Did low birthweight among US blacks really increase?

The low birthweight (LBW) rate among reported United States non-White births increased 32 per cent from 1950 to 1967. States with large increments in non-White LBW rates over the period 1950-67 ("rising LBW states") were compared to states with more stable LBW rates. Paradoxically, states with the most deterioration in LBW rates had the most improvement in LBW risk factors (low income, mothers under age 20 or over age 35, birth order over four). In 1950, at least 9.7 per cent of non-White births in rising LBW states went unreported, and underreporting was biased, with out-of-hospital LBW births who die young least likely to be reported. From 1950 to 1967, non-White out-of-hospital births for the US declined from 42 per cent to 7 per cent, and yearly values for per cent of non-White births in hospital and LBW rates were highly correlated (r = .98). These data suggest that the observed rise in non-White LBW rates from 1950 to 1967 was due in large part to systematic underreporting of LBW births among non-White out-of-hospital deliveries in the 1950s. This underreporting essentially ceased when hospital delivery for non-Whites became nearly universal in the late 1950s and 1960s.     

Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight

Socio-economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called 'the epidemiological paradox of low birthweight'. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population-based cohort studies carried out in the nineties, including 2439 births in Sao Luis, a poor city in north-eastern Brazil, and 2839 births in Ribeirao Preto, a socio-economically well-off city in south-eastern Brazil, were used to explore this paradox. The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirao Preto than in Sao Luis (10.7 vs. 7.6%, P <0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P=0.520) and percentage of small-for-gestational-age (SGA) infants (12.5 vs. 13.5%, P=0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirao Preto (16.4 vs. 9.8%, P=0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in Sao Luis. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirao Preto than in Sao Luis (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirao Preto. Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under-registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.     

What is driving hospitals' patient-safety efforts?

The Institute of Medicine's report To Err Is Human described the alarming prevalence of medical errors and recommended a range of activities to improve patient safety. Three general mechanisms for stimulating hospitals to reduce medical errors are professionalism, regulation, and market forces. Although some believe that market forces are becoming more important, we found that a quasi-regulatory organization (the Joint Commission on Accreditation of Healthcare Organizations) has been the primary driver of hospitals' patient-safety initiatives. Professional and market initiatives have also facilitated improvement, but hospitals report that these have had less impact to date.     

Editorial – What is health promotion ethics?

What does it mean to think about the ethics of health promotion? When most of us think ‘ethics’ we think of the Human Research Ethics Committee applications required for research projects. But I'm thinking of something quite different here: the ethics of health promotion practice. Health promotion ethics is an attempt to answer questions such as: Can we provide a moral justification for what we are doing in health promotion? or What is the right thing to do in health promotion, and how can we tell? As other authors have argued, sometimes these questions are ignored in health promotion in favour of scientific and technical questions about effectiveness. But there is increasing recognition that health promotion is a moral project, that health promotion can be practised in ways that are more or less ethical, and thus that considering ethics in health promotion is just as important as – and related to – considering the evidence about whether or not health promotion works.     

What is urban in the contemporary world?

Central concepts of contemporary life such as politics, civilization, and citizenship derive from the city's form and social organization. The city expresses the socio-spatial division of labor, and Henri Lefebvre proposes to view its transformation within a continuum from the political city to the urban, whereby it completes its domination over the countryside. The city's transformation into the urban takes place when industry brings production (and the proletariat) into that space of power. The city, locus of surplus, power, and the fiesta, a privileged scenario for social reproduction, was subordinated to the industrial logic and underwent a dual process: its centrality imploded, and its outskirts exploded on surrounding areas through the urban fabric, bearing with it the seeds of the polis and civitas. The urban praxis, formerly restricted to the city, re-politicized social space as a whole. In Brazil, the urban has its origins in the military governments' centralizing and integrating policies, following Vargas's expansionism and Kubitschek's developmental interiorization (or occupation of the hinterlands). Today, urban-industrial processes impose themselves over virtually all social space, in contemporary extended urbanization.     

Is low birthweight associated with dental caries in permanent dentition?

The aim of this study was to test the hypothesis of association between low birthweight and dental caries. This study used data from the Third National Health and Nutritional Examination Survey, 1988-94 (NHANES III) including 7- to 11-year-old children with complete dental caries information (n = 2439). Two case definitions for dental caries were used: presence of the disease in more than one tooth, and more than 10% of teeth with dental caries. Low birthweight was defined as those children born weighing <2500 g. Other covariates used in the analysis were sex, age, poverty level, race/ethnicity, frequency of dental visit, education of head of household, daily sucrose intake, blood lead level and blood cotinine level. A separate analysis was conducted for each case definition of dental caries. Bivariable and stratified analysis was performed followed by multivariable Poisson regression. The Stata 8.0 statistical package was used to take into consideration the multistage complex sample. For the definition of more than one tooth with dental caries, the prevalence ratios (PRs) for bivariable and multivariable analyses were 1.28 [95% confidence interval (CI): 0.48, 3.42] and 1.01 [95% CI: 0.41, 2.49] respectively. For the definition of >10% of teeth with dental caries, the PRs for bivariable and multivariable analyses were 1.33 [95% CI: 0.60, 2.96] and 1.32 [95% CI: 0.75, 2.30] respectively. This study could not demonstrate an association between low birthweight and dental caries in permanent teeth of 7- to 11-year-old American children.     

Hospital admissions in the National Health Survey and hospital separations in the National Hospital Morbidity Dataset: What is the difference?

OBJECTIVE: To compare the National Health Survey (NHS) derived estimates of hospital admissions with the number of hospital separations registered in the National Hospital Morbidity Dataset (NHMD). METHODS: Using the person weights in the NHS, the Expanded Confidential Unit Record File of the 2004-05 NHS was used to derive a population estimate of the number of hospital admissions in the 12 months preceding the conduct of the survey. These estimates, by age and sex categories and whether or not the admission involved an overnight stay, were compared with the number of hospital separations registered in the NHMD. RESULTS: The number of hospital admissions estimated from the NHS was approximately two thirds the number of hospital separations registered in the NHMD. The discrepancy between the two data sources was greater when hospital episodes did not involve an overnight stay in hospital. CONCLUSION: There are systematic differences between the number of admissions/separations derived by the NHS and the NHMD for reasons including the technical difference between a hospital admission and a separation, and the sampling frame and scope of the NHS. Researchers looking for individual level data on hospital utilisation must take note of the differences between NHS and the NHMD, and recognise that there are methods to simulate a representative population by enhancing an existing dataset with information from multiple data sources, thus providing researchers a cost-effective data resource.     

What is the payoff in computerized appointment scheduling?

Is your group experiencing difficulty in the area of patient appointment scheduling? By changing from a manual method to a system of on-line computerized appointment scheduling, you will not only realize the value of consistent scheduling, but also the benefits of credit control and a reduction of time-consuming error correction. The process that this group went through in developing a computerized system to meet their specific needs is especially relevant to larger group practices. However, there are systems available that can fulfill the needs of any size group.     

Clinical inquiries: What is the dietary treatment for low HDL cholesterol?

Low-carbohydrate diets raise high-density lipoprotein (HDL) cholesterol levels by approximately 10%; soy protein with isoflavones raises HDL by 3% (strength of recommendation [SOR]: C, based on meta-analysis of physiologic parameters). The Dietary Approaches to Stop Hypertension (DASH) diet and multivitamin supplementation raise HDL 21% to 33% (SOR: C, based on single randomized trial each measuring physiologic parameters). No other dietary interventions studied raise HDL (SOR: C, based on meta-analysis of physiologic parameters).