Why do pregnant women die? A review of maternal deaths from 1990 to 2010 at the University of Alabama at Birmingham.

BACKGROUND: The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009. Compared to Caucasian women, African American women were nearly 4 times as likely to die from childbirth. To better understand the reason for this trend, we conducted a case-control study at University of Alabama at Birmingham (UAB) Hospital. Our primary study hypothesis was that women who died at UAB were more likely to be African American than women in a control group who delivered an infant at UAB and did not die. We expected to find a difference in race proportions and other patient characteristics that would further help to elucidate the cause of a racial disparity in maternal deaths. METHODS: We reviewed all maternal deaths (cases) at UAB Hospital from January 1990 through December 2010 identified based on electronic uniform billing data and ICD-9 codes. Each maternal death was matched 2:1 with women who delivered at a time that most closely coincided with the time of the maternal death in 2-step selection process (electronic identification and manual confirmation). Maternal variables obtained were comorbidities, duration of hospital stay, cause of death, race, distance from home to hospital, income, prenatal care, body mass index, parity, insurance type, mode of delivery, and marital status. The strength of univariate associations of maternal variables and case/control status was calculated. The association of case/control status and race was also examined after controlling for residential distance from the hospital. RESULTS: There was insufficient evidence to suggest racial disparity in maternal death. The proportion of African American women was 57% (42 of 77) in the maternal death group and 61% (94 of 154) in the control group (P = 0.23). The univariate odds ratio for maternal death for African American to Caucasian race was 0.66 (95% confidence interval [CI], 0.37-1.19); the adjusted odds ratio was 1.46 (95% CI, 0.73-3.01). Longer compared with shorter distance of residence to the hospital was a highly significant predictor (P < 0.001) of maternal death. CONCLUSIONS: We did not observe a racial disparity in maternal deaths at UAB Hospital. We suggest that the next step toward understanding racial differences in maternal deaths reported in the United States should be directed at the health care delivery outside the tertiary care hospital setting, particularly at eliminating access barriers to health care for all women.

An improved impact technique for monitoring percutaneous implant integrity.

PURPOSE: The purpose of this study was to investigate the validity of the current Periotest system when measuring implant systems and to present a new system to monitor implant interface integrity. MATERIALS AND METHODS: The new system records an impact accelerometer signal and utilizes software for data analysis to determine the resonance frequency of an implant-abutment system. The new system uses the handpiece from the Periotest to acquire an impact signal but makes no use of the rest of the device. Tests were completed to determine the repeatability of the new system along with the effects clinical variables such as abutment torque, angulation of the handpiece, striking height, and distance handpiece is held from the abutment have on the measurement results. Accuracy of the current Periotest method as well as the new system was independently evaluated through the use of an abutment with a strain gauge attached. RESULTS: The new system for impact testing is shown to have greater accuracy than that of the Periotest device. Additionally, the effects of handpiece distance from abutment and torque (when above 15 Ncm) were found to be negligible while angulation of the handpiece and striking height affected the resonance frequency of the new system. CONCLUSION: The results of the in vitro testing indicate that greater resolution and accuracy can be achieved from an impact test that utilizes a clinical measurement protocol and independent analysis of the impact accelerometer signal.

Effects of applied contact force and volume control setting on output force levels of the BAHA Softband.

The BAHA Softband has been developed to provide a transcutaneous anchor for a BAHA until a child is a surgical candidate for the percutaneous BAHA implant. We tested the objective output force level of the BAHA Classic 300 and Compact connected to a Softband on an artificial mastoid to determine: (1) the effects of direct contact force on output force levels (dB); and (2) the required volume control setting to ensure audibility of speech (assuming an average adult reference equivalent threshold force level). Direct contact force was varied from 2 to 5 N in 1 N steps. Output force level increased with increasing contact force. However, the average increase was 3 dB or lower, suggesting that the contact force is of minor importance. Volume control setting appears to be of much greater importance. It is suggested that the volume setting of either device be set to at least 2.5 to ensure audibility of conversational speech. Data from normal-hearing adults with simulated conductive hearing losses are presented to validate this conclusion.