State legislator gender and other characteristics associated with sponsorship of child health bills.

OBJECTIVE: To examine the characteristics of state legislators who introduce child health bills. METHODS: We conducted a cross-sectional analysis of all bills introduced in Colorado, Louisiana, and Michigan during the 1997-1998 legislative session. We identified the topic for each bill while blinded to legislator characteristics. The primary study outcome was whether the bill topic related to child health. We also categorized whether the bill was signed into law. We examined associations between the outcomes and characteristics of the sponsoring legislators (gender, political party, terms served, chairpersonship of committees, legislative chamber, membership in the legislature's Black Caucus). RESULTS: During 1997 and 1998, legislators in the 3 study states introduced 9833 bills (1234 in Colorado, 4905 in Louisiana, and 3694 in Michigan). Sixty-five bills (0.66%) related to child health issues. Child health bills comprised a significantly higher proportion of all legislation introduced by female legislators compared with male legislators (1.5% vs 0.5%, P <.001). Of bills introduced by Black Caucus members, 1.4% pertained to child health compared with 0.59% of bills introduced by nonmembers (P <.01). In contrast, 0.23% of bills introduced by committee chairpersons pertained to child health versus 0.96% of bills introduced by nonchair legislators (P <.001). These associations remained statistically significant in multivariate analyses controlling for state effects. Whether child health bills were signed into law was not associated with other legislator characteristics. CONCLUSIONS: This study offers valuable insights about the different roles of women, Black Caucus members, and committee chairpersons in the state legislative process regarding children's health.     

Marked abnormal quadruple screen in a patient with severe preeclampsia at 20 weeks with a triploid fetus.

Severe preeclampsia rarely occurs prior to 20 weeks of gestation except in pregnancies with triploidy. The patient reported herein is a 29-year-old primigravida who developed severe preeclampsia at 20 weeks of gestation. Evaluation of the pregnancy demonstrated a markedly abnormal quadruple screen. Amniocentesis demonstrated a fetus with triploidy, despite a normal appearance.     

Circulating serum xenoestrogens and mammographic breast density

Introduction

Humans are widely exposed to estrogenically active phthalates, parabens, and phenols, raising concerns about potential effects on breast tissue and breast cancer risk. We sought to determine the association of circulating serum levels of these chemicals (reflecting recent exposure) with mammographic breast density (a marker of breast cancer risk).

Methods

We recruited postmenopausal women aged 55 to 70 years from mammography clinics in Madison, Wisconsin (N = 264). Subjects completed a questionnaire and provided a blood sample that was analyzed for mono-ethyl phthalate, mono-butyl phthalate, mono-benzyl phthalate, butyl paraben, propyl paraben, octylphenol, nonylphenol, and bisphenol A (BPA). Percentage breast density was measured from mammograms by using a computer-assisted thresholding method.

Results

Serum BPA was positively associated with mammographic breast density after adjusting for age, body mass index, and other potentially confounding factors. Mean percentage density was 12.6% (95% confidence interval (CI), 11.4 to 14.0) among the 193 women with nondetectable BPA levels, 13.7% (95% CI, 10.7 to 17.1) among the 35 women with detectable levels below the median (<0.55 ng/ml), and 17.6% (95% CI, 14.1 to 21.5) among the 34 women with detectable levels above the median (>0.55 ng/ml; P_trend = 0.01). Percentage breast density was also elevated (18.2%; 95% CI, 13.4 to 23.7) among the 18 women with serum mono-ethyl phthalate above the median detected level (>3.77 ng/ml) compared with women with nondetectable BPA levels (13.1%; 95% CI, 11.9 to 14.3; P_trend = 0.07). No other chemicals demonstrated associations with percentage breast density.

Conclusions

Postmenopausal women with high serum levels of BPA and mono-ethyl phthalate had elevated breast density. Further investigation of the impact of BPA and mono-ethyl phthalate on breast cancer risk by using repeated serum measurements or other markers of xenoestrogen exposure are needed.     

Midwifery data collection: options and opportunities

Most midwives are aware of the need to collect clinical practice data and of its usefulness in supporting the care they provide, which contributes to healthy outcomes for mothers and babies. For the individual midwife, there is more than one easily accessible, standardized data collection instrument from which to choose. However, despite these choices, in an American College of Nurse-Midwives (ACNM) Division of Research (DOR) survey on midwifery clinical data collection (N = 263), the majority of member respondents (n = 135; 51%) reported using a self-designed data collection tool, and more than one-third did not know of the ACNM Nurse-Midwifery Clinical Data Sets (NMCDS). On a larger scale, the midwifery profession is also in need of an organized and consistent approach to data collection for the purpose of capturing midwifery practice and outcomes in order to provide data to support legislation, practice, and policy changes. However, the profession currently lacks a single common midwifery practice database. In order to facilitate data aggregation that captures a larger view of midwifery practice at the local, regional, and national levels, it is imperative that all midwives collect relevant data that are uniform and standardized, and that the midwifery professional organizations move forward with the development of a common electronic database. This article describes currently available data collection tools as well as their best uses, applications to practice, and future directions.