American journal of preventive medicine
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We identified immersion injuries of New Jersey residents from mortality and hospital discharge data. The incidence rate was 2.3 immersion injuries (1.3 fatal and 1.0 nonfatal) per 100,000 population per year. Incidence rates were elevated among young children, men, blacks, and residents of counties in the southern part of the state. Case fatality ratios increased with age and were higher for men than for women from 10 to 50 years of age.
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The role of cesarean section in improving infant survival has not been clearly documented. We calculated birthweight- and race-specific infant, neonatal, and postneonatal mortality risks by method of delivery for single- and multiple-delivery infants, using data from 14 states, reported to the Centers for Disease Control through the 1980 National Infant Mortality Surveillance project. For single-delivery infants, the risk of death for infants delivered by cesarean section was 1.6 times higher than for infants delivered vaginally among blacks and 1.2 times higher among whites. ⋯ This analysis demonstrates that, unlike other birthweight categories, infants with a very low birthweight may have better outcomes if delivered by cesarean section. However, we cannot recommend the routine use of cesarean section for delivering very low birthweight infants. Further studies are needed to determine survival of such infants after controlling for maternal and infant conditions that prompted delivery by cesarean section.
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Comparative Study
Postneonatal deaths from infections and injuries: race, maternal risk, and age at death.
Most infants with birthweights greater than or equal to 2,500 g who survive the first 27 days of life have a reasonable opportunity to grow into healthy children. However, some of these infants succumb to two potentially preventable causes of death: infections and injuries. Although the relationship between maternal attributes and risk of death from these causes has been described, little is known about how maternal attributes relate to postneonatal age at death. ⋯ The same was true for three categories of injury death (motor vehicle, fire, and homicide), but not for injury deaths in the category of choking, drowning, or suffocation. Among blacks, these deaths occurred at younger ages, regardless of maternal risk status. Thus, efforts to prevent deaths from choking, drowning, or suffocation among blacks should focus on early infancy.
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Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. ⋯ Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.
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The disparity in health status between black and white Americans exists chiefly because of an excess of preventable disease in blacks. This situation calls for an increase in preventive services for blacks, services which might best be implemented or directed by black specialists in preventive medicine. ⋯ The immediate need for additional black specialists exceeds the total U. S. preventive medicine residency corps.