Substantial decrease in numbers and rates of AIDS deaths over the last decade.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
S E Barkan
Publications and source records attributed to S E Barkan.
The Women's Interagency HIV Study. WIHS Collaborative Study Group.
The Women's Interagency HIV Study comprises the largest U.S. cohort to date of human immunodeficiency virus (HIV)-seropositive women (N = 2,058) with a comparison cohort of seronegative women (N = 568). The methodology, training, and quality assurance activities employed are described. The study population, enrolled between October 1994 and November 1995 through six clinical consortia throughout the United States (totaling 23 sites) represents a typically hard-to-reach study population. More than half of the women in each cohort were living below the federally defined levels of poverty. The women ranged in age from 16 to 73 years; approximately one-quarter self-identified as Latina or Hispanic, over one-half as African-American not of Hispanic origin, and less than 20% as white, non-Hispanic origin. Self-reporting of HIV exposure risk included injection drug use by 34% of the seropositive women and 28% of the seronegative women, heterosexual contact (42% vs 26%), transfusion risk (4% vs 3%) and no identified risk (20% vs 43%). Demographic and HIV exposure risk characteristics of the seropositive cohort were comparable with characteristics of nationally reported AIDS cases in U.S. women. This well characterized cohort of HIV-seropositive and high-risk seronegative women represents a rich opportunity for future studies of HIV disease progression and pathogenesis.
Adolescent↗
Clinical determinants of the racial disparity in very low birth weight.
BACKGROUND: Although the risk of very low birth weight (less than 1500 g) is more than twice as high among blacks as among whites in the United States, the clinical conditions associated with this disparity remain poorly explored. METHODS AND RESULTS: We reviewed the medical records of over 98 percent of all infants weighing 500 to 1499 g who were born in Boston during the period 1980 through 1985 (687 infants), in St. Louis in 1985 and 1986 (397 infants), and in two health districts in Mississippi in 1984 and 1985 (215 infants). The medical records of the infants' mothers were also reviewed. These data were linked to birth-certificate files. During the study periods, there were 49,196 live births in Boston, 16,232 in St. Louis, and 16,332 in the Mississippi districts. The relative risk of very low birth weight among black infants as compared with white infants ranged from 2.3 to 3.2 in the three areas. The higher proportion of black infants with very low birth weights was related to an elevated risk in their mothers of major conditions associated with very low birth weight, primarily chorioamnionitis or premature rupture of the amniotic membrane (associated with 38.0 percent of the excess proportion of black infants with very low birth weights [95 percent confidence interval, 31.3 to 45.4 percent]); idiopathic preterm labor (20.9 percent of the excess [95 percent confidence interval, 16.0 to 26.4 percent]); hypertensive disorders (12.3 percent [95 percent confidence interval, 8.6 to 16.6]); and hemorrhage (9.8 percent [95 percent confidence interval, 5.5 to 13.5]). CONCLUSIONS: The higher proportion of black infants with very low birth weights is associated with a greater frequency of all major maternal conditions precipitating delivery among black women. Reductions in the disparity in birth weight between blacks and whites are not likely to result from any single clinical intervention but, rather, from comprehensive preventive strategies.
Black or African American↗
Abuse of pregnant women and adverse birth outcome. Current knowledge and implications for practice.
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Female↗
Delayed childbearing: no evidence for increased risk of low birth weight and preterm delivery.
Prior studies of the effect of increased maternal age on reproductive outcome in primiparous women have often ignored the possible influence on this relation of more frequent histories of spontaneous abortion and infertility in older women. When these histories are taken into account, the present study of 1,382 white primiparous women who had live singleton deliveries at Yale-New Haven Hospital finds no evidence for an increased risk of low birth weight (relative risk (RR) = 1.06, 95% confidence interval (CI) = 0.38-2.94) or preterm delivery (RR = 1.07, 95% CI = 0.50-2.24) in women delivering at age 30 years or more compared with younger women. Mean birth weight (beta = -19 g, p = 0.57) and gestational age (beta = -0.16 weeks, p = 0.34) were also not significantly affected by older maternal primiparity. Women aged 35 years or more had twice the rate of preterm births compared with women under age 30, although this result was not statistically significant in this data set (RR = 2.07, 95% CI = 0.67-6.35). Other confounding variables were taken into account.
Abortion, Spontaneous↗
Woman abuse and pediatrics: expanding the web of detection.
Efforts to increase the medical care system's responsiveness to victims of domestic violence have been focused on emergency and obstetric/gynecologic care. This paper advocates for expanding the web of detection to include pediatric practitioners. In order to effectively address the issue of domestic violence, medical providers must be linked to community-based resources. Physicians need to understand the complexity of this issue and focus on the process (empowerment) rather than on an outcome (leaving). A broader conceptualization of the battering situation, appropriate medical system response, and specific suggestions for how pediatric providers can inquire about and respond to domestic violence are provided.
Adult↗