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Biomedical subjects

G R Alexander

Publications and source records attributed to G R Alexander.

At least 91 records · Page 5Linked to original sources
PubMed1985

The risk of low birth weight. Alternative models of neonatal mortality.

The authors examine the use of the infant's weight at birth to estimate its risk of mortality by the 28th day of life. The performance of several commonly employed statistical models is compared for the population of single births to resident South Carolina mothers in 1975-1980. A log-linear function, fitting the natural logarithm of the probability of neonatal mortality to birth weight, performs far better in this analysis than a quadratic or a logistic model or a model using the logarithm of the probability of survival. The parsimonious log-linear model also appears preferable to more complex models with additional parameters. The authors use the model in an analysis of data in two-year periods to demonstrate its value as an indicator of underlying changes in neonatal prospects and its easily interpreted parameters. The results highlight the importance of changes in neonatal mortality affecting low birth weight infants, which produce a noticeable shift in the range in which low birth weight is associated with the risk of mortality. These have proven more important in accounting for the decline in mortality rates than have changes affecting only neonates with more typical birth weights in South Carolina in 1975-1980.

Birth Certificates↗
PubMed1985

Correlates of infant death from infectious diarrhea in the southeastern United States.

Infectious diarrhea (ID) caused 242 infant deaths in South Carolina between 1970 and 1978, and is still a significant cause of death in the southeastern United States. Therefore, using South Carolina death certificates from 1970 to 1978 and the state's linked birth/death certificate file, we sought prenatal and postnatal characteristics that might predict death from gastroenteritis in the first year of life. Accuracy of diagnoses was verified from the original death certificates and in a sample of hospital charts. Most deaths caused by ID occurred after the first 28 days of life and were significantly concentrated in the winter. Low birth weight (odds ratio 7.09), nonwhite race (7.00), inadequate prenatal care (4.35), small size of hospital (0.31), and illegitimate birth (2.35) were all significantly associated with postneonatal death. Infants with all of the three strongest predictor characteristics were 14 times as likely to die of ID, but the "predictive value" of this combination for ID death was only 0.54%. Although mothers of these high-risk infants should be given special education about prevention of dehydration, and the families would be logical candidates for a rotavirus vaccine trial, more expensive interventions should not be instituted without a cost-benefit analysis.

Acute Disease↗
PubMed1985

Firearm-related fatalities: an epidemiologic assessment of violent death.

This study examines 1970-78 South Carolina firearm fatalities utilizing vital record data. During this period, 5,808 firearm deaths, classified as accident, homicide, suicide, or undetermined, were reported with an average annual fatality rate of 23.35 deaths per 100,000 estimated population. Firearm fatalities in South Carolina were the sixth leading cause of death in 1975 and accounted for 2.9 per cent of all deaths to residents. A significant period decline in the firearm fatality rate was observed and was attributed mainly to decreases in the non-White rate. In 1978, the fatality rate for non-Whites (18.5) fell below the rate for Whites (19.1) for the first time in the years investigated. Firearm deaths represent a major community health problem and, as such, warrant attention and direct involvement by state and local health professionals.

Accidents↗
PubMed1984

Use of industrial hygiene and safety professionals: a survey of South Carolina manufacturing plants.

There has been considerable debate about manpower adequacy in industrial hygiene and safety, but little indication as to which industries make use of these professionals and to what extent. This paper presents the results of a survey of manufacturing industry in South Carolina, which suggest that plants not only make less use of the services of industrial hygiene and safety engineers than might seem desirable, but have only a limited perception of the need.

Humans↗
PubMed1982

Identifying the cause of ischemic heart disease/myocardial infarction syndrome: a new approach.

Risk factor identification in the coronary heart disease/ myocardial infarction syndrome has failed to account for the epidemic pattern of increase in this century with recent decline. It is hypothesized that the true cause remains unidentified and that innovative application of traditional epidemiologic techniques, to correlate the identifiable peaks in different regions with possible agents, may prove successful.

Coronary Disease↗
PubMed1979

Opiate addiction and suicidal behaviors.

The authors tested the hypothesis that people addicted to opiates manifest more psychopathology in areas that have been identified as predictors for high risk of suicidal behavior than do normal control subjects. They gave 278 patients in a methadone maintenance program and 207 normal control subjects the index of Potential Suicide (IPS), a scale designed to assess suicidal risk. Using discriminate function analysis, the authors found that 87% of 100 of the methadone patients and 98% of 100 of the normal control subjects were correctly identified on the basis of the IPS data.

Adult↗
PubMedDate not supplied

The rationale for a ban on detergent phosphate in the Great Lakes Basin.

Immediate reduction of phosphorus loadings to the Great Lakes is essential to slow accelerated eutrophication. The Great Lakes National Program Office of the US Environmental Protection Agency now advocates adoption of bans on detergent phosphates as the most practical and feasible means of immediately reducing the phosphorus loadings to the Great Lakes. This change in policy from previous reliance on removal by sewage treatment has been adopted for the following reasons: (1) Bans on phosphates will reduce capital and operating costs of treatment and, were adopted, have met with consumer acceptance. (2) In practice, treatment plants have not met design expectations for phosphate removal. (3) Neither nitrilotriacetic acid nor other substitutes for phosphates have proved to be a public health problem. (4) Reduction of phosphorus loadings to treatment plants avoids increasing levels of chlorides and total dissolved solids in effluents. (5) Water quality has improved in small lakes with phosphorus reduction. In summary, detergent phosphate bans alone will not reduce phosphorus loadings to the Great Lakes sufficiently for the long term but the Environmental Protection Agency has concluded that such action is necessary in addition to continued efforts to control non-point sources.

Detergents↗
PubMedDate not supplied

Effects of superior check desmotomy on flexor tendon and suspensory ligament strain in equine cadaver limbs.

OBJECTIVE: To measure the effects of transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) on flexor tendon and suspensory ligament (SL) strain in vitro. STUDY DESIGN: In vitro experimental biomechanical investigation. ANIMALS USED: Ten equine cadaver forelimbs. METHODS: The effects of superior check desmotomy were determined using equine cadaver forelimbs secured in a servocontrolled hydraulic testing machine. Strain sensors were used to measure strain on the superficial and deep digital flexor tendons and SL, and a goniometer was used to measure joint angles when the limb was loaded at 890 N and 3,115 N before desmotomy, and at 3,115 N after desmotomy. RESULTS: Superior check desmotomy was associated with significantly increased strains on the SDF tendon and SL, and significant alterations in the angles of the metacarpophalangeal and carpal joints. CONCLUSIONS: The superior check ligament has an important role in maintaining joint angles and load distribution in the forelimb. Lengthening of the SDF musculotendinous unit after superior check desmotomy may be associated with increased strain on the SL. CLINICAL RELEVANCE: Transection of the accessory ligament of the SDF muscle may predispose horses to SL desmitis postoperatively.

Animals↗
PubMedDate not supplied

Maternal nativity status and pregnancy outcome among U.S.-born Filipinos.

Using 1979-87 Hawaii vital record data on single live births, this study compares by nativity status of the mother the maternal characteristics and pregnancy outcomes of resident Filipino women. Among ethnic minorities in the United States, the pregnancy outcomes of U.S.-born mothers have been reported to compare unfavorably to their foreign-born counterparts. In this study, unequivocally preferential pregnancy outcome indicators were not observed for foreign-born women. Contrary to expectations, a significant, but modest, increase in the risk of preterm delivery was found for infants of Philippines-born mothers, along with a less favorable mean birth weight and gestational age. As a growing minority population in the United States, the atypical determinants and patterns of pregnancy outcome in this population warrants further investigation.

Adolescent↗
PubMedDate not supplied

Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.

Evidence-Based Medicine↗
PubMedDate not supplied

Area-level predictors of use of prenatal care in diverse populations.

Patterns and predictors of the use of prenatal care in Hawaii were examined by census tract, taking into account summary measures of socioeconomic status, environmental conditions, and aggregated indicators of pregnancy-related risk characteristics of mothers. The objectives of the study were to identify those census tracts with high levels of inadequate use of prenatal care services; to develop a model, based on census tract characteristics, to explain observed geographic variations in the use of prenatal care services; and to identify for further investigation specific localities with unanticipated patterns of use. Data were drawn from 1980 census reports and vital statistics live birth files for the period 1979-87. Regression analysis was used to develop a model that was able to predict 61 percent of the census tract variation in the percentages of inadequate use of prenatal care services. Increased proportions of mothers of Japanese and other Asian-descent and of adults with more than high school education were associated with low levels of inadequate use of prenatal care services. Increased proportions of high parity-for-age risk and Samoan mothers were associated with higher levels of inadequate use. Census tract maps of actual and predicted percentages and studentized residual values were used to identify areas with high and low rates of inadequate use of prenatal care services. The area-level methods used are believed applicable to health care planning in other areas with ethnically or socioculturally diverse populations.

Demography↗
PubMedDate not supplied

Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care.

The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.

Abortion, Induced↗
PubMedDate not supplied

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

Cause of Death↗