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Biomedical subjects

J A Fortney

Publications and source records attributed to J A Fortney.

At least 37 records · Page 2Linked to original sources
PubMed1994

Bone mineral density and history of oral contraceptive use.

To examine the relationship between oral contraceptive (OC) use and bone mineral density (BMD), we conducted a cross-sectional study on 352 white, nonsmoking, perimenopausal women aged 40-54 years. We measured bone mineral density of lumbar vertebrae 2-4 with dual photon absorptiometry and mid-radius and distal radius with single photon absorptiometry. After controlling for age, body mass, current physical activity, current calcium intake and history of breastfeeding, our analysis did not find substantial differences in BMD at any site between OC ever users and never users. However, OC ever users had slightly higher lumbar BMD among premenopausal women. No significant association was identified between recency of OC use and BMD. The results of our study suggest that when other factors are accounted for, OC use is not strongly associated with BMD among perimenopausal women, although we cannot exclude a slight beneficial effect.

Adult↗
PubMed1993

Efficacy of external cephalic version: a review.

OBJECTIVE: To assess the efficacy of external cephalic version, including safety, cost-benefit analysis, and impact on the cesarean delivery rate. DATA SOURCES: A MEDLINE search was conducted to identify all articles published in English between 1980-1991 on external cephalic version. References were also cross-checked for all reports. METHODS OF STUDY SELECTION: We reviewed only those articles providing sufficiently detailed data to determine actual numbers of subjects. In cases of duplicate results, only the latest publication was used. Rates of successful version, cesarean delivery, and fetal and maternal complications were presented. DATA EXTRACTION AND SYNTHESIS: Among the United States trials, the success rate was approximately 65% (range 48-77%), and once version succeeded, almost all the fetuses stayed in the vertex position until birth. Among those in whom external version was performed, the mean cesarean delivery rate was 37%, compared with 83% in controls (P < .001). External version would also save 12.3% of the costs of delivering breech patients overall. CONCLUSION: External cephalic version is safe and cost-effective. It substantially reduces the cesarean delivery rate among breech presentations, decreases the risk related to breech delivery, and avoids cesarean delivery in subsequent pregnancies. However, external version will not have a major impact on the high overall cesarean birth rate.

Africa↗
PubMed1992

Lactation history and bone mineral density among perimenopausal women.

To examine the relation between lactation and bone mineral density, we conducted a cross-sectional study among white, nonsmoking, perimenopausal women age 40-54. Three hundred fifty-two women completed a questionnaire covering medical and reproductive histories, physical activity, and diet. We measured the bone density of lumbar vertebrae 2-4 with dual photon absorptiometry, and the midradius and distal radius with single photon absorptiometry. Women with a history of lactation had 41 mg per cm2 higher lumbar bone mineral density than women with no lactation (95% confidence interval = 8-74 mg per cm2), controlling for parity, body mass, physical activity, and menopausal status. We found no important increase at mid- or distal radius.

Adult↗
PubMed1992

Moderate physical activity and bone density among perimenopausal women.

We examined the association between physical activity and bone mineral density (BMD) among 352 perimenopausal women. A personal activity computer was used to estimate the daily energy expenditure on physical activity. BMD was measured by photon absorptiometry at the lumbar spine, midradius, and distal radius. Multiple linear regression, controlling for other factors, indicated that physical activity was positively and significantly associated with BMD at all sites. Moderate physical activity has beneficial effects on BMD among perimenopausal women.

Adult↗
PubMed1990

Reproductive epidemiologic research in developing countries.

This paper discusses the scientific rationale for carrying out reproductive epidemiologic research in developing countries, and the generalizability of results of research done in developed countries to developing countries. Practical problems encountered in doing research in developing countries include limited resources, overcommitted researchers, cost, and study monitoring. Cultural differences that affect the design and conduct of research activities in developing countries are also discussed.

Anemia, Sickle Cell↗
PubMed1990

Do the benefits of breastfeeding outweigh the risk of postnatal transmission of HIV via breastmilk?

Conflicting recommendations have been offered about whether HIV+ mothers should breastfeed. Since there is a strong precedent for US infant feeding practices to be imitated in developing countries, a model was constructed to estimate infant mortality if the CDC admonition for HIV+ mothers not to breastfeed were upheld in less developed settings. Estimates are given for infant mortality in the presence and absence of breastfeeding across several baseline levels of infant mortality and across several theoretical rates of transmission through breastfeeding. The infant mortality associated with HIV infection acquired through breastfeeding is estimated to be lower than the mortality associated with the diseases of infancy that would result if breastmilk were withheld. The difference in these estimates is greater in areas with high baseline levels of infant mortality.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Implications of the ICD-10 definitions related to death in pregnancy, childbirth or the puerperium.

The Tenth Revision of the International Classification of Diseases (ICD-10) will include two new definitions concerning death related to pregnancy: --Late maternal death--the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy. --Pregnancy-related death--the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. This article discusses the rationale underlying these definitions and their implications for public health statistics. The introduction of these definitions is a step, albeit a timid one, towards an increased acceptance of epidemiology in determining the relationships which affect death related to pregnancy. It is to be hoped that the trend thus initiated can be encouraged.

Cause of Death↗
PubMed1988

Oral contraceptives and cervical cancer risk in Costa Rica. Detection bias or causal association?

To examine the relationship between cervical cancer and oral contraceptive (OC) use, we analyzed data from a population-based, case-control study in Costa Rica. Women aged 25 to 58 years in whom cervical cancer was diagnosed and reported to the National Tumor Registry were examined as two separate case groups: invasive cervical cancer and carcinoma in situ (CIS). Controls were women aged 25 to 58 years identified through a national survey. Women who had used OCs had no increased risk of invasive cervical cancer compared with women who had never used OCs (relative risk, 0.8; 95% confidence interval, 0.5 to 1.3). Women who had used OCs had an increased risk of CIS compared with those who had never used OCs (relative risk, 1.6; 95% confidence interval, 1.2 to 2.2). However, further analyses indicated that this increased risk was confined to those who had recently used OCs. Also, the risk of CIS was not elevated in subgroups in which a history of cervical smears was not strongly linked to OC use. The elevated risk of CIS among OC users may therefore reflect a bias caused by enhanced detection of disease rather than a causal association.

Adult↗
PubMed1988

Maternal mortality in Indonesia and Egypt.

Twenty-three percent of deaths to women of reproductive age (15-49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100,000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two-thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children--the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.

Adolescent↗
PubMed1988

A comparison of two cause-of-death classification systems for deaths among women of reproductive age in Menoufia, Egypt.

Mortality data ascertained from sources other than a death registration system can validate the accuracy of the system, but this information is rarely obtained. Data on 1979 deaths among reproductive age women were collected in the 1981-1983 Reproductive Age Mortality Survey (RAMOS) in the governorate of Menoufia, Egypt, and compared with data on these deaths as recorded by the Egyptian death registration system. Although the distribution of the causes of death were similar, there were substantial differences between classification systems for deaths due to particular causes. Over half of the deaths classified differently by the systems were those assigned to circulatory disease on the death certificate. In contrast, there was a high rate of agreement between systems in the classification of trauma deaths. About half (52.4%) of cancer deaths had the same site-specific cancer diagnosis assigned by RAMOS. The percentage of deaths assigned to maternal causes was three times higher in RAMOS (19.2%) than on death certificates (6.1%). Reported mortality rates for this often-preventable cause of death have been substantially underestimated in national death registration systems. Such underreporting masks the need for additional prenatal care and maternal health programmes.

Adolescent↗