Kiyoko M. Parrish

Alcohol consumption and the risk of developing liver cirrhosis: implications for future research.

Studies of the association of alcohol consumption and liver cirrhosis were reviewed, focusing on possible biases of study design. Daily alcohol consumption (as opposed to intermittent binge drinking), amount of alcohol consumed, longer duration of alcohol abuse, and being female were associated with the increased risk of cirrhosis. Follow-up studies reviewed failed to take full advantage of the study design and added little information to existing literature. Retrospective studies were relatively free of bias and are valuable tools in estimating the risk of cirrhosis. Future research needs to take the following variables into consideration: better ascertainment of alcohol consumption, consumption patterns, changes in alcohol consumption, gender, and body weight.

Genetic or cultural determinants of drinking: A study of embarrassment at facial flushing among Japanese and Japanese-Americans

Facial flushing after the ingestion of alcohol is common among Asians. Flushers are genetically less able to tolerate alcohol than nonflushers and are less likely to become alcoholics. This study examined whether lower consumption of alcohol among flushers was correlated with cultural factors such as embarrassment over flushing as well as with biological factors among Japanese in Japan and Japanese-Americans using data from a joint Japan-U.S. collaborative survey. Eight hundred forty-six Japanese and 737 Japanese-American current drinkers with known flushing status were studied. The mean alcohol intake differed significantly between groups: (1) habitat--Japanese versus Japanese-Americans, (2) flushing status--flushers versus nonflushers, and (3) embarrassment about flushing. Among men, ethnicity was the major determinant of alcohol consumption, followed by flushing status and embarrassment about flushing. Among women, differences were not significant. Lower alcohol consumption by flushers than by nonflushers has been attributed to differences in physiological reactions to alcohol. However, this study demonstrated that cultural factors such as embarrassment also contribute to lower alcohol consumption by flushers. The lack of interaction between habitat and flushing status and between habitat and embarrassment status suggests that flushing status and embarrassment status associated with drinking levels are independent of habitat.

StORQS: Washington's Statewide Obstetrical Review and Quality System: overview and provider evaluation.

The Foundation for Health Care Quality (Washington) used three administrative public databases and indicators recommended by the Joint Commission and the American College of Obstetrics and Gynecology to build algorithms to measure quality of obstetric care in the state of Washington. Analyses demonstrated a high degree of variability across hospitals for major processes of care such as cesarean section, vaginal birth after cesarean section, and forceps deliveries. Eighty-five percent of the participating hospitals concluded that important aspects of care were being measured. Ninety-four percent found the information useful in describing their performance compared with other hospitals. Sixty-two percent believed the information was useful for initiating quality improvement projects. Of the 25 indicators tested in the project, indicators rated as most useful were the same 10 obstetric indicators chosen by the Joint Commission after alpha testing.

The association of drinking levels and drinking attitudes among Japanese in Japan and Japanese-Americans in Hawaii and California

This study examined cross-cultural differences in drinking attitudes and drinking levels and their correlation among Japanese in Japan and Japanese-Americans in Hawaii or California. In most situations, an increase in drinking levels was associated with more tolerant drinking attitudes in all three groups. Abstainers were less likely to say that getting drunk is sometimes all right, whereas the reverse was true for heavier drinkers. Drinking levels among Japanese, especially among Japanese women, were not highly associated with how much drinking was perceived as acceptable in each situation, whereas among Japanese-Americans, drinking levels were highly associated with drinking attitudes. Although the Japanese had generally tolerant attitudes toward drinking, they indicated higher abstention rates before driving than Japanese-Americans regardless of their drinking levels. This may reflect the impact of public education on drunken driving in Japan.

Alcohol-Related Problems Encountered by Japanese, Caucasians, and Japanese-Americans

Using population-based survey data, personal-problematic and socioproblematic factors were examined among Japanese in Japan, Japanese-Americans in Hawaii, and Japanese-Americans; Caucasians in California were analyzed as a control group. Caucasian males were more likely to exhibit drinking-related social problems, whereas Japanese males showed more personal-problematic symptoms. Japanese-American men, both in Hawaii and California, were least likely among the three ethnic groups to have personal-problematic symptoms and were more likely to have socioproblematic symptoms than Japanese men. These differences might be explained by differences in the perception of social problems.

Effect of changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates

OBJECTIVE To examine the effect of maternal age on cesarean delivery risk and to quantify the impact of demographic changes since 1970 on primary cesarean delivery rates. DESIGN A cohort study. SETTING Nonfederal short-stay hospitals in Washington State. PARTICIPANTS All women who delivered live singletons with linked birth certificate and hospital discharge data from 1987 through 1990. MAIN OUTCOME MEASURES Maternal age-, birth weight-, and parity-specific primary cesarean delivery rates, Mantel-Haenszel relative risk estimates for primary cesarean delivery by 5-year age category stratified by parity, and direct standardization of 1987 through 1990 primary cesarean rates to 1970 Washington State maternal age, birth weight, and parity distribution. RESULTS Primary cesarean rates ranged from 3.2% for multiparous teenage women who delivered infants weighing 3500 g through 3999 g to 58.9% for primiparous women 40 years of age or older who delivered infants weighing 4000 g or more. After adjustment, the risk of cesarean delivery increased with each 5-year age increment among women 20 years of age or older. We estimated that if the maternal age, parity, and birth weight distribution from 1987 through 1990 were identical to what existed in 1970, Washington States primary cesarean rate from 1987 through 1990 would have been 12.2%, compared with the observed rate of 14.8%. CONCLUSION The lower adjusted primary cesarean rate reflects the demographic changes in the childbearing population, which may be responsible for 18% of the 1987 through 1990 cesarean delivery rates. These findings suggest the importance of using maternal age-, birth weight-, and parity-specific primary cesarean delivery rates to compare populations and study temporal trends.