Problems in determination of skeletal lead burden in archaeological samples: an example from the First African Baptist Church population.

Human bone lead content has been demonstrated to be related to socioeconomic status, occupation and other social and environmental correlates. Skeletal tissue samples from 135 individuals from an early nineteenth century Philadelphia cemetery (First African Baptist Church) were studied by electrothermal atomic absorption spectrometry and X-ray fluorescence for lead content. High bone lead levels led to investigation of possible diagenetic effects. These were investigated by several different approaches including distribution of lead within bone by X-ray fluorescence, histological preservation, soil lead concentration and acidity as well as location and depth of burial. Bone lead levels were very high in children, exceeding those of the adult population that were buried in the cemetery, and also those of present day adults. The antemortem age-related increase in bone lead, reported in other studies, was not evidenced in this population. Lead was evenly deposited in areas of taphonomic bone destruction. Synchrotron X-ray fluorescence studies revealed no consistent pattern of lead microdistribution within the bone. Our conclusions are that postmortem diagenesis of lead ion has penetrated these archaeological bones to a degree that makes their original bone lead content irretrievable by any known method. Increased bone porosity is most likely responsible for the very high levels of lead found in bones of newborns and children.

Duration or disadvantage? Exploring nativity, ethnicity, and health in midlife.

OBJECTIVES: This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage). METHODS: The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals. RESULTS: The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation. DISCUSSION: These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity.

Nativity and older women's health: constructed reliance in the health and retirement study.

Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women's physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.

Aggressive perinatal care for high-order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?

OBJECTIVE: The purpose of this study was to determine the factors that must be considered for appropriate counseling of patients with high-order multiple gestations. STUDY DESIGN: A retrospective chart review was carried out from all high-order multiple gestations that were managed by a single perinatology group from February 1993-June 1998. Twin pregnancies that did not result from fetal reduction procedures were used as a control group. RESULTS: Clinical outcome data were analyzed from 9 quadruplet, 25 triplet, 19 reduced twin, and 24 nonreduced twin pregnancies. Women with quadruplet pregnancies were admitted more frequently at an early gestational age, the infants were delivered earlier, and the maternal and neonatal hospital days were longer than for triplet and reduced and nonreduced twin gestations. Triplet pregnancies had an earlier gestational age at delivery (32.3 vs 34.2 weeks), a higher incidence of preterm labor (87% vs 68%), and a higher percentage of neonatal intensive care unit admissions (94% vs 59%) than reduced twin gestations. Reduced twins were hospitalized longer (16.4 vs 9.8 days), were delivered earlier (34.2 vs 36.2 weeks), had a higher incidence of preterm labor (68% vs 29%), and had a greater percentage of neonatal intensive care unit admissions (59% vs 21%), a greater percentage of birth weight <1500 g, and a greater frequency of respiratory distress syndrome (16% vs 2%) than nonreduced twins. There was no difference in neonatal survival and neurologic morbidity when all groups were compared. CONCLUSION: Although early delivery and prolonged (maternal and neonatal) hospitalization were common with quadruplets and triplets, maternal and neonatal outcomes were excellent. The decision for reduction from triplets to twins may not necessarily change pregnancy outcome but should still be discussed as an option for the parents. Continued efforts need to be made to reduce the overall number of iatrogenic high-order multiple gestations.

Age at migration and family dependency among older Mexican immigrants: recent evidence from the Mexican American EPESE.

This study employs new data on Mexican-origin individuals aged 65 and older in the Southwestern United States to examine the impact of the age at which an individual immigrated to the United States on his or her sources of income and living arrangements. The data reveal that, in general, those who immigrated after the age of 50 are more dependent on their families than the native born or those who immigrated earlier in life. Although our findings must be interpreted cautiously because of small cell sizes, those who immigrated later in life are found to be less likely than the native born or those who immigrated earlier to have private pensions and Social Security income. They are also more likely to be living with their children and to be receiving money from them. We discuss the implications of recent restrictions on the eligibility of even legal immigrants for Supplemental Security Income on intergenerational relations and on the potential burden placed on the older immigrant's family, many of which may be seriously strained in hard economic times.

Transabdominal intra-amniotic endoscopic assessment of previable premature rupture of membranes.

OBJECTIVE: Our purpose was to describe the endoscopic characteristics of the site of rupture in vivo in patients with spontaneous premature rupture of membranes. STUDY DESIGN: Patients with preterm premature rupture of membranes between 16 and 26 weeks of gestation, without evidence of intra-amniotic infection, and with a normal karyotype underwent transabdominal endoscopic examination of the amniotic cavity. Subsequently, an amniopatch of a combination of platelets and cryoprecipitate to seal the membrane defect was administered. The study was approved by the Institutional Review Board of St. Joseph's Hospital in Tampa, Florida, and all patients gave written informed consent. RESULTS: Four patients underwent endoscopic examination and amniopatch administration; three had spontaneous preterm premature rupture of membranes, and in the other the membranes ruptured after an early amniocentesis. The location of the site of rupture was over the internal os in the 3 cases with spontaneous preterm premature rupture of membranes. This area was normal in the patient with iatrogenic preterm premature rupture of membranes. The longer the time between preterm premature rupture of membranes and fetoscopy, the larger and less defined was the site of rupture. The amniopatch restored amniotic integrity for a maximum of 72 hours. CONCLUSIONS: This is the first in vivo endoscopic visualization of the site of spontaneous rupture of membranes from within the uterine cavity. The defect is located over the internal cervical os in patients with spontaneous preterm premature rupture of membranes. There appear to be time-related changes in the morphologic characteristics of the site of rupture. Endoscopic visualization of the site of rupture has the potential for improving our understanding of spontaneous preterm premature rupture of membranes and in the development of possible therapeutic alternatives.

In utero lysis of amniotic bands.

Amniotic band syndrome is a sporadic condition that occurs in approximately 1:1200 to 1:15,000 live births and that may result in amputations, constrictions and other deformities of the fetus. Although some cases present with congenital anomalies that are beyond surgical repair, a selected group of fetuses may show isolated limb constriction. It has been speculated that, without treatment, amputation or severe dysfunction of the limb may occur. Despite these potential complications, surgical treatment for this selected group of fetuses has not been previously performed. We report two cases that were successfully treated using novel minimally invasive surgical techniques. The cases involved fetuses with amniotic band syndrome with associated limb constriction in which the amniotic band was surgically interrupted to avoid spontaneous amputation of the extremity. Adequate blood flow distal to the obstruction was preserved and significant functional improvement of the extremity occurred in both cases, preserving the limbs. These cases represent the first prenatal surgical intervention successfully used to treat constricting amniotic bands in humans. In addition, these cases represent the first time that a non-lethal fetal entity has been surgically treated in utero. The results of this innovative therapy will encourage the efforts to continue developing minimally invasive techniques for the correction of birth defects.

Nativity, declining health, and preferences in living arrangements among elderly Mexican Americans: implications for long-term care.

This study employs data from the 1993-94 Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE) to assess the impact of nativity on preferences in living arrangements for a sample of 3,046 Mexican American individuals over the age of 65. Our results reveal great differences between the native and foreign-born in their desire to live with their children. A larger fraction of the foreign-born than native-born currently live with their children and state that they would care to continue living with their children in the event that they could no longer care for themselves. The data also reveal that the foreign-born face more serious economic constraints than the native-born and suggest that living with children may be motivated in part by economic need. We end by speculating on the implications of these findings for community-based care for elderly Mexican Americans.

The extent of private and public health insurance coverage among adult Hispanics.

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

Physical comorbidity and medical care use in children with emotional problems.

As family disruption, violence, and the decline of community become more common, an ever-growing number of children are exposed to psychological and social stressors that can lead to serious emotional problems. For many children emotional problems can interfere with normal psychological and social development and can have serious long-term effects. In this study data from a large national survey are used to examine patterns of emotional and physical comorbidity and the uses of general medical and mental health services by children ages 4 to 11. Results indicate that emotional problems are common among children with physical illnesses and that emotional problems increase general medical care use. Emotional problems are clearly exacerbated by factors associated with poverty. The data also show that a larger proportion of children in single-parent than in two-parent families experience emotional problems and use mental health services. We discuss the implications of these findings for general pediatric practice.

Motive and the geographic mobility of very old Americans.

The proposition that motives for migration are important in explaining geographic mobility of very old persons was explored in this study. Data from the biennial 1984 through 1990 rounds of the Longitudinal Study on Aging were used to predict the move/not-move behavior of a nationally representative sample of noninstitutionalized respondents aged 70 years and over in 1984. Six motives for elderly migration were identified: health, affiliation, economic security, comfort, functional independence, and getting on with life after family crisis. When incorporated within this motivational framework, reason-for-move data showed that health was not the dominant motive; responses were divided among the five other motive categories. The logistic regression analysis showed that increasing disability was positively related to mobility for respondents in only one of six motive categories. The results suggest that a motive-for-migration perspective broadens the debate on types of, and explanations for, migration behavior of noninstitutionalized very old Americans.

Elective cesarean hysterectomy for treatment of cervical neoplasia. An update.

From January 1, 1979, to March 31, 1991, 37 patients underwent elective cesarean hysterectomy for early cervical neoplasia. Thirty-four patients had cervical intraepithelial neoplasia III, and three patients had stage IA-1 squamous cell carcinoma of the cervix. Twenty-eight were primary cesarean sections; nine had obstetric indications. The mean operative time was 128 minutes; mean estimated blood loss was 1,400 mL. One patient experienced an intraoperative hemorrhage (3,500 mL). There were no other recognized intraoperative complications. Four significant postoperative complications included a vaginal cuff abscess, a wound dehiscence and pelvic abscess, one patient with febrile morbidity and an ileus and ligation with partial transection of a ureter. Patients were discharged on a mean of postoperative day 5.7. Although significant complications occurred, we believe that the noncompliant nature of our patient population justifies elective cesarean hysterectomy for treatment of cervical neoplasia.

Age at migration, social connections, and well-being among elderly Hispanics.

This study employs data from the 1988 National Survey of Hispanic Elderly People to examine the impact of age at migration and social contacts on the self-assessed health, functional disability, and life satisfaction of elderly Cuban Americans, Mexican Americans, and Puerto Ricans in the United States. The results indicate that the difficulties associated with immigration late in life undermine an older person's morale and interfere with the ability to perform basic activities of daily living. Although children are important sources of social support for all Hispanic groups, our findings also reveal important group differences in the use of other community social resources and their impact on health. Older Cuban Americans, in particular, appear to benefit from residence in ethnic enclaves in which they have largely duplicated their culture of origin.

Patterns of illicit drug use at the time of labor in a private and public hospital.

The majority of prevalence data on perinatal substance abuse describe low socioeconomic patient populations. This study of illicit drug use at the time of labor was done to identify patterns of drug use in both private and nonprivate patients. Anonymous urine samples were collected from 1000 patients, 500 admitted in labor to a private hospital and 500 admitted to a public hospital. All samples were screened for cocaine, opiates, cannabinoids, and amphetamines. A positive result of screening for any drug was detected in 8.2% of patients. More positive results of screening for any drug were found in nonprivate patients (11.4%) than private patients (5%), with nonprivate patients significantly more likely to test positive for cocaine or cannabinoids or both. Black patients contributed 64.5% of the positive tests for cocaine, significantly more than white (17.6%) or Hispanic patients (17.6%), whereas white patients contributed significantly more positive tests for cannabinoids (85%) than black (5.4%) or Hispanic patients (7.1%). Assessment of patterns of perinatal drug use in communities will support appropriate allocation of resources and targeting of patient and provider education.

Six-month carbohydrate metabolism studies in women using oral contraceptives containing gestodene and ethinyl estradiol.

Twenty-five women had their carbohydrate metabolism prospectively evaluated during the six months that they used a gestodene and ethinyl estradiol monophasic oral contraceptive. Serum glucose and insulin levels were measured during a 75-gram three-hour oral glucose tolerance test. At the six-month test, the three-hour glucose and the fasting and three-hour insulin values were significantly elevated. The literature on carbohydrate metabolism during gestodene oral contraceptive use is also reviewed.

PIP: The effects of combination-type oral contraceptives (OCs) (containing 75 mcg of the progestin gestodene and 30 mcg of ethinyl estradiol [EE] on carbohydrate metabolism during 6 months of use was evaluated in 25 women with a mean age of 26.1 +or- 1.1 years, parity of .7 +or- .1, and mean control weight of 143.5 +or- 6.1 pounds. An oral glucose tolerance test was performed after a 10-hour fast and a venous blood sample was taken. After drinking 75 g of glucose, repeat blood samples were drawn. After 6 cycles of OC use each subject was given another oral glucose tolerance test. The mean weight was 144.2 +or- 6.2 pounds. No complications and pregnancies occurred. The serum glucose 3-hour value was significantly elevated at the 6-month test. Also, significant increase of the fasting and 3-hour values of insulin were found. The results suggest that gestodene is capable of altering carbohydrate metabolism via its androgen receptor activity. Triphasic preparations (1650 mcg of gestodene and 680 mcg of EE) have a similar effect on carbohydrate metabolism as do monophasic pills (1575 mcg of gestodene and 630 mcg of EE) because of similar total steroid dose. OCs containing low-dose gestodene may alter carbohydrate metabolism to some extent but the longterm effects require further investigation as such new OCs have not been proved to be superior to existing formulations.

Carbohydrate metabolism after three months of using a gestodene-containing monophasic oral contraceptive.

Carbohydrate metabolism was prospectively evaluated in twenty-one normal women prior to and during their use for three months of a monophasic oral contraceptive containing the progestin gestodene plus ethinyl estradiol. The women had a three-hour oral glucose tolerance test using a 75 gram glucose load, measuring serum glucose and insulin levels. The results demonstrate no significant changes in either of the carbohydrate metabolic indices between the two tests. These data support the safety of this new progestin-containing contraceptive.