Factors affecting prenatal care use and pregnancy outcome in Texas: A comparative study among and within Black, Anglo, and Hispanic populations

This research project is a study in the field of public health to test the relationships of demographic, socioeconomic, behavioral, and biological factors with (1) prenatal care use and (2) pregnancy outcome, measured by birth weight. It has been postulated that demographic, socioeconomic, and behavioral factors are associated with differences in the use of prenatal care services. It has also been postulated that differences in demographic, socioeconomic, behavioral, and biological factors result in differences in birth weight. This research attempts to test these two basic conceptual frameworks. At the same time, an attempt is made to determine the population groups and subgroups that are at increased risk (1) of using fewer prenatal care visits, and (2) of displaying a higher incidence of low birth weight babies. An understanding of these relationships of the demographic, socioeconomic, behavioral, and biological factors in the use of prenatal care visits and pregnancy outcome, measured by birth weight, will potentially offer guidance in the planning and policy development of maternal and child health services. The research considers four major components of maternal characteristics: (1) Demographic factors. Ethnicity, household size, maternal parity, and maternal age; (2) Socioeconomic factors. Maternal education, family income, maternal employment, health insurance coverage, and household dwelling; (3) Behavioral factors. Maternal smoking, attendance at child development classes, mother's first prenatal care visit, total number of prenatal care visits, and adequacy of care; and, (4) Biological factors. Maternal weight gain during pregnancy.^ The research considers 16 independent variables and two dependent variables.^ It was concluded that: (1) Generally, differences in demographic, socioeconomic, and behavioral factors were associated with differences in the average number of prenatal care visits between and within population groups and subgroups. The Hispanic mothers were the lowest users of prenatal care services. (2) In some cases, differences in demographic, socioeconomic, behavioral, and biological factors demonstrated differences in the average birth weight of infants between and within population groups and subgroups. (3) Differences in demographic, socioeconomic, behavioral, and biological factors resulted in differences in the rates of low birth weight babies between and within population groups and subgroups. The Black mothers delivered the highest incidence of low birth weight infants.^ These findings could provide guidance in the formulation of public health policies such as MCH services, an increase in the use of prenatal care services by prospective mothers, resulting in reduction of the incidence of low birth weight babies, and consequently aid in reducing the rates of infant mortality. ^

OUT-OF-HOSPITAL CHILDBEARING CENTERS IN THE UNITED STATES: A DESCRIPTIVE STUDY OF THE DEMOGRAPHIC AND MEDICAL-OBSTETRIC CHARACTERISTICS OF WOMEN BEGINNING LABOR THEREIN 1972-1979

There is currently much interest in the appropriate use of obstetrical technology, cost containment and meeting consumers' needs for safe and satisfying maternity care. At the same time, there has been an increase in professionally unattended home births. In response, a new type of service, the out-of-hospital childbearing center (CBC) has been developed which is administratively and structurally separate from the hospital. In the CBC, maternity care is provided by certified nurse-midwives to carefully screened low risk childbearing families in conjunction with physician and hospital back-up.^ It was the purpose of this study to accomplish the following objectives: (1) To describe in a historical prospective study the demographic and medical-obstetric characteristics of patients laboring in eleven selected out-of-hospital childbearing centers in the United States from May 1, 1972, to December 15, 1979. Labor is defined as the onset of regular contractions as determined by the patient. (2) To describe any differences between those patients who require transfer to a back-up hospital and those who do not. (3) To describe administrative and service characteristics of eleven selected out-of-hospital childbearing centers in the United States. (4) To compare the demographic and medical-obstetric characteristics of women laboring in eleven selected out-of-hospital childbearing centers with a national sample of women of similar obstetric risk who according to birth certificates delivered legitimate infants in a hospital setting in the United States in 1972.^ Research concerning CBCs and supportive to the development of CBCs including studies which identified factors associated with fetal and perinatal morbidity and mortality, obstetrical risk screening, and the progress of technological development in obstetrics were reviewed. Information concerning the organization and delivery of care at each selected CBC was also collected and analyzed.^ A stratified, systematic sample of 1938 low risk women who began labor in a selected CBC were included in the study. These women were not unlike those described previously in small single center studies reported in the literature. The mean age was 25 years. Sixty-three per cent were white, 34 per cent Hispanic, 88 per cent married, 45 per cent had completed at least two years of college, nearly one-third were professionals and over a third were housewives. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of school.) UMI ^

Maternal mortality in Texas 2001--2006

Background. Maternal mortality is often used as a measure of health and well being of women across the globe. Improved surveillance efforts at the state level can improve maternal mortality estimates and develop strategies to address the needs of maternal and child health populations. The aims of this study are (1) To provide better estimates of maternal mortality in Texas; (2) To better understand the origin, governance, function, sustainability and impact on policy and practice of maternal mortality review committees at the state level; and (3) To create a comprehensive implementation model for a statewide maternal mortality review committee.^ Methods. AIM I: Analyzed the enhanced surveillance of fetal death and live birth records linked to pregnancy-related and women of childbearing age (15-44 years) deaths records in Texas from 2001-2006. AIM II: Conduct semi-structured telephone interviews of key informants from states with active maternal mortality review committees. AIM III: Develop a comprehensive maternal mortality review committee implementation model for Texas from the results of AIMS I and II. ^ Results. AIM I: Enhanced surveillance methods identified almost 3.5 times more deaths that may be associated with pregnancy than standard methods. The leading cause of pregnancy-associated death from 2001-2006 among all causes, was accidents. The estimated pregnancy-associated mortality ratio for 2001-2006 was 31 maternal deaths per 100,000 live births. Enhanced surveillance confirmed a persistent race/ethnicity trend in maternal mortality. AIM II: Key informant interviews confirmed existing literature on maternal mortality review committees. Sustainability was maintained not only by the funding; but also by the dedication of committee members to conducting reviews and disseminating recommendations to improving quality of care and systems. All statewide committees examined preventability of deaths and provided recommendations to policymakers and stakeholders. Statewide committees also took the initiative to develop and implement programs to align healthcare systems and improve quality of care.^ Conclusion. The comprehensive implementation model for a statewide maternal mortality review committee has the potential to transform the knowledge learned from enhanced surveillance into a systematic effort to evaluate the circumstances surrounding a pregnancy-associated death; influencing policy and practice decisions addressing maternal mortality, women’s health and maternal and child health in Texas.^

Teacher support and encouragement in the classroom and its impact on childhood obesity

Objectives. Obesity is a growing problem in the United States among children. Great efforts are being made to target this problem, both at home and at school. While parents and peers have proven an effective means of distributing information, the well of the influence of teacher encouragement of health behaviors remains untapped. The purpose of this study is to assess the association of teacher encouragement with diet and physical activity behaviors and obesity in a sample of eighth grade students in central Texas. ^ Methods. In the spring of 2011, the Coordinated Approach to Child Health (CATCH) study distributed teacher surveys to each of the teachers in the schools on the grant. In addition to questions concerning the implementation of CATCH, this survey employed social support questions to gauge the prevalence of teacher encouragement of health behaviors in the classroom. During the same time frame, eighth graders in these same schools completed student surveys which assessed dietary and physical activity knowledge and behaviors and demographics and participated in objective measures of student height and weight. A cross-sectional secondary data analysis was conducted in order to compare self-reported teacher encouragement to student behaviors and several student obesity measures on a by school basis. ^ Results. 1150 teachers and 2582 students from 29 of the 30 measurement schools returned completed surveys. No statistically significant relationship was found between the six teacher encouragement measures and their corresponding student reported health behaviors, nor was one found the mean support per school and child percent overweight. A menial positive relationship was found between the mean support per school and child BMI z-scores, BMI, and percent obese (p = 0.035, 0.003 and 0.003, respectively); however, these relationships were not in the predicted direction. ^ Conclusion. While the findings of this investigation show primarily null results, motivating questions as to the impact to teacher encouragement on middle school student's health remain. It is possible that in order to draw more effective conclusions, more comprehensive studies are warranted which specifically target these relationships.^

Commercial Sexual Exploitation and Missing Children in the Coastal Region of Sao Paulo State, Brazil

The commercial sexual exploitation of children (CSEC) has emerged as one of the world’s most heinous crimes. The problem affects millions of children worldwide and no country or community is fully immune from its effects. This paper reports first generation research of the relationship that exists between CSEC and the phenomenon of missing children living in and around the coastal regions of the state of Sao Paulo, Brazil, the country’s richest State. Data are reported from interviews and case records of 64 children and adolescents, who were receiving care through a major youth serving non-governmental organization (NGO) located in the coastal city of Sao Vicente. Also, data about missing children and adolescents were collected from Police Reports – a total of 858 Police Reports. In Brazil, prostitution is not a crime itself, however, the exploitation of prostitution is a crime. Therefore, the police have no information about children or adolescents in this situation, they only have information about the clients and exploiters. Thus, this investigation sought to accomplish two objectives: 1) to establish the relationship between missing and sexual exploited children; and 2) to sensitize police and child-serving authorities in both the governmental and nongovernmental sectors to the nature, extent, and seriousness of many unrecognized cases of CSEC and missing children that come to their attention. The observed results indicated that the missing children police report are significantly underestimated. They do not represent the number of children that run away and/or are involved in commercial sexual exploitation.

For Safety’s Sake: A Case Study of School Security Efforts and Their Impact on Education Reform

Several studies have shown that the need to create safe and orderly schools has increasingly been addressed in a manner that disconnects these priorities from broader concerns related to student success, school culture, and child development. In this paper, we explore the consequences of expanding security procedures in response to an incident involving interracial conflict at an urban high school in the United States. We offer this case study to demonstrate how the primacy placed on safety and security resulted in the neglect of other important educational goals, such as academic engagement and a positive school culture. Through an analysis of observational, interview, focus group, and survey data, we show that while it is essential for schools to take measures that ensure the safety of students and staff, it is equally important for safety to be recognized as part of a larger set of goals that schools must concurrently pursue in order to meet the educational and developmental needs of the students they serve.

Chamber evaluation of a personal organic vapor dosimeter at ppb concentrations of VOCs, varying temperatures and humidities with 24 -hour exposures

An exposure system was constructed to evaluate the performance of a personal organic vapor dosimeter (3520 OVM) at ppb concentrations of nine selected target volatile organic compounds (VOCs). These concentration levels are generally encountered in community air environments, both indoor and outdoor. It was demonstrated that the chamber system could provide closely-controlled conditions of VOC concentrations, temperature and relative humidity (RH) required for the experiments. The target experimental conditions included combinations of three VOC concentrations (10, 20 and 200 $\rm\mu g/m\sp3),$ three temperatures (10, 25 and 40$\sp\circ$C) and three RHs (12, 50 and 90% RH), leading to a total of 27 exposure conditions. No backgrounds of target VOCs were found in the exposure chamber system. In the exposure chamber, the variation of the temperature was controlled within $\pm$1$\sp\circ$C, and the variation of RH was controlled within $\pm$1.5% at 12% RH, $\pm$2% at 50% RH and $\pm$3% at 90% RH. High-emission permeation tubes were utilized to generate the target VOCs. Various patterns of the permeation rates were observed over time. The lifetimes and permeation rates of the tubes differed by compound, length of the tube and manufacturer. By carefully selecting the source and length of the tubes, and closely monitoring tube weight loss over time, the permeation tubes can be used for delivering low and stable concentrations of VOCs during multiple days.^ The results of this study indicate that the performance of the 3520 OVM is compound-specific and depends on concentration, temperature and humidity. With the exception of 1,3-butadiene under most conditions, and styrene and methylene chloride at very high relative humidities, recoveries were generally within $\pm$25% of theory, indicating that the 3520 OVM can be effectively used over the range of concentrations and environmental conditions tested with a 24-hour sampling period. Increasing humidities resulted in increasing negative bias from full recovery. Reverse diffusion conducted at 200 $\rm\mu g/m\sp3$ and five temperature/humidity combinations indicated severe diffusion losses only for 1,3-butadiene, methylene chloride and styrene under increased humidity. Overall, the results of this study do not support the need to employ diffusion samplers with backup sections for the exposure conditions tested. ^

Various ratios of C1-C5 hydrocarbons, gas composition and computed temperature at DSDP Leg 64 Holes

I have evaluated shipboard data and preliminary interpretations related to organic geochemistry in light of additional shore-based analyses. Data on interstitial gas, the C/N ratio, and fluorescence indicate that organic matter was altered by sills and that these were all single intrusions except the upper sill complex at Site 481, which was a multiple emplacement. Site 477 had the highest in situ temperature, estimated from interstitial gas composition to be 225°C.

Vegetation, soil and site characteristics of samples taken along the Yamal Transet in 2007-2008

The overarching goal of the Yamal portion of the Greening of the Arctic project is to examine how the terrain and anthropogenic factors of reindeer herding and resource development combined with the climate variations on the Yamal Peninsula affect the spatial and temporal patterns of vegetation change and how these changes are in turn affecting traditional herding of the indigenous people of the region. The purpose of the expeditions was to collect groundobservations in support of remote sensing studies at four locations along a transect that traverses all the major bioclimate subzones of the Yamal Peninsula. This data report is a summary of information collected during the 2007 and 2008 expeditions. It includes all the information from the 2008 data report (Walker et al. 2008) plus new information collected at Kharasavey in Aug 2008. The locations included in this report are Nadym (northern taiga subzone), Laborovaya (southern tundra = subzone E of the Circumpolar Arctic Vegetation Map (CAVM), Vaskiny Dachi (southern typical tundra = subzone D), and Kharasavey (northern typical tundra = subzone C). Another expedition is planned for summer 2009 to the northernmost site at Belyy Ostrov (Arctic tundra = subzone B). Data are reported from 10 study sites - 2 at Nadym, 2 at Laborovaya, and 3 at Vaskiny Dachi and 3 at Kharasavey. The sites are representative of the zonal soils and vegetation, but also include variation related to substrate (clayey vs. sandy soils). Most of the information was collected along 5 transects at each sample site, 5 permanent vegetation study plots, and 1-2 soil pits at each site. The expedition also established soil and permafrost monitoring sites at each location. This data report includes: (1) background for the project, (2) general descriptions and photographs of each locality and sample site, (3) maps of the sites, study plots, and transects at each location, (4) summary of sampling methods used, (5) tabular summaries of the vegetation data (species lists, estimates of cover abundance for each species within vegetation plots, measured percent ground cover of species along transects, site factors for each study plot), (6) summaries of the Normalized Difference Vegetation Index (NDVI) and leaf area index (LAI) along each transect, (7) soil descriptions and photos of the soil pits at each study site, (8) summaries of thaw measurements along each transect, and (9) contact information for each of the participants. One of the primary objectives was to provide the Russian partners with full documentation of the methods so that Russian observers in future years could repeat the observations independently.

Pb isotope and geochemical record of Arctic sediments

Elemental and Pb isotope measurements were performed on leachates and residues from surface sediments and two <50 cm cores (MC04 and MC16) collected along a NE-SW transect through Fram Strait. Geochemical and isotopic properties of residues from surface sediments define three distinct spatial domains within the Strait: 1) the easternmost edge of the Strait; 2) the eastern part of the Strait off the Svalbard margins; and 3) the western part of the Strait, influenced by supplies from Svalbard, the Nordic seas with possible contributions from northwestern Siberian margins, and sea ice and water outflow from the Arctic, respectively. Core MC16, in the third domain beneath the outflowing Arctic waters, spans the Last Glacial Maximum present interval. Sediments from this core were leached to obtain detrital (residues) and exchangeable (leachates) fractions. Detrital supplies to core MC16 are believed to originate mainly from melting of the overlying sea ice and thus can be used to document changes in Arctic sedimentary sources. Detrital 206Pb/204Pb and 208Pb/206Pb ratios illustrate two mixing trends, Trends A and B, corresponding to the pre- and post-Younger Dryas (YD) intervals, respectively. These trends represent binary mixtures with a common end-member (Canadian margins) and either a Siberian (Trend A) or Greenland (Trend B) margin end-member. The YD is marked by an isotopic excursion toward the Canadian end-member, suggesting a very active Beaufort Gyre possibly triggered by massive drainage of the Laurentide ice sheet. Pb isotope compositions of leachates, thought to represent the signature of the overlying water masses, define a unique linear trend coincident with Trend A. This suggests that water masses acquired their signature through exchange with particulate fluxes along the Canadian and Siberian continental margins.

Physiological and biochemical characteristics of polar cod (Boreogadus saida) from Kongsfjorden

Seasonality of biomarker baseline levels were studied in polar cod (Boreogadus saida), caught in Kongsfjorden, Svalbard, in April, July, September and December, 2006-2007. Physiological parameters (condition factor, gonado- and hepato-somatic indexes, energy reserves, potential metabolic activity and antifreeze activity) in polar cod were used to interpret the seasonality of potential biomarkers. The highest levels of ethoxyresorufin-O-deethylase (EROD) activity occurred concomitantly with the highest potential metabolic activity in July due to e.g. intense feeding. During pre-spawning, EROD showed significant inhibition and gender differences. Hence, its potential use in environmental monitoring should imply gender differentiation at least during this period. Glutathione S-transferase and catalase activities were stable from April to September, but changed in December suggesting a link to low biological activity. Knowledge of the biomarker baseline levels and their seasonal trends in polar cod is essential for a trustworthy interpretation of forthcoming toxicity data and environmental monitoring in the Arctic.

Metallic Fluence Monitors and J-value standards

Utilizing the neutron-irradiation parameter J is one of the major uncertainties in 40Ar/39Ar dating. The associated error of the individual J-value for a sample of unknown age depends on the accuracy of the age of the geological standards, the fast-neutron fluence distribution in the reactor and the distances between standards and samples during irradiation. While it is generally assumed that rotating irradiation evens out radial neutron fluence gradients, we observed axial and radial variations of the J-values in sample irradiations in the rotating channels of two reactors. To quantify them, we included three-dimensionally distributed metallic fast- (Ni) and thermal- (Co) neutron fluence monitors in three irradiations and geological age standards in three more. Two irradiations were carried out under Cd-shielding in the FRG1 reactor in Geesthacht, Germany, and four without Cd-shielding in the LVR-15 reactor in Rez, Czech Republic. The 58Ni(nf,p)58Co activation reaction and ?-spectrometry of the 811 keV peak associated with the subsequent decay of 58Co to 58Fe allow to calculate the fast-neutron fluence. The fast-neutron fluences at known positions in the irradiation container correlate with the J-values determined by mass-spectrometric 40Ar/39Ar measurements of the geological age standards. Ra-dial neutron fluence gradients are up to 1.8 %/cm in FRG1 and up to 2.2 %/cm in LVR-15; the corre-sponding axial gradients are up to 5.9 and 2.1 %/cm. We conclude that sample rotation might not al-ways suffice to meet the needs of high-precision dating and gradient monitoring can be crucial.