Medical vs. Surgical treatment of ectopic pregnancy. The University of New Mexico's six-year experience.

OBJECTIVE: To review and compare the treatments for ectopic pregnancy in a university setting serving an indigent population. STUDY DESIGN: Charts assigned an ICD-9 code for ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed for presenting symptoms, hCG levels, ultrasound findings, treatment modality and need for subsequent treatment. RESULTS: Of 401 patients treated for ectopic pregnancy, 7 were managed expectantly. One hundred nineteen (30%) patients received methotrexate. Seventy percent (83/119) of these ectopic pregnancies resolved with a single dose and an additional 11 after a second dose, for a 79% overall success rate. Twenty-five patients (21%) failed methotrexate therapy and required surgical treatment, and 11 (9%) pregnancies were ruptured. Primary treatment was surgical in 275 (69%) patients: 172 (63%) underwent laparoscopy and 103 (37%) laparotomy. Primary laparoscopic treatment was successful in 90%. Success rates were significantly lower for medical therapy as compared to laparoscopic treatment (79% vs. 90%, odds ratio 2.2, 95% confidence interval 1.1, 4.3; P = .02). No discriminating predictors of successful treatment with methotrexate were identified. CONCLUSION: The success rate of methotrexate therapy for ectopic pregnancy was lower than that of surgical management in a university setting serving an indigent population.

Using surname data in U.S. Puerto Rican mortality analysis.

Evidence suggests that among mainland-born decedents. Hispanic (particularly Puerto Rican) origin may have been underreported in states that have added an ancestry item to their death certificates. This study uses the 1980 Census Bureau Spanish-surname list to code surnames on New York City death certificates. By examining the correspondence between surname type and the response to the ancestry item, we identify potential underreporting of Hispanic ethnicity for Spanish-surnamed decedents. A surname-based method then is used to adjust mortality data for mainland-born Puerto Rican decedents.

Life expectancy in less developed countries: socioeconomic development or public health?

Various studies have enquired into the influence of socioeconomic development or public health measures on life expectancies in less developed countries. Analysis of the effect of these two groups of factors upon life expectancy, using data for 95 less developed countries, indicates that mortality is primarily influenced by such socioeconomic development measures as urbanization, industrialization, and education, and secondarily by such public health measures as access to safe water, physicians, and adequate nutrition.

PIP: Using data collected from 5 major sources on life expectancy and the variables affecting it for 95 less developed countries (LDCs), the researchers examine life expectancies against some of Goldscheider's indicators of modernization: 1) percentage of population living in urban areas, 2) percentage of population engaged in agriculture, 3) percentage of population that is literate, 4) percentage of population with access to safe water, 5) mean daily caloric intake per head, and 6) population per physician. Results show that percentage of population in agriculture is the most highly correlated variable with life expectancy, followed by literacy, and safe water. Using standard multiple regression, the authors found that altogether, those variables explain 79% of the variation in life expectancy. The variables contributing the most to the variance in life expectancy are 2 of the socioeconomic variables--literacy and percentage of population in agriculture, suggesting that socioeconomic conditions have a greater influence on life expectancy than health conditions. Using a socioeconomic index (composed of urban, literacy, and industries other than agriculture) and a health conditions index (composed of safe water, calorie intake, and number of physicians per 100,000 population), clearly showed the importance of socioeconomic development over health variables. Urbanization is less influential with regard to life expectancy than was anticipated, perhaps because of unhealthy conditions in LDC cities. More emphasis should be placed upon education, since increasing literacy may eliminate more factors associated with malnutrition and disease than further importation of public health measures.