Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996

BACKGROUND: Maternal mortality is a sensitive indicator for inequity in health. We describe recent trends in overall and cause-specific maternal mortality ratio among women of German and non-German nationality residing in West Germany. METHODS: Using birth and death register data for 1980-1996 we related 1067 cases of maternal death (ICD 9: 630-676) to 11.2 million live births. We assessed the effects of nationality and of marital status, a proxy for socioeconomic status, controlling for year of death and age of the mother in a Poisson regression model. RESULTS: Maternal mortality ratio in West Germany decreased from 13 per 100000 live births in 1980-1988 to 6.1 in 1989-1996. The crude relative risk for non-German nationality decreased from 1.9 (95% CI: 1.6-2.3) to 1.3 (1.0-1.7); after adjusting for age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6 (95% CI: 1.2-2.1). Unmarried women incurred an adjusted relative risk of 1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality from abortions which largely disappeared in 1989-1996; concurrently, being unmarried no longer conveyed an additional risk to them. The risk status of German mothers developed unfavourably: increasing proportions are unmarried, which continues to be a marker of elevated relative risk in this group. CONCLUSIONS: Our findings suggest continuously improving accessibility and quality of obstetric services, in particular for women of non-German nationality. Still, inequity in maternal risk continues to exist. Maternal risk, however, is not determined by the simple distinction 'German' versus 'non-German'; its association with socioeconomic status extends beyond nationality.     

Better health data with a portable microcomputer at the periphery: an anthropometric survey in Cape Verde

A portable microcomputer was programmed to record anthropometric nutritional data from children aged under 7 years in either a clinic or a population survey situation. An alarm sounds when the anthropometric measurements of a child are below a predetermined value; an immediate check thus avoids the need for subsequent data cleaning and discarding of doubtful information. Data cut-off points in the computer can be adjusted to suit the survey or service needs of the situation. A print-out at the end of the clinic session provides immediate feedback for the staff and a record of the nutritional status of the group.     

Risk factors for perinatal death in Cape Verde

Summary.   Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case–control study in 1992–93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37–46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.     

Evaluation of antenatal risk factors lit Cape Verde

The prevalence of antenatal risk factors and their association with adverse pregnancy outcome were prospectively studied in the county of Praia, Cape Verde. Of 4693 women registering for antenatal care, 8% were randomly selected from October 1991 through December 1992. Eventually 358 women were observed until puerperium when a physical examination and a structured interview took place. Three out of four women of the cohort were exposed to risk factors according to the existing risk classification in Praia, and 9% presented high risk factors. Thirty two percent of the cohort faced adverse pregnancy outcomes. Adverse pregnancy outcomes were significantly increased among women who presented high risk factors, but 82% of all adverse outcomes occurred among other women. The antenatal risk classification investigated cannot be considered an effective tool for detection of women at risk of adverse pregnancy outcome.     

Neighbourhood support to families with a disabled child: observations on a coping strategy off caregivers in a Jamaican community-based rehabilitation programme

Summary In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organization's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to be asked for and provided under exceptional circumstances only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help — which is more likely in the case of disabled children.     

Primary health care and the consequences of a strategy of denial: inefficient and uneconomical management of health problems due to a far-reaching omission of clients' world view, self image and psyche from the context of therapy

In spite of high prevalence rates, non-somatic health problems remain largely neglected in Third World First line health services. Deficits in staff qualification and motivation, clients' lack of readiness to perceive their problems as psychogenic, and "superstitious" beliefs as to their causation, material constraints, and the inapplicability of Western psychotherapeutic techniques in non-Western cultures are quoted as possible explanations. We assess their validity and potential consequences for the quality of service delivery; a different approach towards the training of staff, aiming at the integration of attention to psychological problems into everyday service provision, is discussed.     

Metaphyseal fracture healing in a sheep model of low turnover osteoporosis induced by hypothalamic–pituitary disconnection (HPD)

We recently established a large animal model of osteoporosis in sheep using hypothalamic–pituitary disconnection (HPD). As central regulation is important for bone metabolism, HPD‐sheep develop severe osteoporosis because of low bone turnover. In this study we investigated metaphyseal fracture healing in HPD‐sheep. To elucidate potential pathomechanisms, we included a treatment group receiving thyroxine T4 and 17β‐estradiol. Because clinically osteoporotic fractures often occur in the bone metaphysis, HPD‐sheep and healthy controls received an osteotomy in the distal femoral condyle. Half of the HPD‐sheep were systemically treated with thyroxine T4 and 17β‐estradiol during the healing period. Fracture healing was evaluated after 8 weeks using pQCT, µCT, and histomorphometrical analysis. Bone mineral density (BMD) and bone volume/total volume (BV/TV) were considerably reduced by 30% and 36%, respectively, in the osteotomy gap of the HPD‐sheep compared to healthy sheep. Histomorphometry also revealed a decreased amount of newly formed bone (?29%) and some remaining cartilage in the HPD‐group, suggesting that HPD disturbed fracture healing. Thyroxine T4 and 17β‐estradiol substitution considerably improved bone healing in the HPD‐sheep. Our results indicate that fracture healing requires central regulation and that thyroxine T4 and 17β‐estradiol contribute to the complex pathomechanisms of delayed metaphyseal bone healing in HPD‐sheep. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1851–1857, 2013

     

Comparative studies on the biological significance of the marker for proliferation Ki-67-Antigen and PCNA in primary ovarian carcinoma

OBJECTIVE: It was shown in experimental and clinical investigations, that the biological behavior of malignant tumors is reflected by their proliferative activity. PCNA and Ki-67-Antigen are two nuclear antigens and considered to represent important markers of proliferation. We investigated their proliferation index in primary ovarian carcinomas and correlated the results with tumor stage, grading, histological type and survival. MATERIAL AND METHODS: The expression of PCNA and Ki-67-Antigen was immunohistochemically evaluated using the monoclonal antibodies MIB-1 and PC 10 on formalin-fixed, paraffin-embedded tissue of 49 patients. Statistical data were calculated by means of Fisher's Exact Test and Pearson's Chi 2 Test, survival was estimated by Kaplan Meier Curves. RESULTS: PCNA-expression was shown in all ovarian carcinomas and Ki-67-Antigen-expression was detected with one exception (98%) in all tumors, too. No correlation could be found between Ki-67-Antigen-expression and the prognostic factors mentioned above, whereas a high PCNA-expression was significantly correlated with the tumor grading (G3), (p < 0.05). Patients with ovarian carcinomas with high PCNA proliferation index showed the tendency of a shorter overall survival. DISCUSSION: Ki-67-Antigen and PCNA-expression could be detected in almost all primary ovarian carcinomas. PCNA compared to Ki-67-Antigen is considered to be more useful for the determination of the proliferative activity of ovarian carcinomas, although there was shown just a tendency of overall survival dependent on PCNA-expression, and there was a significant correlation only between PCNA-proliferation index and tumor grading.