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PubMed1977

Fetal loss, twinning and birth weight after oral-contraceptive use.

To evaluate the effect of oral-contraceptive use on subsequent offspring, I reviewed information on the pregnancies of 19,887 women who indicated, in response to a mail questionnaire, that they had used oral contraceptives. The rates of spontaneous abortion and stillbirth were smaller for former users than for nonusers--a finding consistent with previous studies. Twinning was more frequent among births of infants conceived soon after cessation of oral contraceptives, the rate being approximately twice the expected value for women who had used oral contraceptives for more than six months (P = 0.1). The sex distribution of the twins indicated that the increase was mainly in dizygous twins (P = 0.02), in accordance with predictions about increased twinning after cessation of oral contraceptive use. No relation was evident between oral contraceptive use and birth weight.

Abortion, Spontaneous↗
PubMed1979

Epidemiologic survey of accidental dentofacial injuries among U.S. Army personnel.

This epidemiologic study of accidental dentofacial injuries to U.S. Army personnel was conducted to determine the frequency and distribution patterns of accidental dentofacial injuries to soldiers. Administratively, it was anticipated that this data would permit identification of high-risk groups and would suggest feasible preventive measures. This 9-month study was conducted on 16 Army posts with a combined population at risk of 210,500 soldiers; a standardized data collection form was completed by the dental corps officer treating the injury case and then was mailed to a central collection site for analysis. The data from this dentofacial injury study clearly reveal that differential risks exist for various military subpopulations. While the overall U.S. Army accidental dentofacial injury rate was 37.7 cases/10,000/year, this rate varied greatly for specific subgroups with high-risk factors including young males, lower enlisted ranks, recent recruits, and combat training posts. The primary specific causes of these injuries were fistfights (nearly 30%), sports (over 20%), and vehicles (about 15%).

Accidents↗
PubMed2001

Women in agriculture: risk and injury experiences on family farms.

OBJECTIVES: To determine the one-year incidence of nonfatal farm injuries among women actively engaged in farm work; to determine the distribution of these injuries by external cause, severity, and other characteristics; and to determine the potential risk factors for injuries among farm women. METHODS: A population-based study of the occurrence of agricultural injuries during the previous year was conducted in a stratified, random sample of 1096 actively working farm women in Texas and Louisiana. Sampling pools were generated from county plat listings in Texas and maintained mailing lists in Louisiana; counties were selected based on geographical and agricultural diversity. Eligible women were interviewed by phone about injury occurrences and patterns. RESULTS: The cumulative one-year incidence of farm injuries for women in this area was 5% (95% CI = 3.7-6.3), based on the number of farm women injured. Lower extremities were the most frequently injured body parts. The leading external causes were contact with foreign object/substance, falls, and overdoing/lifting/hauling. Most injuries occurred in the summer or spring. Factors predictive of increased injury risk in adjusted logistic regression included working on large-animal farms, more time spent in farm work, persistent back pain or weakness during the previous 12 months, driving a tractor, and hauling farm goods to market. Most women consulted physicians as a result of their injuries. CONCLUSION: Physicians are in a unique position to institute interventions to prevent risky behaviors.

Adult↗
PubMed1984

[Autoaggressive behavior of the mentally retarded--results of a survey].

An initial mail survey in Sweden has shown that, roughly, at least 4 percent of all mentally retarded persons display self-abusive behaviour. Those concerned usually are severely or profoundly mentally retarded, and the autoaggressive behaviour occurs very frequently, in most instances daily. Almost three quarters of self-abusing retarded persons live in institutional settings, such as special hospitals or residential homes for the mentally retarded. The age distribution found in the self-abusing population deviates substantially from the expected distribution. Life expectancy seems reduced. Gender-specific differences have not been found. A social-psychological care approach (empathy, improved life conditions, meaningful activities, systematic behavioural modification) may have an alleviating, or even remedial, influence.

Adolescent↗
PubMed1994

Sleep onset insomnia, sleep maintaining insomnia and insomnia with early morning awakening--temporal stability of subtypes in a longitudinal study on general practice attenders.

The present study investigated the temporal stability of insomnia patterns during a 4-month study period, classifying insomnia as sleep-onset insomnia, sleep-maintaining insomnia or insomnia with early morning awakening. In a longitudinal study design, 2,512 general practice attenders were investigated at the time of the first inquiry (T1) with a questionnaire. Four months later (T2), all patients complaining of difficulties in initiating and/or maintaining sleep and/or early morning awakening (n = 328) were again contacted by mail and received the same questionnaire as at T1. According to the reported symptoms, patients were assigned to the different subtypes of insomnia. The diagnosis at T1 was then compared with the diagnosis at T2 4 months later. Only about half of all patients who complained of difficulties in initiating sleep at T1 still exclusively reported sleep-onset insomnia 4 months later, whereas the remaining patients were distributed to different subtypes. The stability of sleep-maintaining insomnia and insomnia with early morning awakening was even lower. Comorbidity with a somatic or psychiatric disorder at T1 and change in hypnotic treatment did not account for the instability of the respective subgroup of insomnia. These findings illustrate that cross-sectional studies focusing on subtypes of insomnia, e.g. sleep-onset insomnia, may lead to erroneous results.

Adolescent↗
PubMed2006

Follow-up of anorectal anomalies: the Italian parents' and patients' perspective.

BACKGROUND: Several studies addressed the long-term follow-up of anorectal anomalies (ARM) in relation to clinical issues (eg, continence) and quality of life. However, most of these studies are based upon questionnaires designed by physicians and/or health-care professionals, which may be sources of bias. METHODS: To investigate whether parents of children (patients themselves or older children or adults) who were born with ARM had the perception that they received appropriate care and follow-up, a survey was carried out in Italy, in 2003, among families with children with ARM. A 20-item questionnaire was mailed to 425 patients and parents listed in the AIMAR (Italian association for anorectal malformation) database and was returned by 209 families. The questionnaire covered different aspects of ARM: type of malformations and surgery, associated anomalies, fecal and urinary continence, as well as aspects about information given to the parents and satisfaction of care and follow-up received. RESULT: The patients and parents demonstrated a good understanding of distribution of malformations and their anatomical classification; nevertheless, 67% of responders had to travel outside their living area for surgery. Bowel management (BM) was commonly used among subjects; however, a significant percentage of patients using regular enemas were still soiling (58 patients were clean and 116 soiled). Urinary continence problems were mostly found in females with cloaca; nevertheless, 21 male patients reported occasional dribbling of difficult interpretation. Most subjects were provided with a good explanation about their or their child's malformation at time of reconstructive surgery, but the same level of information was missing about functional prognosis later in life when the need of an appropriate psychologic support was also felt. CONCLUSIONS: Patients and parents born with ARM are generally satisfied with the information received and with the short-term postreconstructive follow-up care. At longer follow-up, although more than a quarter of patients are completely clean, there is a significant percentage of subjects who still soil while following a BM program. This is explained by the small number of nurses and BM specialists who are involved in the rehabilitation process and by the lack of appropriate information about functional prognosis that are conveyed to the parents. In this respect, psychologic support in bridging the gap between cure and care may be critical.

Abnormalities, Multiple↗
PubMed1997

Measurements of nitrogen dioxide and sulphur dioxide concentrations in urban and rural areas of Poland using a passive sampling method.

Measurements of 1-month concentrations of NO(2) and SO(2) were carried out in the period from May 1993 to April 1994 in 147 points in 30 major cities of Poland and in 31 points in rural areas. The measurement points were divided into five classes representing: centres of cities, residential areas, industrial areas, traffic locations and rural areas. Passive samplers were prepared in one laboratory, mailed to local laboratories for sampling and then returned for analysis. The same samplers were used for collecting both NO(2) and SO(2). Analyses for NO(2) absorbed as nitrite were made spectrophotometrically after reaction with Saltzman reagent. Sulphur dioxide was determined as sulphate with ion chromatography. The consistency of data allowed comparison of levels of air pollution in different cities and the production of maps of spatial distribution of NO(2) and SO(2) in rural areas of Poland.

Journal Article↗
PubMed2000

Assessment of the COOP charts with and without pictures in a Swiss population.

OBJECTIVES: This study aimed to assess the validity of COOP charts in a general population sample, to examine whether illustrations contribute to instrument validity, and to establish general population norms. METHODS: A general population mail survey was conducted among 20-79 years old residents of the Swiss canton of Vaud. Participants were invited to complete COOP charts, the SF-36 Health Survey; they also provided data on health service use in the previous month. Two thirds of the respondents received standard COOP charts, the rest received charts without illustrations. RESULTS: Overall 1250 persons responded (54%). The presence of illustrations did not affect score distributions, except that the illustrated 'physical fitness' chart drew greater non-response (10 vs. 3%, p < 0.001). Validity tests were similar for illustrated and picture-less charts. Factor analysis yielded two principal components, corresponding to physical and mental health. Six COOP charts showed strong and nearly linear relationships with corresponding SF36 scores (all p < 0.001), demonstrating concurrent validity. Similarly, most COOP charts were associated with the use of medical services in the past month. Only the chart on 'social support' partly deviated from construct validity hypotheses. Population norms revealed a generally lower health status in women and an age-related decline in physical health. CONCLUSIONS: COOP charts can be used to assess the health status of a general population. Their validity is good, with the possible exception of the 'social support' chart. The illustrations do not affect the properties of this instrument.

Adult↗
PubMedDate not supplied

Shift length and on-duty rest patterns in rotor-wing air medical programs.

INTRODUCTION: Air medical teams provide around-the-clock critical care, a pattern at risk of inducing performance-altering fatigue from circadian disruption and sleep deprivation. Safety is an essential issue in the air medical industry, but little data are available on shift length and on-duty rest practices. We report the results of a survey concerning those practices and analyze the relationships to crew duty practices by program model (hospital-operated, vendor-operated, independent, or public safety), base location, flight volume, and job requirements. METHODS: A survey was mailed to 182 Association of Air Medical Services-member rotor-wing air medical programs in the United States that complete scene flights with a flight nurse. One-hundred-twenty-nine programs (70.9%) returned anonymous surveys, all of which were used for data analysis. Results were analyzed with descriptive and nonparametric statistics. RESULTS: All pilots work shifts between 10 and 14 hours. For medical team members the shift distribution is: </= 8 hours, 0.4%; 9 to 12 hours, 44.2%; 12 to 16 hours, 7.0%; 17 to 24 hours, 45%; > 24 hours, 3.5%. An independent association exists between shift length greater than 12 hours and each of the following: flight volume per-aircraft under 731 flights/year, program model other than hospital operated, and nonhospital base (Fisher's exact test with Bonferroni correction, P < .01 for each). All pilots are allowed on-duty rest on both day and night shifts. On-duty rest is permitted for 67.4% of medical team members: 18.2% only at night, and 49.2% at any time of day. The presence of any period of on-duty crew rest is significantly associated with nonhospital base, program model other than hospital-operated, and shift length exceeding 12 hours (Fisher's exact test with Bonferroni correction, P < .01 for each). The presence of a nonflight clinical assignment while on flight duty is associated with a prohibition against on-duty rest (Fisher's exact test with Bonferroni correction, P < .05). CONCLUSION: Notable differences arose between on-duty work and rest patterns for pilots and medical team members. Medical team members generally work longer shifts than pilots do, with shifts exceeding 12 hours as the most common staffing pattern. Medical team members also have less access to on-duty rest than do pilots. Traditional hospital-operated programs are more likely to use shorter shifts and prohibit on-duty rest for the medical teams, whereas vendor-operated, independent, or public safety programs are more likely to use longer shifts and permit on-duty rest. As the industry works toward a unified approach to mitigating the impact of fatigue on safe operation, variable practices based on job description and program style may be a factor.

Air Ambulances↗
PubMed2006

Three-dimensional locations and boundaries of motor and premotor cortices as defined by functional brain imaging: a meta-analysis.

The mesial premotor cortex (pre-supplementary motor area and supplementary motor area proper), lateral premotor cortex (dorsal premotor cortex and ventral premotor cortex), and primary sensorimotor cortex (primary motor cortex and primary somatosensory cortex) have been identified as key cortical areas for sensorimotor function. However, the three-dimensional (3-D) anatomic boundaries between these regions remain unclear. In order to clarify the locations and boundaries for these six sensorimotor regions, we surveyed 126 articles describing pre-supplementary motor area, supplementary motor area proper, dorsal premotor cortex, ventral premotor cortex, primary motor cortex, and primary somatosensory cortex. Using strict inclusion criteria, we recorded the reported normalized stereotaxic coordinates (Talairach and Tournoux or MNI) from each experiment. We then computed the probability distributions describing the likelihood of activation, and characterized the shape, extent, and area of each sensorimotor region in 3-D. Additionally, we evaluated the nature of the overlap between the six sensorimotor regions. Using the findings from this meta-analysis, along with suggestions and guidelines of previous researchers, we developed the Human Motor Area Template (HMAT) that can be used for ROI analysis. HMAT is available through e-mail from the corresponding author.

Algorithms↗
PubMed1995

ASHP national survey of hospital-based pharmaceutical services--1994.

The results of a national survey of pharmaceutical services in federal and nonfederal community hospitals conducted by ASHP during summer 1994 are reported and compared with the findings of earlier ASHP surveys. A simple random sample of community hospitals (federal and nonfederal) was selected from hospitals registered by the American Hospital Association. A questionnaire was mailed to each director of pharmacy. The adjusted gross sample size was 896. The net response rate was 44% (393 usable replies). The mean number of hours that respondents' pharmacies were open per week for inpatient services was 107.5. An increasing number of pharmacy directors were managing other departments within the institution. Of respondents, 18% indicated that a patient-focused-care model was in place. Complete unit dose drug distribution was offered by 92% of respondents, and 67% provided complete, comprehensive i.v. admixture services. A total of 29% provided decentralized inpatient pharmaceutical services. Automation of some type to support drug distribution was used by 55%. Provision of ambulatory care pharmaceutical services was indicated by 82% of nonfederal hospitals and by 98% of federal hospitals. Home infusion therapy services were offered by 27% of respondents. Some 89% had a computerized pharmacy system. The most commonly offered clinical pharmacy services for inpatients were drug-use evaluations and programs to monitor drug therapy, adverse drug reactions, and drug-food interactions. About half of respondents indicated that they did not provide pharmaceutical care. One third indicated that pharmacists had the authority to write drug orders or prescriptions. Pharmacokinetic consultations were provided by 65% and nutritional-support consultations by 35%. Of nonfederal respondents, 86% participated in quality assurance for inpatient dispensing and 28% did so for ambulatory care dispensing. A well-controlled formulary system was in place at 60% of the hospitals. About 74% of inpatient pharmacy expenditures went for drugs and fluids, 20% for staff activities, and 6% for other noncapital expenditures. Almost half of respondents indicated that staff reductions had occurred. About 9% of nonfederal hospitals had an ASHP-accredited residency program. The 1994 ASHP survey revealed a continuation of growth in some areas of hospital pharmacy (clinical services, computerization, formulary management techniques, and residency programs) and identified static areas (ambulatory care services, scope of drug distribution services, and quality assurance programs) that should be addressed by pharmacy leaders.

Ambulatory Care↗
PubMed2001

Cost-effectiveness analysis of dialysis and kidney transplants in Japan.

Although kidney transplantation is considered to be more desirable than dialysis in terms of cost-effectiveness and patients' quality of life, there have been very few cases of kidney transplants in Japan. This study was conducted to compare the cost-effectiveness of dialysis and kidney transplants using Disability-Adjusted Life Years (DALYs) as an indicator of effectiveness. Most data necessary for the DALYs analysis were obtained from publications. The disability weights for dialysis patients and kidney transplant patients were estimated based on a questionnaire e-mailed to medical officials of the Japanese Government. Expected duration of treatment was estimated from the survival rates of dialysis patients and the graft-survival rates of transplant patients using the Weibull model method. The cost of dialysis and living-related donor (LRD) transplant included only medical expenditures and neglected all other costs, and the cost of cadaveric donor (CAD) transplant included the budget for organ procurement and distribution in addition to medical expenditures. The analysis showed that dialysis averted 138,019 DALYs/year, living-related donor transplant averted 5,740 DALYs/year, and CAD transplant averted 1,892 DALYs/year. The cost-effectiveness ratio (C-E ratio) was 9,546 thousand yen/DALY for dialysis, 1,809 thousand yen/DALY for LRD transplant, and 2,322 thousand yen/DALY for CAD transplant. These results could be used for the decision making of the Government on what resources should be allocated to the promotion of kidney transplantation. Also, the methodology used in this study can be applied to cost-effectiveness analysis of other organ transplants.

Adolescent↗
PubMed2005

Energizing community health improvement: the promise of microgrants.

BACKGROUND: The Healthy Carolinians community microgrants project provided microgrants to community-based organizations (CBOs) across North Carolina. These grants were made to serve as a catalyst to engage the CBOs in health promotion activities that addressed Healthy People 2010 objectives. The purpose of this initiative was to increase the awareness of Healthy People 2010 objectives, mobilize resources, and create new partners in community health improvement. CONTEXT: In 1993, Healthy Carolinians, a statewide network of public-private partnerships, was established at the county level to address North Carolina's health objectives that aligned with national Healthy People 2010 objectives. This network of Healthy Carolinians partnerships provided the vehicle for distributing the microgrants. METHODS: Funding was distributed to 32 Healthy Carolinians partnerships that, in turn, awarded 199 microgrants (2010 dollars each) to CBOs to address state and national health objectives. Each CBO selected its own objectives based on Healthy People 2010 objectives and designed its own interventions. Surveys of the CBO project managers and final reports were used for evaluation. A survey of the Healthy Carolinians partnership coordinators provided additional insight. CONSEQUENCES: Of the 199 surveys mailed to CBOs, 153 (77%) responded. Nearly half (43.7%) of the microgrants were used to focus on three major health risk factors: 27.1% on physical activity and fitness, 13.1% on nutrition and overweight, and 3.5% on tobacco use. At the end of the project, 96.1% of the respondents reported that they were familiar with the Healthy People 2010 objectives. Final reports showed that an estimated 52,739 hours of CBO staff and volunteer time were contributed to microgrant programs. All Healthy Carolinians partnership coordinators responded to a survey; 100% stated that they had new access to priority populations within their community. INTERPRETATION: The Healthy Carolinians microgrant project demonstrated a cost-effective, alternative approach to funding community-based health promotion and injury control activities. This model was decentralized, so it empowered communities and CBOs to be responsible for community health improvement. Public health professionals with limited funds should consider this alternative approach, which mobilized existing community organizations and effectively addressed national and state health objectives.

Community Health Services↗
PubMedDate not supplied

Relationship between educational level of dental hygienists and their perceptions regarding postcertificate/postassociate degree programs.

A survey was mailed to a stratified random sample of 357 licensed dental hygienists residing in Colorado, Kansas, Nebraska, South Dakota, and Wyoming. The purpose of the study was to investigate the relationship between degree held and practitioner perceptions regarding the need for, interest in, and content and structure of postcertificate/postassociate programs leading to a bachelor of science in dental hygiene degree (BSDH). Responses were received from 250 practitioners (70%), which were evenly distributed among the five states. Respondents were asked to record their level of agreement with a series of statements pertaining to postcertificate/postassociate dental hygiene education using a five-point Likert scale ranging from "strongly agree" to "strongly disagree." The findings indicated a significant correlation existed between degree held and practitioner perceptions regarding (1) the need for postcertificate/postassociate dental hygiene programs, (2) the testing of potential students for clinical competency, (3) granting academic credit for work experience, and (4) the provision of flexible attendance and scheduling options. There was no significant correlation between degree held and practitioner perceptions regarding (1) a required core curriculum with individualized specialty areas of study or (2) a baccalaureate in another or related discipline offers more career options than a BSDH.

Adult↗
PubMed1999

Age and anesthetic practice: a regional perspective.

STUDY OBJECTIVE: To obtain information about practitioners' behaviors, perceptions, and perspectives concerning issues related to advancing age and anesthetic practice. DESIGN: Questionnaire survey mailed to 1,208 active and retired American Society of Anesthesiologists (ASA) members in Northern New England. Topics included hours worked, practice policies, stress level of activities, observed in colleagues and personally perceived errors and problems associated with performance, and plans, preparation, and reasons for retirement. SETTING: Practicing respondents worked in academic, community, or federal hospitals, and in ambulatory surgical facilities. MEASUREMENTS AND MAIN RESULTS: For descriptive analysis, counts and frequency distributions were calculated for each question. Statistical methods were used to test differences across age groups and to identify sources of differences. Approximately 40% of respondents in each age group worked an average work week of 50 to 59 hours. Respondents aged 40 to 49 years worked the longest work weeks and duty periods and were more concerned about liability issues than other age groups. Respondents age 60+ tended to work shorter average and maximum work weeks, although 5% of them continued to work 70- to 79-hour weeks. There was no statistically significant difference in hours worked among men and women. Approximately 20% to 30% of respondents relieved older colleagues of late night or call duties, and asked them to restrict or to stop practice out of concern for patient safety. Night call was equally stressful for all age groups. Economic uncertainty, production pressure, and interpersonal relations were more stressful for younger respondents. In preparation for retirement, shifting away from complex cases and phased reduction in clinical activity were increasingly prevalent with each advancing age group. Important reasons for retirement included attitude changes, physical limitations, and declining health. CONCLUSIONS: Despite modest age-associated trends, chronological age per se is not a strong correlate of an individual's practice pattern, behaviors, or perceptions about performance.

Adult↗
PubMed2003

Who is using chronic acid suppression therapy and why?

OBJECTIVES: Acid suppression medications have become one of the most commonly prescribed classes of therapeutic agents. Because little data exists describing the chronic use of these agents among a general population, we sought to determine the patterns of use of proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) in clinical practice, as well as the distribution and severity of symptoms in patients prescribed these therapies. METHODS: Pharmacy billing data from two insurers were used to identify all patients on chronic (>90 days) PPIs and H2RAs within a large, eastern Massachusetts provider network. Patient demographics, diagnoses, frequency of office visits, and information about diagnostic testing were obtained from billing databases. A questionnaire addressing recent upper GI symptoms, over-the-counter medication use, and gastroenterologist consultations was mailed to a 1,139 patient subset (35%) of eligible patients. We compared the diagnoses of patients on chronic therapy with those of the general population of the network. We also compared the frequency of symptoms and diagnostic testing between those prescribed H2RAs and PPIs. RESULTS: From a total population of 168,727 adult patients, we identified 4,684 (2.8%) prescribed chronic acid suppression therapy, with 47% taking H2RAs and 57% taking PPIs (4% filled prescriptions for both simultaneously). A relevant GI diagnosis was found using billing data for only 61% of patients, mainly for gastroesophageal reflux disease (38%) and dyspepsia (42%), with many patients carrying both diagnoses. Our survey (response rate 59%) revealed that more than 30% of responders experienced heartburn or reflux more than twice a week, and more than half experienced symptoms of dyspepsia at least once a week. Diagnostic testing was uncommon, with only 19% having undergone esophagogastroduodenoscopy within the prior 2 yr. CONCLUSIONS: Acid suppression medications were used chronically by a large number of patients within this population. A significant proportion of patients on chronic PPI or H2RA lacked definitive upper GI diagnoses in their billing data. The high symptom burden and low use of diagnostic testing indicates opportunities for improvement in the care of patients on chronic acid suppression therapy.

Adult↗
PubMed1993

Prevalence and incidence of scrapie in The Netherlands: a questionnaire survey.

Two independent nationwide surveys of randomly selected sheep farmers were conducted: in one a questionnaire was mailed to farmers and in the other the farmers were interviewed. The questionnaire was designed to obtain data on the occurrence of scrapie in the national sheep flock of the Netherlands. Farmers owning 30 or more ewes were selected from a database at the Ministry of Agriculture, Nature Management and Fisheries, resulting in 10,000 addresses. Two lists of names were compiled at random. In the postal survey 700 questionnaires were distributed, and 137 farmers were interviewed directly. The response rate in the postal survey was 37 per cent and in the interview survey 100 per cent. The results from the two surveys did not differ significantly. Six per cent of the farmers indicated that they had at some time observed signs of scrapie in their flock. For the total sheep population in the Netherlands, the prevalence of flocks with sheep showing signs of scrapie was between 3.8 per cent and 8.4 per cent (with 95 per cent certainty). In 1989 and 1990 the incidence rate within infected flocks was 1.27 cases/100 ewes/year, and the incidence rate for the total sample population was 0.1 case/100 ewes/year.

Animals↗
PubMed1989

Survey of maternal-fetal medicine subspecialists: professional activities, job setting, and satisfaction.

We analyzed the job setting, professional activities, and satisfaction of subspecialists in maternal-fetal medicine. A two-page questionnaire was mailed to all members of the Society of Perinatal Obstetricians. The results were analyzed by multiple regression and multivariate analysis. Of 603 questionnaires mailed, 496 (80%) were returned; 70% of all certified maternal-fetal medicine subspecialists responded. The job setting of respondents was university hospital-based faculty in 66%, community hospital-based salaried in 15%, private practice in 10%, and other in 9%. The average percent of professional time devoted to each area was as follows: clinical work, 57% of all professional time; research, 18%; administrative, 15%; and educational, 11%. Time distribution, volume of hysterectomies, and number of peer-review publications were the only significant differences among job settings. For university hospital-based faculty, the time distribution was 50% clinical, 23% research, 16% administrative, and 11% educational. For community hospital-based salaried physicians, it was 63% clinical, 10% research, 16% administrative, and 11% educational; for private practice, it was 84% clinical, 7% research, 5% administrative, and 6% educational. Types of activities of maternal-fetal medicine subspecialists included ultrasound (75% of respondents, mean 436 studies per year), gynecologic procedures (71% of subspecialists, volume of 8.7 hysterectomies per year), genetic procedures (83%; 125 procedures per year), research (87%), recent peer-review publications (80%), grants (40%), and medicolegal reviews (64%). Ninety-five percent had a medical-school faculty appointment.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗