JAMA : the journal of the American Medical Association
-
Multicenter Study Comparative Study Clinical Trial
Facts and artifacts about anemia and preterm delivery.
The effect of anemia (hematocrit less than or equal to 0.34) on subsequent preterm birth was prospectively studied in 35,423 pregnancies. The incidence of preterm birth among women with and without anemia at each week during the third trimester was compared. Early in the third trimester, there was a weak association between anemia and preterm delivery. ⋯ Compared with hematocrits at 40 weeks' gestation, the odds ratios for anemia reached a maximum at 28 weeks and fell sharply as term approached. When the hematocrits of women in term labor were compared with those of women in preterm labor, a spurious dose-response effect for anemia was created. We conclude that anemia is not a strong factor in the pathogenesis of preterm birth and that comparison of hematocrits from women who are in preterm and term labor produces biased results.
-
Prisoners are reported to have a higher suicide rate than the community. We studied suicides in the Maryland prison system to determine the level of risk and risk factors for inmate suicide. There were 37 male inmate suicide deaths between 1979 and 1987 (39.6 suicides per 100,000 male inmates), which is significantly higher than the age- and race-adjusted male suicide rate in the general population of Maryland (22.0 per 100,000). ⋯ The methods of suicide chosen by inmates were hanging (86%), cutting wound (5%), antidepressant overdose (5%), and fall from height (3%). We conclude that inmate suicide represents a significant correctional health and public health problem. Specific implications for prevention of inmate suicide are examined.
-
Maternal mortality is one of the great neglected problems of health care in developing countries. The World Health Organization estimates that approximately 500,000 women die each year from pregnancy-related causes, more than 98% of these deaths occurring in the developing world. Maternal mortality rates in developing countries are as much as 100 times higher than those seen in industrialized countries. ⋯ It is suggested that no new or costly technologies are needed; rather that appropriate priority-setting and allocation of needed resources are essential to the solution of the problem. There are few interventions that hold much hope of success at the village level, although antibiotics, ergonovine maleate, and sedatives might be usefully utilized, after appropriate training. Overall, however, networks of maternity care facilities, trained personnel, and means of transport are necessary to provide needed emergency maternity care services.