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Biomedical subjects

D H Freeman

Publications and source records attributed to D H Freeman.

At least 73 records · Page 4Linked to original sources
PubMed1983

Early gestational bleeding and pregnancy outcome: a multivariable analysis.

The effect of early vaginal bleeding on pregnancy outcome was assessed for 16 305 singleton stillborn and liveborn deliveries at three obstetric units in Jerusalem, Israel during 1975-1976. A total of 2385 women (14.6%) reported gestational bleeding before the seventh month of pregnancy. Of these, 2166 reported light bleeding (spotting), 191 heavy bleeding, and 28 both light and heavy bleeding. Logistic regression models revealed an unexpected interaction among light bleeding, hormone usage, and pregnancy outcome in that the risks of a low birth weight, pre-term and small-for-dates term delivery were significantly increased only for those women who had light bleeding and who had not used therapeutic hormones. Heavy vaginal bleeding, in contrast, was associated with an excess risk of these perinatal complications regardless of hormone usage. There was also a suggestion that certain subgroups of women with vaginal bleeding might be at an increased risk of delivering an offspring with congenital malformations.

Female↗
PubMed1983

Analysis of data from successive complex sample surveys, with an example of hypertension prevalence from the United States Health Examination Survey.

There are a number of ongoing large complex sample surveys focused on health data being undertaken at present. Because of time and cost constraints, these surveys are usually highly stratified multistage cluster samples. The complexity of this design has made the usual simple random sampling assumptions untenable and therefore analyses are rarely more than descriptive in nature with some pairwise comparison using t-tests. Generalized regression procedures using weighted least squares are now available for solving this difficulty by incorporating the sample design into the data analysis through the variances and covariances of the sample estimates. These procedures are extended to the analysis of data from complex surveys conducted at two or more different points in time (successive surveys). The method is illustrated with an example taken from published data of hypertension prevalence estimates from the Health Examination Survey-Cycle I (1960-1962) and the Health and Nutrition Examination Survey (1971-1975).

Adult↗
PubMed1982

Increased risk of nephrolithiasis in patients with steatorrhea.

Patients with ileal disease have increased absorption of dietary oxalate, hyperoxaluria, and an increased incidence of nephrolithiasis. Patients with steatorrhea of varying etiologies also have hyperoxaluria. To determine whether steatorrhea per se is associated with nephrolithiasis, we reviewed the charts of all adult patients who had a 72-hr fecal fat analysis from 1968 to 1978. The 159 patients with steatorrhea were compared to 162 patients without steatorrhea. The two groups were comparable in age, sex, urine specific gravity, and serum uric acid and phosphorus; serum calcium was slightly less in the steatorrhea group (8.7 +/- 0.1 vs 9.0 +/- 0.1, P less than 0.02). Although 19 patients with steatorrhea had nephrolithiasis compared to 7 control patients (P = 0.01), 15 of these 19 patients had ileal disease and only 4 of the 118 patients with steatorrhea but without ileal disease had stones. Categorical data analysis revealed that steatorrhea, diarrhea (stool weight greater than 225 g/day), male sex, and ileal disease were significantly associated with nephrolithiasis with a relative risk of 3.0, 2.7, 3.1, and 8.0, respectively. When patients without ileal disease were analyzed separately, however, steatorrhea, diarrhea, and sex were no longer risk factors. In contrast, in patients with ileal disease the incidence of nephrolithiasis increased with the severity of steatorrhea. The relative risk of nephrolithiasis in male patients with ileal disease and fecal fat greater than 20 g/day was 26.3 (P less than 0.01). Thus, the presence of both ileal disease and steatorrhea greatly increases the risk of nephrolithiasis; however, neither steatorrhea alone nor ileal disease alone are risk factors for nephrolithiasis.

Celiac Disease↗
PubMed1982

Hydatidiform mole in the United States (1970-1977): a statistical and theoretical analysis.

The incidence of hydatidiform mole and some epidemiologic features of the disease in the United States were studied. Data for the present study were obtained from the Hospital Discharge Survey (1970-1977) of the National Center for Health Statistics. The estimated incidence of hydatidiform mole over the eight-year period was 108.4 per 100,000 pregnancies (SE = 10.3) or one case in every 923 pregnancies. There was an apparent increase in the incidence rate from 1970 to 1975, but the rate dropped slightly after 1975. The distribution of hydatidiform mole by maternal age showed the highest rate among women 35 years and older, and the second highest rate among women aged 15-19. The distribution by maternal age found for the entire sample was also apparent within each race category. Overall, black women appeared to have an incidence rate half that of white women. Regional differences in the United States were observed in spite of race and age adjustment. Existing studies are reviewed in light of morphologic and cytogenetic classification schemes and recent hypothesis for the androgenetic origin of hydatidiform mole. A fresh approach to the epidemiology of hydatidiform mole which combines epidemiologic and genetic studies is indicated.

Adolescent↗
PubMed1982

Hospitalization for medical-legal and other abortions in the United States 1970-1977.

The National Hospital Discharge Survey records for medical-legal, spontaneous, and "other" abortions (ICDA-8 640-641, 643, and 644 respectively) for 1970-1977 were analyzed to investigate the impact of liberalized access to abortion on abortion-related morbidity in the United States. The analysis suggests that in census regions where an increase in medical-legal abortions performed in hospitals occurred over the study period there was an associated decreased likelihood of a "spontaneous" or "other" abortion. The spontaneous and "other" abortion codes appear to have been used synonymously and a small number of each used to classify complications of both illegal and legal abortions performed outside hospitals. There was a significant reduction in length of stay for spontaneous and other abortions between 1970 and 1977. This is suggestive of decreasing severe presenting symptomatology for complicated abortion. The study further suggests that: during 1970-77 illegal abortions were largely replaced by legal procedures; increases in legal abortions beyond those replacing illegal have not resulted in increased rates of hospitalization for complicated abortion; and, the case morbidity rate for legal abortion appears to have declined.

Abortion, Induced↗
PubMed1982

Changes in age and sex specific tonsillectomy rates: United States, 1970-1977.

National estimates of tonsillectomy rates were generated from the Hospital Discharge Survey for the years 1970 and 1977. A comparison of the rates over the seven-year period revealed significant declines in T&A for all age and sex categories and in tonsillectomy alone for males aged 20 through 29. It was also observed that sex differences found in 1970 persisted in 1977. (Am J Public Health 1982; 72:488-491.)

Adenoidectomy↗
PubMed1981

Incidence of acute traumatic hospitalized spinal cord injury in the United States, 1970-1977.

The incidence of hospitalization for acute spinal cord injury in the United States from 1970 to 1977 has been calculated using a detailed subsetting of the National Hospital Discharge Survey (HDS). The overall eight-year incidence was 40.1 (SE = 3.8) per million population in the United States. Patients admitted for spinal cord injury were more than twice as likely to be male (male to female ratio = 2.4:1 and spinal cord injury was particularly common in males ages 20-24 (118.3/10(6)) and 25-34 (98.7/10(6). Blacks also appeared to be at twice the risk than whites. Case fatality during hospitalization was 11.2% overall, was 36% more common in males and increased markedly with advanced age with 35.9% of males greater than or equal to 65 years old dying during hospitalization. The HDS data are in general agreement with previous regional studies of incidence and appear to provide a reasonably valid and cost-effective method for monitoring the national incidence of hospitalized spinal cord injury.

Adolescent↗
PubMed1981

A scale for evaluation of spinal cord injury.

A scale has been developed for assessment of the severity of spinal cord injury and the prognosis for recovery. Based on neurological examination, this scale employs numerical grading of selected functions below the level of the injury. The scale is adaptable to prospective as well as retrospective studies, and provides a reliable estimation of prognosis and, therefore, a means of comparing the effectiveness of differing treatment modalities. In relation to a group of 37 patients with cervical spinal cord injury treated under one protocol and assessed within 24 hours and again at 1 year from injury, a descriptive model of the patterns of recovery has been obtained. Relative recovery of the initial deficit measured as a "percentage recovery ratio" is presented as an analytical tool for comparison of effectiveness of different methods of therapy.

Analysis of Variance↗
PubMed1980

Summary rates.

The use of summary rates of reporting health data is discussed. Directly and indirectly adjusted rates are compared under two models of no interaction. A method of analysis is described whereby a model is first fitted to data in order to investigate assumptions, and subsequently the smoothed rates based on the model are summarized using an adjusted rate. We prefer directly adjusted rates when such a summarization is appropriate and the required data are available. An example is given which illustrates the method of estimation.

Data Collection↗
PubMed1977

A general methodology for the analysis of experiments with repeated measurement of categorical data.

This paper is concerned with the analysis of multivariate categorical data which are obtained from repeated measurement experiments. An expository discussion of pertinent hypotheses for such situations is given, and appropriate test statistics are developed through the application of weighted least squares methods. Special consideration is given to computational problems associated with the manipulation of large tables including the treatment of empty cells. Three applications of the methodology are provided.

Drug Evaluation↗
PubMed1976

An analysis of physician visit data from a complex sample survey.

A generalization of ordinary least squares methods is used in the analysis of physician visit data from a complex sample survey. The emphasis, in this paper, is on the valid substantive inferences to be drawn from an analysis of this type of data. The procedure is found to be useful in two ways. First, the resultion on a national basis. It is concluded that age is an imp-s of a comparative sampling study are reported. Second, the procedure is used to remove statistically non-significant variation from the data in order to generate fitted or smoothed estimates on which the substantive analyst may focus his attention. These fitted values are then examined for implications to physician service utilization on a national basis. It is concluded that age is an important variable while the effect of sex and race depends on age. Similarly, residence and income are important but the effect of education depends on the level of income.

Adolescent↗
PubMedDate not supplied

Frequency and correlates of adjustment disorder related to cardiac surgery in older patients.

The diagnosis of adjustment disorder is a dilemma in older medically ill patients. The authors conducted a prospective study of older cardiac surgery patients. Semistructured interview techniques were used to distinguish emotional impairment from physical impairment to diagnose an adjustment disorder. Among 71 patients interviewed at three points in time, 50.7% had an adjustment disorder. At 6 months after surgery, 30.6% were still showing evidence of emotional functional impairment. Continued impairment was related to initial severity of depressive and anxiety symptoms. Implications and suggestions for future research are discussed.

Activities of Daily Living↗