. Prescriptions dispensed for selected drugs that may be used for the medical management of subfertility and assisted conception became more common over this period. The fragmented nature of the data precluded direct comparison with changes in multiple birth rates, however. CONCLUSIONS: Although the causes of the rise since 1980 in multiple birth rates in general, and the dramatic rise in the triplet rate in particular, cannot be ascertained or quantified directly from routinely collected data, drugs used for subfertility and more recently, assisted conception, probably had a major role.

Adult↗
PubMed1996

The regionalization of perinatal care in Wales and Washington State.

OBJECTIVES: The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS: The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals. RESULTS: Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. CONCLUSIONS: Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.

Birth Certificates↗
PubMed1996

Birthweight and health and development at the age of 7 years.

This study was set up to compare the frequency of health, educational and behavioural problems in a geographically defined birth cohort of 7-year-old children grouped by weight at birth. The study design was based on a multi-stage postal survey, with sampling stratified by birthweight. It took place in the four counties of Oxfordshire, Buckinghamshire, Berkshire and Northamptonshire which make up the former Oxford region. We studied 1319 live births to women resident in the former Oxford region in 1985, including all those with birthweights under 1500 g, or whose weight was not recorded, and a sample of those who weighed 1500-2499 g, and of those who weighed 2500 g or more at birth. The children in the sample were traced through the National Health Service Central Register (NHSCR) and self-administered questionnaires were sent to their parents, general practitioners (GP) and teachers. Of the 1169 children who were alive at the age of 7 years and were successfully traced, 805 (75%) were followed up by postal survey. The use of health services, and of additional educational support was higher, and school performance was poorer among children who had weighed less than 1500 g at birth than among children who had weighed 2500 g or more, with the rates for children who had weighed 1500-2499 g falling in between. This survey method identifies the higher rate of health and educational problems in children weighing under 2500 g at birth, particularly those with birthweight under 1500 g, compared with other children. The method could be developed to provide a way of monitoring any changes over time in the prevalence of these problems. This information can be used to assess the health and educational needs of 7-year-old children in the population.

Adult↗
PubMed1995

Teenage smoking.

Explore the source record for details and available documents.

Adolescent↗
PubMed1995

The Oxford growth study: a district growth surveillance programme 1988-1994.

OBJECTIVES: To develop a method of community based growth assessment. SETTING: Oxford District, United Kingdom. METHODS: A system of growth surveillance involving a community consultant paediatrician, a paediatric endocrinologist, a clinical auxologist, a project coordinator, and the many primary health care teams was started. Letters and meetings were arranged to introduce the programme to general practitioners and health visitors, emphasising the importance of growth assessment in normal child development. They were asked to measure all children as part of their routine developmental checks at 3 and 4.5 years of age. Community growth assessment clinics staffed by an experienced auxologist were established. Children whose heights were more than two standard deviation (SD) scores below the mean or whose height SD score decreased between the two ages were referred to the clinic. Any child whose height was more than 3 SD scores below the mean was referred directly to the paediatric endocrinologist. Those seen in the community clinics were followed up for a year and if their velocity was > 25th centile, karyotype normal, and bone age appropriately delayed, they were discharged to the general practitioner for further follow up. Any child with an annual velocity < 25th centile was referred to the endocrinologist. RESULTS: Of 20,338 children monitored, 260 (1.3%) had heights > -2 SD scores. Seventy six were lost to follow up, 35 were measuring errors, 69 were already seeing a paediatrician, leaving 80 children to be evaluated. Of these, 69 were "short normals" and 11 were newly identified diagnoses. CONCLUSIONS: This system of secondary referral keeps normal healthy children out of hospital, avoids unnecessary over-investigation, reduces travel and anxiety for families, avoids filling specialist clinics with normal children, and provides an inexpensive system of growth surveillance.

Analysis of Variance↗
PubMed1995

Safety and place of birth in Scotland.

BACKGROUND: The recent publication of policies suggesting women should have choice about where they give birth prompted a comparison of stillbirth and neonatal mortality rates for three types of maternity unit in relation to changes in booking and place of delivery. METHODS: Scottish Maternity Discharge records and data from stillbirth and neonatal death reports for Scotland were used to analyse stillbirth and neonatal mortality rates according to the level of care, birthweight and cause of death for the years 1986-1990. RESULTS: For those categories of stillbirths and neonatal deaths which are amenable to prevention by perinatal care, intrapartum stillbirth rates were higher in general practitioner (GP) units than in consultant units, but these accounted for only 11 stillbirths and the difference is compatible with chance variation. Neonatal mortality among babies weighting 2500 g or more was independent of type of hospital. Among babies weighing under 1500 g or 1500-2499 g, neonatal mortality was significantly higher in non-teaching hospitals than in teaching hospitals. CONCLUSIONS: Although the differences are compatible with chance variation, there is some suggestion that small GP hospitals might have higher rates of intrapartum stillbirths and such rates should be monitored. Provided that there are no barriers to transfer to hospitals with consultant units when appropriate, there is no evidence that these small GP hospitals are unsafe. The high neonatal mortality rates, especially among babies weighing 1500-2499 g in non-teaching consultant units, compared with teaching units, should be investigated further.

Birth Weight↗