Patients with resolution of low-lying placenta and placenta previa remain at increased risk of postpartum hemorrhage.

OBJECTIVE: To determine whether women who experience resolution of low placentation (low-lying placenta or placenta previa) are at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. METHODS: This was a retrospective cohort study of women who delivered at Mount Sinai Hospital between 2015 and 2019, and who were diagnosed with low-lying placenta or placenta previa on transvaginal ultrasound at the time of the second-trimester anatomical survey, with resolution of low placentation on subsequent ultrasound examination. Women undergoing second-trimester anatomical survey who had normal placentation on transvaginal ultrasound 3 days before or after the cases were randomly identified for comparison. The primary outcome was the rate of postpartum hemorrhage. Secondary outcomes included the need for a blood transfusion, use of additional uterotonic medication, the need for additional procedures to control bleeding, and maternal admission to the intensive care unit. Outcomes were assessed using a multivariable logistic regression model. RESULTS: A total of 1256 women were identified for analysis, of whom 628 had resolved low placentation and 628 had normal placentation. Women with resolved low placentation, compared to those with normal placentation throughout pregnancy, had significantly higher mean age (33.0 ± 5.4 years vs 31.9 ± 5.5 years; P < 0.01) and lower mean body mass index at delivery (27.9 ± 5.5 kg/m2 vs 30.2 ± 5.7 kg/m2 ; P < 0.01), and were more likely to have undergone in-vitro fertilization, be of non-Hispanic white race, have posterior placental location (all P < 0.01) and have private/commercial health insurance (P = 0.04). Patients with resolved low placentation vs normal placentation had greater odds of postpartum hemorrhage (adjusted odds ratio (aOR), 3.5 (95% CI, 2.0-6.0); P < 0.01), use of additional uterotonic medication (aOR, 2.2 (95% CI, 1.5-3.1); P < 0.01) and increased rates of additional procedures to control bleeding (aOR, 4.0 (95% CI, 1.3-11.9); P = 0.01). CONCLUSION: Despite high rates of resolution of low-lying placenta and placenta previa by term, women with resolved low placentation remain at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends.

BACKGROUND: The American Cancer Society, the National Cancer Institute (NCI), the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention, including the National Center for Health Statistics (NCHS), collaborate to provide an annual update on cancer occurrence and trends in the United States. This year's report contains a special feature that focuses on cancers with recent increasing trends. METHODS: From 1992 through 1998, age-adjusted rates and annual percent changes are calculated for cancer incidence and underlying cause of death with the use of NCI incidence and NCHS mortality data. Joinpoint analysis, a model of joined line segments, is used to examine long-term trends for the four most common cancers and for those cancers with recent increasing trends in incidence or mortality. Statistically significant findings are based on a P value of.05 by use of a two-sided test. State-specific incidence and death rates for 1994 through 1998 are reported for major cancers. RESULTS: From 1992 through 1998, total cancer death rates declined in males and females, while cancer incidence rates declined only in males. Incidence rates in females increased slightly, largely because of breast cancer increases that occurred in some older age groups, possibly as a result of increased early detection. Female lung cancer mortality, a major cause of death in women, continued to increase but more slowly than in earlier years. In addition, the incidence or mortality rate increased in 10 other sites, accounting for about 13% of total cancer incidence and mortality in the United States. CONCLUSIONS: Overall cancer incidence and death rates continued to decline in the United States. Future progress will require sustained improvements in cancer prevention, screening, and treatment.

Annual report to the nation on the status of cancer, 1973-1996, with a special section on lung cancer and tobacco smoking.

BACKGROUND: The American Cancer Society, the National Cancer Institute (NCI), and the Centers for Disease Control and Prevention (CDC), including the National Center for Health Statistics (NCHS), provide the second annual report to the nation on progress in cancer prevention and control, with a special section on lung cancer and tobacco smoking. METHODS: Age-adjusted rates (using the 1970 U.S. standard population) were based on cancer incidence data from NCI and underlying cause of death data compiled by NCHS. The prevalence of tobacco use was derived from CDC surveys. Reported P values are two-sided. RESULTS: From 1990 through 1996, cancer incidence (-0.9% per year; P = .16) and cancer death (-0.6% per year; P = .001) rates for all sites combined decreased. Among the 10 leading cancer incidence sites, statistically significant decreases in incidence rates were seen in males for leukemia and cancers of the lung, colon/rectum, urinary bladder, and oral cavity and pharynx. Except for lung cancer, incidence rates for these cancers also declined in females. Among the 10 leading cancer mortality sites, statistically significant decreases in cancer death rates were seen for cancers of the male lung, female breast, the prostate, male pancreas, and male brain and, for both sexes, cancers of the colon/rectum and stomach. Age-specific analyses of lung cancer revealed that rates in males first declined at younger ages and then for each older age group successively over time; rates in females appeared to be in the early stages of following the same pattern, with rates decreasing for women aged 40-59 years. CONCLUSIONS: The declines in cancer incidence and death rates, particularly for lung cancer, are encouraging. However, unless recent upward trends in smoking among adolescents can be reversed, the lung cancer rates that are currently declining in the United States may rise again.

Quality of death rates by race and Hispanic origin: a summary of current research, 1999.

OBJECTIVES: This report provides a summary of current knowledge and research on the quality and reliability of death rates by race and Hispanic origin in official mortality statistics of the United States produced by the National Center for Health Statistics (NCHS). It also provides a quantitative assessment of bias in death rates by race and Hispanic origin. It identifies areas for targeted research. METHODS: Death rates are based on information on deaths (numerators of the rates) from death certificates filed in the states and compiled into a national database by NCHS, and on population data (denominators) from the Census Bureau. Selected studies of race/Hispanic-origin misclassification and under coverage are summarized on deaths and population. Estimates are made of the separate and the joint bias on death rates by race and Hispanic origin from the two sources. Simplifying assumptions are made about the stability of the biases over time and among age groups. Original results are presented using an expanded and updated database from the National Longitudinal Mortality Study. RESULTS: While biases in the numerator and denominator tend to offset each other somewhat, death rates for all groups show net effects of race misclassification and under coverage. For the white population and the black population, published death rates are overstated in official publications by an estimated 1.0 percent and 5.0 percent, respectively, resulting principally from undercounts of these population groups in the census. Death rates for the other minority groups are understated in official publications approximately as follows: American Indians, 21 percent; Asian or Pacific Islanders, 11 percent; and Hispanics, 2 percent. These estimates do not take into account differential misreporting of age among the race/ethnic groups.

Age-adjusted death rates: consequences of the Year 2000 standard.

PURPOSE: For nearly 60 years, official U.S. mortality statistics have been age-adjusted using the age distribution from the U.S. population for the year 1940. A new population standard, the projected Year 2000 U.S. standard, has been approved for use by the Department of Health and Human Services (DHHS). It will be implemented for official U.S. Government statistics published for deaths occurring in 1999. The new standard reflects the older age distribution of the population; 6.8% of the population was age 65 years or more in 1940, as compared to 12.6% projected for 2000. METHODS: This paper investigates the consequences of the new age distribution standard by comparing death rates by time, place, and population characteristics, adjusted to both the 1940 and projected 2000 population standards. RESULTS: The new standard changes the level of the age-adjusted death rate for total mortality and for many causes of death, as compared to the 1940 standard. For example, the 1995 death rate for diseases of the heart is 138 per 100,000 population when adjusted using the 1940 standard, but is 296 per 100,000 using the Year 2000 standard. The new standard may change the comparison of age-adjusted rates if there are substantial differences in the age-specific rates. For example, the ratio of age-adjusted death rates for ischemic heart disease in black relative to white males is 1.07 using the 1940 standard, but is 0.96 using the Year 2000 standard. CONCLUSIONS: The new Year 2000 age standard has the potential to change both levels and comparisons of age-adjusted rates. Age-adjustment is an averaging process, and consequently, has the potential to view the data effectively as a whole while possibly obscuring important age-specific details.

National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984.

National population-based data systems of the National Center for Health Statistics (NCHS) were used to study the epidemiology of asthma in the United States over the last 20 years. Asthma is more prevalent among males, those living below the poverty level, persons living in the South and West, and blacks; however, this difference did not attain statistical significance. Death rates from asthma among the older age groups probably increased between 1968 and 1982, with a substantial increase since 1979. For children, the evidence is less clear, but the death rate has increased for children over five years of age during the period from 1979 to 1982. Between 1964 and 1980, asthma has become more prevalent in children under 17 years of age, but this does not reflect an increase in the severity of asthma over this same time period. Hospitalization rates for asthma between 1965 and 1983 increased by 50 percent in adults and by over 200 percent in children. Rates for black patients are 50 percent higher in adults and 150 percent greater in children. It is concluded that there has been a marked increase in hospitalization rates for asthma, a moderate increase in death rates from asthma and a smaller increase in overall prevalence of the disease in the United States.

Heart rate and physical activity of children during dental treatment.

Children with grossly observable physical activity during intraoral injection have significant heart rate accelerations. Children in whom movement is absent or confined to the muscles of facial expression experience heart rate deceleration. Both groups of children show anxiety, hence heart rate cannot be used to index anxiety. Moreover, anxiety cannot be described along a single dimension of arousal.

Dental radiology. Role of plain radiographic examination.

When a patient presents to a dental office, the imaging modality selected by the dentist is determined by the clinical examination and symptoms. Pain, swelling, or paresthesia usually results in a screening panoramic radiograph. Once a suspicious area is detected, other plain films can be used to provide greater detail. Caries and its sequela and periodontal disease and the surrounding tissues can best be evaluated by intraoral images. In general, today's general dental practice delivers a wide range of preventative and restorative treatments demanding maximum diagnostic information. This can only be accomplished by the dentist having knowledge of the various types of projections that can provide an aid to diagnosis.

Dental students' attitude to gender roles.

This investigation assessed attitudes held by United States women and men dental students toward professional and sex role concepts. The concepts included: female dental student, male dental student, dentist, adult woman, adult man, wife and husband. These attitudes were evaluated and compared in the context of the students' current and future professional roles and their sex roles. Although there were several differences in attitudes between the two subject groups, the results suggest that the women and men dental students viewed their various roles as consistent with one another. It is particularly important to note that the women dental student is viewed by both gender groups as having professional and sex roles which do not conflict.

Alzheimer's disease as a cause of death in the United States.

OBJECTIVE: To describe the scope of mortality from and trends in Alzheimer's disease, to show how Alzheimer's disease ranks as a leading cause of death, to describe a methodological change regarding ranking, and to discuss issues related to the reporting of Alzheimer's disease on death certificates. METHODS: The authors analyzed mortality data from the National Vital Statistics System. RESULTS: Alzheimer's disease has increasingly been reported as a cause of death on death certificates in the United States; however, this increase may represent a variety of factors including improved diagnosis and awareness of the disease or changes in the perception of Alzheimer's disease as a cause of death. In 1995, Alzheimer's disease was identified as the underlying cause of 20,606 deaths. Overall, Alzheimer's disease was the 14th leading cause of death in 1995; for people 65 years of age or older, it was the 8th leading cause of death. Both death rates and cause-of-death ranking differed by selected demographic variables. CONCLUSIONS: In recognition of the importance of the condition as a major public health problem, Alzheimer's disease was added to the list of causes eligible to be ranked as leading causes of death in the United States beginning with mortality data for 1994. Several issues need to be kept in mind in interpreting mortality data on Alzheimer's disease, including how diagnoses are made, how the condition is classified, and the purpose of death certificates.

Attitudes toward women dental students among male dental students and male dental faculty members.

The results of this study support the following conclusions: 1. Male dental faculty and male dental students have similar perceptions of women enrolled in dental school. 2. Male dental faculty and male dental students rate women dental students high on the evaluative and activity scales of the semantic differential but relatively low in potency measures. 3. Male dental faculty and male dental students perceive women dental students as different from both the sex role of women and the professional role of dentist.

Variant HeLa cells selected for their resistance to ouabain.

The cardiac glyoside, ouabain, normally kills HeLa cells at concentrations of about 10-7 M or greater. By treating a population of HeLa cells with increasingly higher concentrations of the drug, a vaiant population was obtained of HeLa cells capable of growing in medium containing 10-4 M ouabain. Inhibition of volume regulation of cells subjected to hypotonic shock was used as a measure of inhibition of active transport of Na across the plasma membrane. In that way of dose-response curves for the rapid effects of ouabain and other inhibitors of active Na transport were obtained with both the original, ouabain-sensitive (OS) and the variant, ouabain-resistant (OR) cells. Three other cardiac glycosides (digoxin, digtoxin and hellebrin) and two aglycones (digitoxigenin and strophanthidin) were found to be equally as effective as ouabain in inhibiting volume regulation of the OS cells; the concentration whichproduced half-maximum inhibition, I(max/2), was about 6X 10-7 M in each case. Similar inhibition of the OR population by ouabain was observed only when the concentration exceeded 10-4 M [I(max/2-2.5 X 10-4 M], and the other steroid compounds had no effect on the variant cells at the highest concentrations tested (-2 X 10-5 M). OR and OS cells different also in their sensitivities to its cardoactive erythrophleum alkaloid, coumingine; I(max/2) for OS and OR cells was 5 X 10-8 M and 6 X 10-7 M, respectively. These results in addition to results of ouabain binding experiments and measurements of the rates of reversal of inhibition of volume regulation, suggest that a major reason for the differential sensitivities of the two phenotypes to these drugs is different affinities of their sodium pumps for inhibitors of active transport.

Death data as input to policy-making.

United States and international mortality statistics are analyzed for various applications because of their importance for identifying and monitoring health problems, developing programs for disease prevention and health promotion, and for portraying trends and patterns. Since public and corporate policy is significantly affected by vital statistics data, the quality of the information on the death certificate should be as accurate and complete as possible.