The Significance of Importance: An Evaluation of Ferrans and Powers’ Quality of Life Index

Ferrans and Powers’ Quality of Life Index (QLI) defines and assesses quality of life (QoL) in terms of importance-weighted life satisfaction. This study assessed the value of such weights and explored the relationship between weighted and unweighted (satisfaction only) scores and single-item rated overall life satisfaction (LS) and QoL. Data were collected by a postal survey to 81 Parkinson’s disease patients (88% response rate). Correlations between weighted and unweighted QLI scores were ≥0.96, except for one subscale (r_s = 0.85). Item non-response rates ranged between 4.2 and 45.1% and 1.4 and 38% for the weighted and unweighted QLI, respectively. Cronbach’s α exceeded 0.7 for weighted and unweighted versions of two out of the four subscales and the total score. Scaling success rates were similar for weighted and unweighted scores and did not support the current subscale structure. Unexpectedly, weighted total scores correlated stronger with LS than with QoL, and unweighted scores displayed the opposite pattern. This study found no advantages by using importance-weighted satisfaction scores. The correlational pattern with overall LS and QoL challenges the QLI approach to QoL, although these observations may relate to the use of multiplicative item weights. This study has implications also beyond the QLI regarding, e.g., the use of multiplicative weights and the relationship between life satisfaction and QoL.     

Duration of pregnancy in relation to seafood intake during early and mid pregnancy: prospective cohort

We examined the association between exposure to seafood intake during two periods of pregnancy on the one hand and risks of preterm delivery and postterm delivery on the other. In a prospective cohort of 8729 pregnant Danish women, we assessed frequency of fish meals during the first and second trimester of pregnancy by questionnaires completed around gestation weeks 16 and 30, respectively. When fish intake was based solely on intake reported for the early period of pregnancy, mean gestation length was shorter by 3.91 (95% CI: 2.24–5.58) days and odds of preterm delivery were increased 2.38 (1.23–4.61) times in those who never consumed fish (n = 308) vs. those who consumed both fish as main meal and fish in sandwiches at least once per week (n = 785). These measures were similar when fish intake was based solely on intake reported for mid-pregnancy. In the subgroup of women reporting same intake in the two trimesters, those who never consumed fish (n = 165) had 8.57 (5.46–11.7) days shorter mean gestation and 19.6 (2.32–165) times increased odds of preterm delivery, compared to high fish consumers (n = 127); odds of elective and postterm delivery were reduced by a factor 0.33 (0.11–1.02) and 0.34 (0.12–0.95), respectively, in zero fish consumers. All analyses were adjusted for potential confounding by factors such as maternal smoking, height, and prepregnant weight. We conclude that never consuming fish in the first two trimesters of pregnancy was an extremely strong risk factor for preterm delivery but was also associated with reduced risks of elective delivery and postterm delivery.     

Black–white differences in health-related quality of life among older adults

Very little information exists on racial differences in quality of life among older adults. In this paper, we examine black–white differences in health-related quality of life (HRQOL) and identify factors that may account for these differences. The participants were 5,986 community-dwelling persons age 65+ (62% black at baseline) from the Chicago Health and Aging Project. Poor HRQOL was defined as having 14 or more self-reported physically or mentally unhealthy days over the past 30 days. A higher proportion of blacks (11.0%) than whites (9.7%) reported poor HRQOL. After adjusting for age and sex, blacks had increased odds of reporting poor HRQOL compared with whites (odds ratio [OR] = 1.72; 95% CI: 1.50–1.98). The black–white differences in HRQOL tended to increase with age (p < 0.05) and were greater among females (p < 0.05). Lifetime socioeconomic status, summary measures of medical conditions, and cognitive function accounted for most of the black–white difference (OR = 1.06; 95% CI: 0.89–1.27). Our results suggest that racial differences in HRQOL are associated with the combined effects of social disadvantage, poor physical health, and lower cognitive function.     

Does fear of retaliation deter requests for ethics consultation?

Background Reports suggest that some health care personnel fear retaliation from seeking ethics consultation. We therefore examined the prevalence and determinants of fear of retaliation and determined whether this fear is associated with diminished likelihood of consulting an ethics committee. Methods We surveyed registered nurses (RNs) and social workers (SWs) in four US states to identify ethical problems they encounter. We developed a retaliation index (1–7 point range) with higher scores indicating a higher perceived likelihood of retaliation. Linear regression analysis was performed to identify socio-demographic and job characteristics associated with fear of retaliation. Logistic regression analysis was performed to determine whether fear of retaliation was associated with less likelihood of seeking consultation. Results Our sample (N = 1215) was primarily female (85%) and Caucasian (83%) with a mean age of 46 years and 17 years of practice. Among the sample, 293 (48.7%) RNs and 309 (51.3%) SWs reported access to an ethics consultation service. Amongst those with access, 2.8% (n = 17) personally experienced retaliation, 9.1% (n = 55) observed colleagues experience retaliation, 30.2% (n = 182) reported no experience with retaliation but considered it a realistic fear, and 50.8% (n = 305) did not perceive retaliation to be a problem. In logistic regression modeling, fear of retaliation was not associated with the likelihood (OR = 0.64; 95% CI = 0.22–1.89) or frequency of requesting ethics consultation (OR = 0.81; 95% CI = 0.27–2.38). Conclusion Fear of retaliation from seeking ethics consultation is common among nurses and social workers, nonetheless this fear is not associated with reduced requests for ethics consultation.     

Household Exposure to Secondhand Smoke is Associated with Decreased Physical and Mental Health of Mothers in the USA

Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000–2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80–0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73–0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers.     

The Advantage of Imputation of Missing Income Data to Evaluate the Association Between Income and Self-Reported Health Status (SRH) in a Mexican American Cohort Study

Missing data often occur in cross-sectional surveys and longitudinal and experimental studies. The purpose of this study was to compare the prediction of self-rated health (SRH), a robust predictor of morbidity and mortality among diverse populations, before and after imputation of the missing variable “yearly household income.” We reviewed data from 4,162 participants of Mexican origin recruited from July 1, 2002, through December 31, 2005, and who were enrolled in a population-based cohort study. Missing yearly income data were imputed using three different single imputation methods and one multiple imputation under a Bayesian approach. Of 4,162 participants, 3,121 were randomly assigned to a training set (to derive the yearly income imputation methods and develop the health-outcome prediction models) and 1,041 to a testing set (to compare the areas under the curve (AUC) of the receiver-operating characteristic of the resulting health-outcome prediction models). The discriminatory powers of the SRH prediction models were good (range, 69–72%) and compared to the prediction model obtained after no imputation of missing yearly income, all other imputation methods improved the prediction of SRH (P < 0.05 for all comparisons) with the AUC for the model after multiple imputation being the highest (AUC = 0.731). Furthermore, given that yearly income was imputed using multiple imputation, the odds of SRH as good or better increased by 11% for each $5,000 increment in yearly income. This study showed that although imputation of missing data for a key predictor variable can improve a risk health-outcome prediction model, further work is needed to illuminate the risk factors associated with SRH.     

A Life Course Perspective on Depressive Symptoms in Mid-Pregnancy

Objective: To examine the prevalence of depressive symptoms in mid-pregnancy and their relation to life circumstances across the life course in a community-based sample. Methods: The Pregnancy Outcomes and Community Health (POUCH) Study enrolled women at 16–26 weeks' gestation from 52 clinics in five Michigan communities. At enrollment women completed a screening instrument for depressive symptoms (CES-D) and questions about life circumstances covering three “periods,” i.e. previous 6 months, adulthood, and childhood. Questions were grouped into sub-constructs (e.g., abuse, economic, substance use, loss, and legal) for each “period” and evaluated in relation to CES-D scores. Analyses included 1321 POUCH participants divided into three subgroups: teens; women ≥20 years insured by Medicaid (disadvantaged); and women ≥20 years not insured by Medicaid (advantaged). Results: A positive CES-D screen (≥16) was more common in teens (46%) and disadvantaged women (47%) than in advantaged women (23%). Recent problems (previous 6 months) with abuse, economics, and substance use in someone close were each associated with higher adjusted mean CES-D scores (2.3–7.5 increase) in the three subgroups of women. In life course analyses, abuse and substance use in teens, and abuse and economic problems in disadvantaged and advantaged women were strongly linked to higher adjusted mean CES-D scores when these problems occurred both in childhood and adulthood (range 2.2–7.1 increase), whereas the associations were more modest when problems were confined to childhood. Conclusions: Strategies for addressing the public health problem of depressive symptoms in mid-pregnancy will benefit from a life course perspective.     

CDLQI, Scorad and Ness: Are they Correlated?

Background Quality of life (QOL) and clinical severity scores are important parameters in the evaluation of distress experienced by children with atopic dermatitis (AD). The SCORing Atopic Dermatitis (SCOARD) is a widely used clinical score for assessing AD symptomatology over the preceding 3 days and the Nottingham Eczema Severity Score (NESS) is another score useful for AD symptoms over the preceding 12 months. Objective We evaluated if these parameters are correlated with QOL in children with AD. Patients/Methods We assessed quality of life, clinical scores, total IgE and eosinophil count in peripheral blood in AD patients at our paediatric dermatology clinic over a 14-month period. Results Eighty AD patients (42 males and 38 females; mean [SD] age 11.7 [3.7] years) were recruited. The median (interquartile range, IQR) IgE, eosinophil counts and eosinophil percentage were 2988 (1069–7847) kIU/L; 0.6 (0.4–0.9) × 10⁻⁹/L; and 9 (6–12)%, respectively. Quality of life as measured with CDLQI (The Children’s Dermatology Life Quality Index) generally did not correlate well with both the acute and chronic AD severity scores (objective SCORAD and total CDQLI, ρ = 0.17, p > 0.05; total NESS and total CDQLI, ρ = 0.29, p < 0.05). Factor analysis further confirmed that the objective indicators (serum total IgE, eosinophil count and objective SCORAD), self-reported scores (NESS and subjective SCORAD) and CDLQI were separate dimensions in the assessment of AD in children. Conclusion Quality of life, disease severity scores and laboratory atopic markers represent different domains in AD assessment. They do not necessarily correlate well with each other and all three aspects must be individually evaluated to assess the well-being of these patients.     

Deteriorating health status in Stockholm 1998–2002: results from repeated population surveys using the EQ-5D

Rationale, aim and methodology In order to measure the change in health status in Sweden, the generic health-related quality of life instrument, the EQ-5D, was included in the 1998 (n = 4,950) and 2002 (n = 49,914) cross-sectional postal Public Health Surveys, a representative sample (21–84 years) of the Stockholm County population, with response rates about 63% in both years. The EQ-5D provides data on five dimensions of health as well as an overall index value (1 = full health; 0 = dead). Results Over time the health index decreased statistically significantly from 0.858 to 0.841 for men and from 0.833 to 0.797 for women. Women had significantly more health problems in 2002 in four out of the five dimensions, with the largest increase in the dimensions anxiety/depression (33–43%) and pain/discomfort (47–53%). The health index was significantly lower in all age-groups for women. Men had significantly more health problems 2002 in two dimensions, and the largest increase in anxiety/depression (24–31%). The health index decreased significantly over time for younger men. Conclusion The observed deterioration in health status over time gives reason for concern. Investigation of reasons for the declining health status should be a research priority. The 1998 and 2002 Public Health Surveys in Stockholm County     

A simple imputation algorithm reduced missing data in SF-12 health surveys

OBJECTIVE: The SF-12 Health Survey is a 12-item questionnaire that yields two summary scores (physical and mental health). Neither score can be computed when an item is missing. We explored imputation methods for missing scores for this instrument. STUDY DESIGN AND SETTING: Using data from a population-based survey, we tested several ways of imputing simulated missing data. RESULTS: Among 1250 participants, 118 (9.6%) had at last one missing SF-12 item. Missing data were more common among women, older respondents, non-Swiss nationals, and health service users. Among the 1132 respondents with complete data, replacement of any item with the mean population item weight yielded good results: the mean correlation between imputed and true score was 0.979 for both the physical and mental score. Results remained satisfactory when up to three of the six key items for each score (items that contribute predominantly to a given score), and any number of non-key items, were replaced by the mean. Application of this imputation algorithm to the original survey reduced the proportion of missing scores to <1%. Respondents with incomplete surveys, hence imputed scores, had lower scores than respondents with complete data (physical score: 44.9 vs. 49.8, p < 0.001, mental score: 44.4 vs. 46.3, p=0.064). CONCLUSIONS: A simple imputation algorithm can substantially reduce the proportion of missing scores for the SF-12 health survey, and consequently reduce non-response bias.     

Immigration and Selected Indicators of Health Status and Healthcare Utilization among the Chinese

We examined indicators of health status and healthcare utilization according to immigration status to assess the ‘healthy immigrant effect’ for Chinese adults. Data for Chinese in Taiwan (n = 15,549) were from the 2001 Taiwan National Health Interview Survey (NHIS). Data for U.S.-born Chinese (n = 964) and Chinese Immigrants in the U.S. (n = 253) were from the 1998–2004 U.S. NHIS. We used multivariate logistic regression to estimate the adjusted odds of perceived poor health, having ever smoked, and past year emergency room visits according to immigration status. For Chinese immigrants, more years in the U.S. were associated with lower odds of reporting poor health (OR = 0.4; 95% CI = 0.2–0.8) and past-year emergency room use (OR = 0.5; 95% CI = 0.3–0.9). Compared with recent Chinese immigrants (<5 years in U.S.), Chinese in Taiwan had higher odds of reporting poor health (OR = 6.2; 95% CI = 3.2–12.1) and having ever smoked (OR = 1.6; 95% CI = 1.1–2.5). Our results suggest that those who migrate have better health profiles than those who do not migrate. However, recent Chinese immigrants were not significantly different than U.S.-born Chinese.     

Estimation of non-response bias in the Medicare FFS HOS

We examined non-response bias in physical component summary scores (PCS) and mental component summary scores (MCS) in the Medicare fee-for-service (FFS) Health Outcomes Survey (HOS) using two alternative methods, response propensity weighting and imputation for non-respondents. The two approaches gave nearly identical estimates of non-response bias. PCS scores were 0.74 points lower and MCS scores 0.51 points lower after adjustment for non-response through imputation and 0.63 and 0.46 lower after adjustment for propensity weighting. These levels are small for component scores suggesting that survey non-response to the FFS HOS does not adversely affect estimates of average health status for this population.     

Comparison of Risk Factors for Small-for-Gestational-Age and Preterm in a Portuguese Cohort of Newborns

Objective: To identify risk factors for small-for-gestational-age and preterm in a Portuguese cohort of newborns. Study design: Socio-demographic, anthropometric, behavioural and obstetrical characteristics were evaluated in 4.193 women consecutively delivered. Term small-for-gestational-age (n = 342) and non-small-for-gestational-age preterm (n = 148) were compared to non-small-for-gestational-age term births (n = 3538). Adjusted odds ratios and etiologic fractions were calculated. Results: Low height, low weight when entering pregnancy and low weight gain were significantly associated with small-for-gestational-age, but not preterm. These were the factors with the highest etiologic fraction for small-for-gestational-age. An increased risk of small-for-gestational-age was found for women who smoked during pregnancy (OR = 2.39; 95% CI: 1.66–3.46) and began antenatal care after pregnancy first trimester (OR = 1.86; 95% CI: 1.32–2.62). Previous abortion was associated with small-for-gestational-age (OR = 1.72; 95% CI: 1.16–2.55) and previous preterm with preterm (OR = 3.20; 95% CI: 1.26–8.14). Conclusions: Low anthropometrics, smoking and late antenatal care were risk factors for small-for-gestational-age, but not preterm. Maternal anthropometrics were the factors with the highest impact on small-for-gestational-age. No factor showed a great contribution to preterm birth.     

Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh

This study examines the change in health-related quality oflife (HRQoL) among (60 years) elderly persons as a result ofhealth education intervention. A community-based interventionstudy was performed in eight randomly selected villages (Intervention:n = 4; Control: n = 4) in rural Bangladesh. A total of 1135elderly persons was selected for this study. The analyses include839 participants (Intervention: n = 425; Control: n = 414) whoparticipated in both baseline and post-intervention surveys.Participants in the intervention area were further stratifiedinto compliant (n = 315) and non-compliant (n = 110) groupsbased on the reported compliance to the intervention activities.The intervention includes, for example, physical activity, adviceon healthy food intake and other aspects of management. To createan enabling environment, social awareness was provided by meansof information about the contribution of and challenges facedby elderly persons at home and the community, including informationabout elderly persons' health and health care. The interventionactivities were provided to the elderly persons, caregivers,household members and community people for 15 months. The HRQoLwas assessed using a multi-dimensional generic instrument designedfor elderly persons. Multivariate analyses revealed that inthe non-compliant group the probabilities of increased scoreswere less likely in overall HRQoL (OR 0.52, 95% CI 0.32–0.82).Among the Control group, increased scores were less likely inthe physical (OR 73, 95% CI 0.54–0.99), social (OR 0.37,95% CI 0.27–0.50), spiritual (OR 0.60, 95% CI 0.34–0.94),environment (OR 0.36, 95% CI 0.26–0.49) dimensions andoverall HRQoL (OR 0.44, 95% CI 0.32–0.59) (adjusted forage, sex, literacy, marital status and economic status). Thisstudy concludes that provision of community-based health educationintervention might be a potential public health initiative toenhance the HRQoL in old age.     

Overweight male personnel of the Japan Self-Defense Forces with body mass indices of 23.0–24.9 and obesity-related metabolic disorders

Objectives To assess the validity of the criterion of overweight for Asian people that is recommended by Western Pacific Region of the World Health Organization. Methods We carried out a cross-sectional analysis of the association between the criterion of overweight for ethnic Asian people—body mass indices (BMI) of 23.0–24.9 kg/m²—and the presence of obesity-related metabolic disorders among middle-aged Japanese men (n = 974, age range 51–59). Results The odds ratios (95% confidence interval) of overweight to those with normal weight (BMI < 23.0 kg/m²) were 1.61 (1.11–2.33) for the presence of impaired glucose tolerance, 1.95 (1.30–2.93) for hypertension, 2.22 (1.63–3.03) for hypercholesterolemia, 2.83 (2.02–3.97) for hypertriglyceridemia, and 2.06 (1.06–4.00) for hyperuricemia. Overweight was not associated with the presence of type 2 diabetes or with high γ-glutamyl transrease in the present study (odds ratios: 1.09 and 1.05, respectively). Adjustment for age, rank, and lifestyle factors affected the results only slightly. Conclusions Based on these results, we conclude that the Asian criterion of overweight appears to be rational in terms of its association with obesity-related metabolic disorders in male personnel of the Japan Self-Defense Forces in their fifties.     

A comparison of methods to address item non-response when testing for differential item functioning in multidimensional patient-reported outcome measures

Purpose

Item non-response (i.e., missing data) may mask the detection of differential item functioning (DIF) in patient-reported outcome measures or result in biased DIF estimates. Non-response can be challenging to address in ordinal data. We investigated an unsupervised machine-learning method for ordinal item-level imputation and compared it with commonly-used item non-response methods when testing for DIF.

Methods

Computer simulation and real-world data were used to assess several item non-response methods using the item response theory likelihood ratio test for DIF. The methods included: (a) list-wise deletion (LD), (b) half-mean imputation (HMI), (c) full information maximum likelihood (FIML), and (d) non-negative matrix factorization (NNMF), which adopts a machine-learning approach to impute missing values. Control of Type I error rates were evaluated using a liberal robustness criterion for α?=?0.05 (i.e., 0.025–0.075). Statistical power was assessed with and without adoption of an item non-response method; differences?>?10% were considered substantial.

Results

Type I error rates for detecting DIF using LD, FIML and NNMF methods were controlled within the bounds of the robustness criterion for?>?95% of simulation conditions, although the NNMF occasionally resulted in inflated rates. The HMI method always resulted in inflated error rates with 50% missing data. Differences in power to detect moderate DIF effects for LD, FIML and NNMF methods were substantial with 50% missing data and otherwise insubstantial.

Conclusion

The NNMF method demonstrated comparable performance to commonly-used non-response methods. This computationally-efficient method represents a promising approach to address item-level non-response when testing for DIF.

     

Relation of Maternal Low Birth Weight to Infant Growth Retardation and Prematurity

Objectives: This study sought to determine the relationship between maternal birth weight, infant intrauterine growth retardation, and prematurity. Methods: Stratified and logistic regression analyses were performed on a dataset of computerized Illinois vital records of African American (N = 61,849) and White (N = 203,698) infants born between 1989 and 1991 and their mothers born between 1956 and 1975. Results: Race-specific rates of small-for-gestational age (weight-for-gestational age <10th percentile) and preterm (<37 weeks) infants rose as maternal birth weight declined. The adjusted (controlling for maternal age, education, marital status, parity, prenatal care utilization, and cigarette smoking) odds ratio (95% confidence interval) of small-for-gestational age for maternal low birth weight (<2500 g) among African Americans and Whites were 1.7 (1.1.4–1.9) and 1.8 (1.7–2.0), respectively. The adjusted odds ratio (95% confidence interval) of prematurity for maternal low birth weight (<2500 g) among African Americans and Whites were 1.6 (1.3–1.9) and 1.3 (1.0–1.6), respectively. The racial disparity in the rates of small-for-gestational age and prematurity persisted independent of maternal birth weight: adjusted odds ratio equaled 2.2 (2.1–2.4) and 1.5 (1.4–1.7), respectively. Conclusions: Maternal low birth weight is a risk factor for infant intrauterine growth retardation and prematurity among African Americans independent of maternal risk status during pregnancy; it is a risk factor for infant intrauterine growth retardation among Whites. Maternal low birth weight fails to explain the racial disparity in the rates of small-for-gestational age and premature infants.     

Healthcare Providers’ Satisfaction with a State Children’s Health Insurance Program (SCHIP)

Purpose This study’s purpose was to understand how experiences with and perceptions of the health care plan characteristics influence provider satisfaction with a State Children’s Health Insurance Program (SCHIP). Methods Physicians and other health care providers participating in one program (ALL Kids) were mailed a survey (n = 500). Pediatricians were the most likely to return the survey. We used frequencies, chi-square and logistic regression analysis to explore relationships. Results The odds of being less satisfied with the program among providers who perceived that reimbursement in the ALL Kids program was less compared to private insurance were almost 7 times (OR = 6.81; 95% CI = (1.88–24.73)) greater than for those who perceived that reimbursement was more or the same in ALL Kids. Likewise, respondents who perceived that All Kids families were less likely than families with private insurance to return for follow-up visits were less satisfied with ALL Kids (OR = 17.42; 95% CI = (1.85–164.70)). Conclusions The stigma of SCHIP may be less than that often associated with Medicaid; however, this investigation should be considered with others that have identified barriers for provider’s participation. This study indicates that provider satisfaction is related to their perceptions of SCHIP policies and families, though it does not tell us what factors might contribute to this perception, such as, previous experience with public insurance (Medicaid) and publicly insured patients. Increasing reimbursement rates may not address perceptions that affect provider views of publicly-supported health plans and the participating families.     

Efficacy of a Randomized Cell Phone-Based Counseling Intervention in Postponing Subsequent Pregnancy Among Teen Mothers

The purpose of this study is to explore state-level fetal death rates and <24 h infant mortality rates for deliveries less than 500 g in order to estimate outcomes classification differences at the edge of viability. We selected singleton deliveries to US resident mothers born <500 g and >20 weeks gestation from the NCHS live birth-infant death and fetal death files for 1999–2002 (n = 37,813). Infant deaths within 24 h of birth were selected to estimate odds of classification as a fetal death versus a live birth/infant death by state. Logistic regression was used to derive odds of classification as a fetal death and to adjust for maternal characteristics, calculating unadjusted and adjusted odds ratios. We identified 37,813 outcomes from 48 states reporting in this birthweight category. Unadjusted odds of classification of outcomes as a fetal death versus a live birth/death within 24 h by state ranged from OR = 0.38 (95% CI = 0.24–0.59) to OR = 2.93 (95% CI = 2.26–3.78); adjusted for maternal age and race, the range narrowed slightly to a OR = 0.31 (95% CI = 0.20–0.48) to aOR = 2.54 (95% CI = 1.96–3.30). Six states were more likely to classify outcomes as a live birth/infant death, while 14 states were more likely to classify as a fetal death, when compared to a large reference state. The remaining states did not differ significantly in their outcomes. The fraction of outcomes classified as fetal deaths varied by state during the years studied. This study suggests fetal death and early infant death outcomes reported for babies less than 500 g reflect differential classification thus influencing the validity of these vital statistics data at the state level. Further studies are needed to explore the factors that influence these differences.     

A Strength-Endurance Index for Power Grip

Introduction The purpose of this study was to quantify muscle strength and endurance in power grip. Method Workers (74 M and 74 F, 18–72 years) squeezed a dynamometer for a 60 s, 18-cycle test. Initial strength (IS) and final strength (FS) were calculated as the mean peak force for cycles 1–3 and 16–18, respectively. Endurance was defined by the strength decrement index (SDI) where SDI = (IS − FS)/IS × 100. A grip strength-endurance analyzer was constructed from IS and SDI data which were depicted on two parallel, linearly scaled axes. Discrete IS and SDI scores were connected on each axis with a vector. The vector (Vmag) was measured directly from the analyzer and its direction identified from its slope. Integer scales transformed discrete IS and SDI scores into individual strength-endurance performance scores (SEPS). Results Better than 95% of the sample (n ≥ 141) scored within acceptable test ranges defined as the combined sample mean ± 2SD, for SDI, Vmag and SEPS. Vmag was the best predictor for SEPS. Linear regression for SEPS was SEPS (combined) = 0.09 (Vmag) − 0.29: (SEE = 0.829). The analyzer revealed individual scores outside acceptable ranges for injured and uninjured efforts. Conclusion The development of a power grip strength-endurance analyzer provided a simple method to graph individual power grip performances. Converting strength and endurance scores to integers and summing them (SEPS) provided a simple means to represent individual estimates of power grip strength-endurance performance.