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Biomedical subjects

F DeStefano

Publications and source records attributed to F DeStefano.

At least 73 records · Page 4Linked to original sources
PubMed1984

Mortality among young black women using contraceptives.

Data on the risk of death associated with various contraceptive methods are incomplete. Therefore, we analyzed the mortality rates for young, black inner-city women who used one of four methods of contraception--oral contraceptives, depomedroxyprogesterone acetate, intrauterine (contraceptive) devices, and barrier methods. The subjects were 30,580 15- to 44-year-old women who enrolled at a family planning clinic between 1967 and 1972 and who were observed by monitoring death certificates through the end of 1977. Forty percent of the 218 deaths observed were from accidents and violence. Use of this family planning clinic greatly reduced the risk of death from childbearing; only two deaths were associated with pregnancy and childbirth, compared with the 24 deaths expected. Overall, users of the four methods died at similar, low rates. Given that this study involves considerable loss to follow-up, possible acute effects of contraceptives (eg, infections or thrombosis) are more accurately estimated than possible long-term effects (eg, cancer).

Adolescent↗
PubMed1983

Deaths attributable to tubal sterilization in the United States, 1977 to 1981.

In 1979, the Centers for Disease Control began surveillance of deaths attributable to tubal sterilization in order to determine why they occur and what may be done to prevent them. Since that time, 29 such deaths have been identified as occurring in the United States from 1977 through 1981. Of these 29 deaths, 11 followed complications of general anesthesia, seven were due to sepsis, four were due to hemorrhage, three were due to myocardial infarction, and four deaths were related to other causes. Some of these deaths might have been prevented by use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, safer use of unipolar coagulation or use of alternative techniques, careful insertion of the needle and trocar for laparoscopy, and discontinuation of oral contraceptives before sterilization. Further surveillance may help to make tubal sterilization even safer.

Adult↗
PubMed1983

The safety and efficacy of tubal sterilization: an international overview.

This article presents a synthesis of some of the major published studies on the efficacy and safety of tubal sterilization. The conclusions of this overview are that tubal sterilization is a safe operation, long-term sequelae of tubal sterilization have not been well documented, and the risk of pregnancy following tubal sterilization is less than 1 in 100. Continued study is needed to determine how to make a safe and effective procedure even safer and more effective.

Female↗
PubMed1983

Risk of wound and pelvic infection after laparoscopic tubal sterilization: instrument disinfection versus sterilization.

To determine if disinfection, rather than sterilization, of laparoscopic equipment leads to an increase in the risk of postlaparoscopy infection, the authors analyzed data from a multicenter prospective study conducted by the Centers for Disease Control on the safety of sterilizing operations. From September 1978 through July 1981, 3903 women underwent laparoscopic tubal sterilization procedures in which the equipment was sterilized with ethylene oxide (58%) or disinfected with glutaraldehyde (42%). The overall risk of wound infection in each group was 1.5 per 100 women. The relative risk of wound infection for disinfection versus sterilization of the equipment was 0.5 when adjusted for differences in the two groups. The corresponding relative risk of pelvic infection was 1.2. These results suggest that laparoscopy equipment disinfected with glutaraldehyde is not associated with an increased risk of wound or pelvic infection compared with equipment sterilized with ethylene oxide.

Adolescent↗
PubMed1983

Menstrual changes after tubal sterilization.

The authors used data from a multicenter prospective study of female sterilization surgery to study changes in menstrual function following tubal sterilization. Duration of menstrual bleeding, menstrual cycle length, cycle regularity, amount of menstrual bleeding, menstrual pain, and intermenstrual bleeding were examined. The authors followed 2456 women for two years after tubal sterilization surgery. Each woman served as her own control; her menstrual function at the two-year follow-up interview was compared with her menstrual function at the preoperative interview. Except for menstrual pain among women who underwent unipolar electrocoagulation procedures, there was no increase in the prevalence of adverse menstrual function after tubal sterilization. For all menstrual variables, 50% or more of women with adverse function preoperatively had an improvement by two years after tubal sterilization.

Adolescent↗
PubMed1983

Risk factors for complications of interval tubal sterilization by laparotomy.

The complication rate among 282 women undergoing interval tubal sterilization by laparotomy was studied as part of the prospective multicenter Collaborative Review of Sterilization. Using a standard definition of major complications, the overall complication rate was 5.7 per 100 procedures. Women experiencing complications had a significantly lengthened postoperative recovery period before the resumption of normal activities. Important risk factors for complications included diabetes, cigarette smoking, previous abdominal or pelvic surgery, and a history of pelvic inflammatory disease. Women with an initial abdominal incision of 7 cm or longer had three times the complication rate of women with shorter incisions. These results provide objective evidence that, for tubal sterilizations, minilaparotomy (laparotomy with a small abdominal incision) is associated with lower morbidity than is conventional laparotomy.

Abdomen↗
PubMed1982

Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.

Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade, few recent studies have been conducted to determine the risk of complications. We examined data from the Collaborative Review of Sterilization, a prospective, multicenter, observational study coordinated by the Centers for Disease Control, to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches. Between September, 1978, and August, 1981, 1,851 women from nine institutions were included in the study. Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group. Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity, bleeding requiring transfusion, hospitalization, and convalescence than abdominal hysterectomy. Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinically appropriate.

Adolescent↗
PubMed1982

Mortality risk associated with tubal sterilization in United States hospitals.

Despite the millions of women who have undergone tubal sterilization in United States hospitals, little has been published about the risk of death from these procedures. To estimate a case-fatality rate of tubal sterilization, we combined data from the Commission on Professional and Hospital Activities and the National Center for Health Statistics with a review of the clinical circumstances for each woman whose death was identified as being potentially sterilization attributable. Considering all deaths temporally associated with tubal sterilization, we estimate that the case-fatality rate is nearly 8/100,000 procedures. When only deaths determined to be attributable to the sterilization operation per se are considered, the case-fatality rate is approximately 4/100,000 procedures, making death attributable to tubal sterilization a rear event.

Epidemiologic Methods↗
PubMed1982

Demographic trends in tubal sterilization: United States, 1970-1978.

In the period 1970-1977, an estimated 4,236,000 women 15-44 years of age had tubal sterilization operations in United States hospitals. Both the number and the rate of tubal sterilizations increased each year from 1970-1977, but in 1978 both declined. Tubal sterilization rates for Black women were higher than for White women. Black women also tended to be younger at the time of tubal sterilization. For the nation as a whole, the mean age at the time of tubal sterilization remained constant at about 30 with the youngest age group having the highest proportion of never-married women.

Adolescent↗
PubMed1982

Deaths associated with laparoscopic sterilization in the United States, 1977-79.

In 1979, the Centers for Disease Control began epidemiologic surveillance of deaths associated with tubal sterilization as part of an effort to assess the mortality risks associated with different methods of fertility control. The surveillance system identified nine deaths following laparoscopic sterilization in the United States from 1977 through 1979. The causes of these deaths and how some of them might have been averted are discussed.

Female↗
PubMed1982

Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗
PubMed1981

The impact of laparoscopy on tubal sterilization in United States hospitals, 1970 and 1975 to 1978.

During the 1970s, tubal sterilization became an important method of fertility control in the United States. Over the same period laparoscopy emerged as an important innovation, one that has been associated with both a shift from postpartum to interval sterilization and a dramatic decrease in length of hospital stay required for sterilization. The use of laparoscopy has also been associated with an increase in hospital-based outpatient sterilization, particularly in the West. The number of sterilizations performed in hospitals and the use of laparoscopy for interval sterilization in hospitals both appear to have peaked. The laparoscope is an example of a technologic advance that has reduced medical care costs.

Adolescent↗
PubMed1979

Blood pressure survey on the Navajo Indian reservation.

The authors conducted blood pressure screening on the Navajo Indian reservation in northeastern Arizona and northwestern New Mexico. Six hundred forty Navajos over 19 years of age were surveyed at various sites. The mean systolic and diastolic blood pressures in Navajo men and women did not show as great increases with age as those seen among white and black Americans. Navajos also had generally lower blood pressures and lower prevalence of hypertension than white and black Americans. The authors were unable to demonstrate any association between degree of acculturation and blood pressure, but they did find that obesity in both men and women and alcohol use in men were associated with a higher prevalence of elevated pressure in the Navajos.

Adult↗
PubMedDate not supplied

The Vaccine Safety Datalink project.

The Vaccine Safety Datalink (VSD) is a collaborative project between the National Immunization Program of the Centers for Disease Control and Prevention (CDC) and several large health maintenance organizations (HMOs) in the United States. The project began in 1990 with the primary purpose of rigorously evaluating concerns about the safety of vaccines. Computerized data on vaccination, medical outcome (e.g. hospital discharge, outpatient visits, emergency room visits, and deaths), and covariate data (e.g. birth certificates and census) are prospectively collected at multiple HMOs (initially four) and linked under joint protocol for analyses. Approximately 6 million people (2% of the US population) are members of HMOs participating in the VSD. The VSD has proven to be a valuable resource that has provided important information on a number of vaccine safety issues. The databases and infrastructure created for the VSD have also provided opportunities to address other immunization questions including vaccination coverage and cost-effectiveness. In a recent investigation of intussusception following rotavirus vaccination, the VSD methodology was expanded to include 10 managed care organizations. A cohort study was conducted that allowed estimation of incidence rates of intussusception and attributable risks associated with rotavirus vaccine.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

The association of peripheral arterial disease with hostility in a young, healthy veteran population.

The association of peripheral arterial disease (PAD) with hostility, a component of Type A behavior, has not been investigated. Previous studies have found an association between coronary arterial disease and hostility. We used Doppler tests to define PAD as consisting of a resting index less than 0.9, absence of posterior tibial waveform, or presence of a femoral bruit. Among 4,462 male veterans, the prevalence and odds ratio of PAD increased statistically significantly with an increase in the Cook-Medley hostility scale. The prevalence of PAD was 0.7%, 1.1%, 1.4%, and 1.6% in the first, second, third, and fourth quartiles of the hostility scale, respectively. Using the first quartile as a reference group, we found that odds ratios of PAD were 1.6, 1.9, and 2.2 for the second, third, and fourth quartiles, respectively. Odds ratios, adjusted for age, race, cigarette smoking, hypertension, familial ischemic heart disease, diabetes, and elevated LDL/HDL were 1.4, 1.6, and 1.8, respectively. The magnitude of the odds ratios and their statistically significant trend suggest an association between PAD and hostility.

Adult↗
PubMedDate not supplied

Relation of serum testosterone levels to high density lipoprotein cholesterol and other characteristics in men.

Although levels of high density lipoprotein (HDL) cholesterol in males decrease during adolescence and after treatment with testosterone derivatives, several studies have reported that levels of HDL cholesterol are positively associated with endogenous levels of testosterone in men. This association was further examined using data collected during 1985 and 1986 from 3,562 white and 500 black men who ranged in age from 31 to 45 years. Black men had higher mean levels of both HDL cholesterol (8 mg/dl) and total testosterone (33 ng/dl) than white men, and positive associations were observed between testosterone and HDL cholesterol levels (r = 0.22, whites; r = 0.26, blacks). In addition, levels of testosterone were related positively to alcohol consumption and cigarette smoking and negatively to age, Quetelet index, and use of beta-blockers. We used stratification and regression analyses to determine if any of these characteristics could account for the positive association between levels of HDL cholesterol and total testosterone. Although controlling for most factors had little influence, adjusting for Quetelet index reduced the strength of the association between levels of testosterone and HDL cholesterol by approximately 30%. These findings suggest that the positive association between levels of testosterone and HDL cholesterol may not be causal. Multivariable analyses that control for obesity and other potentially confounding characteristics should be used in studies that assess the relation of testosterone levels to coronary heart disease.

Adult↗
PubMedDate not supplied

Safety of routine childhood vaccinations. An epidemiological review.

Immunisations have been one of the most cost-effective public health interventions in human history. Despite remarkable progress, several challenges face immunisation programs worldwide. Paradoxically, despite vaccines' clear effectiveness in reducing risks of diseases that were previously widely prevalent and caused substantial morbidity and mortality, current vaccination policies have become increasingly controversial due to concerns about vaccine safety. Vaccines, like other pharmaceutical products, are not entirely risk-free. While most known adverse effects are minor and self-limited, some vaccines have been associated with very rare but serious adverse effects. Because such rare effects are often not evident until vaccines come into widespread use, ongoing surveillance programs to monitor vaccine safety are needed. Such monitoring will be essential if the public is to accept the increasing number of new vaccines made possible by biotechnology. The interpretation of data from vaccine safety research is complex and is associated with some uncertainty. Effectively communicating this uncertainty and continuing to improve understanding of rare risks and risk factors are essential for "mature" immunisation programs to maintain public confidence in immunisations.

Adolescent↗