Paul M. Densen

A life table of pregnancy terminations and correlates of fetal loss.

Partial findings in cohort study of the relationship between maternal morbidity and pregnancy outcome based on the medical records of 32 medical group of the Health Insurance Plan (HIP) of Greater New York are discussed. The conditions for which women receive medical care prior to conception and during pregnancy are related to the occurrence of fetal mortality prematurity congenital anomalies and other morbid conditions that appear in the first 2 years after birth. Measures fetal loss at various stages of pregnancy is measured and the relationship of the mothers age gravidity and prior pregnancy experiences to fetal mortality with particular emphasis on early pregnancy loss is reexamined. This phase of the research has been completed for a segment of the 2-year cohort under study. Included in the study reported here are the pregnancy terminations among women whose last menstrual period (LMP) prior to pregnancy began between March 1 1958 and February 28 1989 and who received care from HIP obstetricians. This totals 6844 pregnancies. The final results will include these women and a 2nd years cohort of women with L7Ps from March 1 1959 through February 29 1960. The 2-year experience will involve about 15000 pregnancies. Data were obtained from routine reports of medical care rendered HIP members physicians and the medical charts of the obstetricians. The probability of a pregnancy ending in a particular week of gestation as determined from physicians records follows a bimodal distribution. The initial peak occurs during the previability period psecifically at 10 weeks gestation as measured from the LMP. The 2nd and much higher peak occurs at 40 weeks which is generally regarded as approximating the desired full-term period of gestation. The rate of total fetal loss is 142/1000 pregnancies. 48% of the loss is under 12 weeks gestation; another 32% is at 12-19 weeks; and 12% is at 20 weeks or more gestation. Fetal loss increases with age of mother after age 20. This relationship is found at all durations of pregnancy. Total fetal loss also varies directly with gravida of the mother. In those with terminations at 20 weeks or more gestation gravida 1 women have a higher range of fetal loss than gravida women. At the early gestation ages 12 weeks or less the situation is reversed with gravida 1 women having the lower rate. Outcome of the last prior pregnancy is a major factor in the outcome of the current pregnancy. Women whose last pregnancy ended in a fetal death have twice have twice as high a loss rate in their next pregnancy as other women.

Concerning High and Low Utilizers of Service in a Medical Care Plan, and the Persistence of Utilization Levels over a Three Year Period.

HE unequal distribution of episodes of illness and physical and social disability in various population groups has been the subject of intensive investigation for years. These studies have demonstrated repeatedly that small groups account for disproportionately large shares of the adverse events experienced by the population and that there is a tendency for high incidence groups to remain high for extended periods of time. A distinguishing characteristic of inquiries in more recent years has been the application made of this type of observation to specific medical care, industrial, health and welfare problems. Thus, the uneven distribution of medical costs in the population (1) has spurred much of the interest in the extension of health insurance to all types of physician services. The concentration of the bulk of industrial absenteeism and illnesses in a minority of employees has led to questions of direct concern to management as well as to more general questions regarding the role of the social and interpersonal environment in the occurrence of these episodes. (2) In the public welfare field, the receipt by a relatively few disabled indigent families of most of the expenditures for community health and dependency services has resulted in concerted efforts to find better methods of prevention or control. (3) Two observations of the utilization experience of members of the Health Insurance Plan of Greater New York (HIP)

The Vanderbilt cooperative study of maternal and infant nutrition. VI. Relationship of obstetric performance to nutrition.

Abstract 1. 1. The nutriture of 2,046 obstetric patients who attended the Vanderbilt University Hospital between 1945 and 1950 has been evaluated on the basis of nutrient intake, laboratory and biochemical determinations, and clinical physical examinations. 2. 2. The metabolic and physiologic changes in these during the gestational period have been outlined. 3. 3. Twenty-five abnormal obstetric and fetal conditions have been examined for evidence of nutritional stigmas during the gestational period. 4. 4. Different levels of nutrient intake have been studied for any influence on the development of obstetric and fetal abnormalities. 5. 5. In this group of patients who are reasonably representative of wide-spread obstetric experience in the United States, there is no clear indietment of nutritional lack as an important etiological agent in the numerous conditions studied. 6. 6. The findings to direct attention to the effect of pregnancy and lactation upon the nutritional state of the woman, particularly during the postpartum period or when an obstetric complication occurs.

The vanderbilt cooperative study of maternal and infant nutrition

Abstract 1. 1. A brief outline of the purpose and plan of the Vanderbilt Cooperative Study of Maternal and Infant Nutrition is given. 2. 2. The sample is 2,046 patients who had their complete prenatal and obstetric care at the Vanderbilt University Hospital. This is the total available material from 1945 to 1950. 3. 3. The economic status of these patients was in the low to moderate income range. 4. 4. The results of the prenatal and obstetric course of the 2,046 patients are reported, with comparison with generally accepted textbook incidences and also with incidences in representative previous nutritional studies.

A survey of respiratory disease among New York City postal and transit workers: I. Prevalence of symptoms☆

Abstract The New York City Health Department has conducted a survey of respiratory symptoms among postal and transit workers as a part of ongoing epidemiologic studies of chronic respiratory disease. This report, the first of a series on the survey findings, presents the study design together with data on prevalence of symptoms. A total of 12,604 men were interviewed, using the British Medical Research Councils questionnaire, and were tested with the McKesson Vitalor. The study covered all men in specified job categories and included white and non-white men ranging in age from 20 to 70. The prevalence of chronic bronchitis was found to be 15% for white and 10% for non-white postal workers, compared with rates of 12 and 9%, respectively, among transit workers. Respiratory disease symptom prevalence rates are reported according to age, race, smoking habits, job classification, and area of residence. A follow-up of 2,000 transit workers representing subgroups identified by the prevalence survey is now in progress.

The elderly and the health care system: another perspective.

Sources of information about the populations health and its utilization of parts of the system are more numerous and varied than ever before. For the elderly, the range of formal and informal services used, and the patterns of use, are more complex than is revealed by most data bases. The annual movement of a hypothetical 100,000 elderly persons through the health care system is schematically diagrammed. The interrelatedness of seemingly discrete components is demonstrated; periodic review of such movement can contribute to judicious and efficient planning of services and their use.

The H.I.P. study of incidence and prognosis of coronary heart disease: Methodology

Abstract Experience during the past two years indicates that the prepaid medical care setting of H.I.P. provides a practical way of conducting a large scale study of the incidence and prognosis of manifestations of CHD newly diagnosed in a defined population of 120,000 adults. Characteristics of this population are established by mail surveys. The records developed in the normal course of medical care in H.I.P. are used as the initial screening mechanism for identifying those individuals who may have incurred a new manifestation of CHD. Detailed historical, physical, and ECG data are obtained at examinations conducted by a study staff of specially trained internists utilizing standardized methods and highly structured reporting forms. Structured non-medical interviews are carried out at these sessions by trained study staff workers. These data are supplemented by information abstracted from hospital and medical records. The final diagnostic classification is made by the study medical director in accord with criteria developed specifically for this purpose. Individuals satisfying the study criteria for a newly diagnosed manifestation of CHD are followed at regular intervals to define the prognosis of that manifestation, and to relate the course to a number of medical, physiologic, demographic, social, and personal characteristics. The mechanism described is highly efficient for identifying and classifying large numbers of patients soon after the earliest medical suspicion of a variety of manifestations of CHD, and is particularly suited to a study with primary emphasis on the prognosis of CHD from the time of initial diagnosis.

A survey of respiratory disease among New York City postal and transit workers: 2. Ventilatory function test results

Abstract One-second forced expiratory volumes (FEV1.0) were measured for 12,500 men in New York City who were included in a survey of respiratory disease symptoms among postmen and transit workers. The study design and data on prevalence of symptoms were given in an earlier report. Study of ventilatory function test results showed distinctive patterns with respect to age, smoking habits, and respiratory disease symptoms. One-second forced expiratory volumes decreased with age in all study groups; age-specific means were slightly higher for white than for non-white men; the lowest FEV1 values were found among cigarette smokers, especially the heavy smokers, and the highest values were those of non-smokers or men without symptoms; variations in patterns of the decline with age, as well as differences in age-specific mean FEV1 values, were evident among groups of men reporting different symptoms of respiratory disease.

An Approach to the Assessment of Long-Term Care

Publisher Summary This chapter discusses an approach to the assessment of long-term care. Progress in developing methods for assessing the quality of medical care is dependent on the completeness of information on the natural history of disease and the relationship between the processes of medical care and patient outcomes. The chapter discusses the classifications in the Patient Classification for Long-Term Care: Users Manual as the basis for developing a patient-assessment procedure that can be implemented in long-term care facilities and will provide information for planning and evaluating patient care, as well as for program review. To develop a patient-assessment procedure, the assessment system will have to (1) provide information on patients who can be used for decisions about the type and place of care appropriate to their needs and (2) be sensitive to changes over time in the conditions of patients. With these procedures in place, the outcomes of patients in different types of care programs can be evaluated.

14. The patient classification for long-term care developed by four research groups in the United States.

Delineation of long-term care problems and measurement of the effectiveness of efforts to deal with them requires a reliable method of describing observations made in the field. Recognizing this need, four groups of investigators have collaborated to produce the Patient Classification for Long-Term Care. Criteria for design of the Classification and its uses are described with specific reference to monitoring the quality of care, to policy making for long-term care, to research, and to education and training. Areas requiring further work are adaptation to care in noninstitutional settings and to children with long-term problems, and development of detailed psychosocial descriptors. Practical application of a classification scheme should not, however, wait upon the solution of all existing problems; a built-in mechanism of revision, analogous to that of the ICD, would make it possible to get on with the job of patient care, improving our methods of observation as we go, on the basis of experience.