Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Gender inequities in sexual risks among youth with HIV in Kigali, Rwanda

Understanding the experiences of youth living with HIV (YLH) is necessary for implementing interventions that mitigate HIV transmission. We conducted a survey of sexual behaviours and sources of knowledge among 107 youths aged 16-24 attending two HIV clinics in Kigali, Rwanda. Respondents were 72% women and 28% men, with median age 18 years. Of those sexually active in the past six months, 56% reported inconsistent condom use; 53% of sexually active respondents reported having sexually transmitted infection (STI) symptoms in the past six months. The median age difference between respondent and first sex partner was nine years for women, and 0.5 years for men (P = 0.006). Women more frequently reported being forced to have sex (29% girls versus 6.5% boys, P = 0.011) and exchanging sex for money (66% girls versus. 17% boys, P = 0.033). Strengthening female YLH's financial and material resources may reduce the number of sexual partners, asymmetries within partnerships and risk of HIV transmission.

Effect of sorafenib in symptomatic metastatic medullary thyroid cancer

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Background: RET receptor tyrosin kinase activity plays a major role in medullary thyroid cancer (MTC) tumor growth. Sorafenib is an oral agent that selectively targets RET tyrosine kinases. Methods: 5 patients (pts) with metastatic MTC with excessive elevation of calcitonin(CTN) serum levels entered this pilotstudy. Hypercalcitonemia-related symptoms were present in all pts (3 severe diarrhea, 2 moderate) and metastasis- related symptoms were present in 4 pts (2 severe pain, 2 moderate). All pts had had prior thyreoidectomy and cervical +- mediastinal lymphnode dissection, 4 pts had prior octreotide therapy, 3 prior chemotherapy. Pts received 800 mg or 400 mg (weight < 50 kg) Sorafenib as a starting dose. According to the protocol, the dose was reduced gradually in 200 mg scale when pts revealed therapy induced side effects to avoid worsening of quality of life. Sorafenib has to be administered at least 3 months, the scheduled duration of therapy was 6 months. Physical examination, calcitonin and CEA levels were monitored every 4 weeks, measurable metastatic lesions were controlled by appropriate means 3 and 6 months after starting therapy. Primary objective was to assess the effect on CTN dependent symptoms, second objectives included assessments of tumor response (RECIST) and biochemical response. Results: After 2–3 months CTN decreased to levels >50% of baseline in all pts, to levels >90% in 2 pts. According to that all pts were free of CTN related symptoms after 4 weeks. In 4 pts CEA levels reacted in a similar way. After 6 months controls of metastatic lesions were classified as CR-1 pt, PR-1 pt, NC-3 pts. 2 pts with severe metastasis-related pain were off analgesics after 3 months of treatment. Due to side effects Sorafenib dosage was reduced to 50% of the initial dose in all patients. Interestingly marked TSH - elevations were observed in 3 pts which indicates a direct influence to the hypothalamic-pituary-axis. Conclusion: Sorafenib has to be considered as an effective teatment of symptomatic, metastatic MTC.

No significant financial relationships to disclose.

Taurine-induced synaptic potentiation and the late phase of long-term potentiation are related mechanistically

The application of taurine (2-aminoethanesulfonic acid) induces a long-lasting increase of synaptic efficacy and axon excitability (LLP-TAU) in rat hippocampal CA1 area. After taurine withdrawal, LLP-TAU lasted at least 3 h. This fact prompted us to assess whether the mechanisms involved in the maintenance of this particular potentiation were similar to those implicated in the late phase of long-term potentiation (L-LTP). In the presence of KN-62, an inhibitor of calcium/calmodulin-dependent protein kinase, taurine perfusion (10 mM, 30 min) did not affect the induction of LLP-TAU. However, LLP-TAU maintenance was completely suppressed by KT5720, an inhibitor of the cAMP-dependent protein kinase (PKA). Moreover, the late phase of LLP-TAU was blocked by inhibiting protein synthesis with anisomycin. In addition, taurine perfusion increased the phosphorylation of cAMP response element-binding protein (CREB), although did not affect cAMP levels. These features of LLP-TAU do not appear to be caused by the activation of D1/D5 dopamine receptors, as taurine also induced synaptic potentiation in the presence of SCH23390, an antagonist of this type of receptors. Finally, the late phase of both L-LTP and LLP-TAU occluded mutually. These results suggest that taurine triggers the sequence of some of the molecular events involved in the induction of L-LTP.

A conceptual framework to measure performance of the public health system

OBJECTIVES

This article describes a unifying conceptual framework for the public health system as a way to facilitate the measurement of public health system performance.

METHODS

A conceptual framework for the public health system was developed on the basis of the work of Donabedian and a conceptual model previously developed by Bernard Turnock and Arden Handler.

RESULTS

The conceptual framework consists of 5 components that can be considered in relationship to each other: macro context, mission, structural capacity, processes, and outcomes. Although the availability of measures for each of these components varies, the framework can be used to examine the performance of public health systems as well as that of agencies and programs.

CONCLUSIONS

A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public health system performance.

L-DOPA and glia-conditioned medium have additive effects on tyrosine hydroxylase expression in human catecholamine-rich neuroblastoma NB69 cells

The aim of this study was to investigate the effect of L-DOPA and glia-conditioned medium (GCM) on cell viability, tyrosine hydroxylase (TH) expression, dopamine (DA) metabolism and glutathione (GSH) levels of NB69 cells. L-DOPA (200 microM) induced differentiation of NB69 cells of more than 4 weeks in vitro, as shown by phase-contrast microscopy and TH immunocytochemistry, and decreased replication, as shown by 5-bromodeoxyuridine immunostaining. L-DOPA did not increase the number of necrotic or apoptotic cells, as shown by morphological features, Trypan Blue, lactate dehydrogenase activity, bis-benzimide staining and TUNEL assay. Furthermore, L-DOPA (200 microM) increased Bcl-xL protein expression. Incubation of cells with L-DOPA (50, 100, 200 microM) for 24 h resulted in an increase in TH protein levels (174, 196 and 212% versus control). Neither carbidopa, an inhibitor of L-aromatic amino acid decarboxylase enzyme, nor L-buthionine sulfoximine, which inhibits GSH synthesis, or ascorbic acid, an antioxidant, blocked the L-DOPA-induced effect on TH protein expression. L-DOPA (0, 50, 100 and 200 microM) plus GCM further increased the amount of TH protein (346, 446, 472 and 424%). L-DOPA (200 microM) increased TH protein levels to 132, 191 and 245% of controls after incubation for 24, 48 and 72 h. DA metabolism in NB69 cells was increased in cultures treated with either L-DOPA (200-300 microM) or GCM and these two agents had a synergistic effect on DA metabolism. In addition, L-DOPA (200 microM) or/and GCM-treated cells increased their GSH extracellular levels (223, 257, 300% of controls) after 48 h of treatment. The L-DOPA-induced increase of TH protein expression in NB69 cells was independent of DA production, free radicals and GSH up-regulation.

Building the analytic capacity of the State Maternal and Child Health workforce--a history of the HRSA/MCHB Academic Partnership

The Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) in conjunction with Schools of Public Health has sponsored a variety of graduate education and continuing education initiatives during the last 15 years aimed at enhancing the analytic capacity of the maternal and child health (MCH) workforce. These initiatives are described, with lessons learned as well as recommendations for future efforts provided.

Functional implications of the noradrenergic-cholinergic switch induced by retinoic acid in NB69 neuroblastoma cells

Some neuroblastoma cell lines change their neurotransmitter phenotype from noradrenergic to cholinergic under retinoic acid treatment. Such "neurotransmitter switch" seems to be a consequence of changes in the expression and activity of the biosynthetic machinery for both neurotransmitters. In this study, we have characterized this "neurotransmitter switch" induced by retinoic acid in a human neuroblastoma cell line (NB69) showing catecholaminergic characteristics. Retinoic acid treatment reduced tyrosine hydroxylase activity and noradrenaline levels in NB69 cells but did not modify the expression of this enzyme. Moreover, the calcium-dependent release of [(3)H]noradrenaline in control cells was highly reduced by retinoic acid treatment. On the other hand, NB69 cells treated with retinoic acid enhanced the expression of choline acetyltransferase and acquired the capability to release [(3)H]acetylcholine in a calcium-dependent way. In addition, we found that the expression of the vesicular monoamine transporter 2 (VMAT2) and the vesicular acetylcholine transporter (VAChT) was increased in those cells treated with retinoic acid. Immunostaining revealed that retinoic acid treatment changed the cellular distribution of both vesicular monoamine transporter 2 and vesicular acetylcholine transporter. In conclusion, retinoic acid induces a noradrenergic to cholinergic switch in NB69 cells by acting at several levels of the neurotransmitter phenotypic expression.

Low-income African-American mothers' perception of exposure to racial discrimination and infant birth weight

We performed a hospital-based case-control study of African-American mothers to explore the relation between a mother's perception of exposure to racial discrimination during pregnancy and very low birth weight. We administered a structured questionnaire to low-income mothers of very low birth weight (<1500 gm; N = 25) and non-low birth weight (>2500 gm; N = 60) infants. The unadjusted and adjusted odds ratio of very low birth weight for maternal exposure to racial discrimination were 1.9 (0.5-6.6) and 3.2 (0.9-11.3), respectively. We conclude that maternal perception of exposure to racial discrimination during pregnancy may be associated with very low birth weight in their infants.

Effective MCH epidemiology in state health agencies: lessons from an evaluation of the Maternal and Child Health Epidemiology Program (MCHEP)

OBJECTIVES

The Maternal and Child Health Epidemiology Program (MCHEP), jointly sponsored by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA), was evaluated in 1996-1997. As part of this evaluation, an effort was undertaken to identify components of effective MCH epidemiology, to examine their prevalence across participating states, and to assess differences with respect to these components between MCHEP and non-MCHEP states.

METHODS

A case-study evaluation was undertaken in which nine states (five MCHEP and four non-MCHEP) rated themselves on a benchmark questionnaire and participated in interviews conducted during site visits. At the completion of the evaluation, 16 components of effective MCH epidemiology in state health agencies were identified. The nine states were rated by the evaluation team on each component. Ratings across all states and between MCHEP and non-MCHEP states were compared.

RESULTS

There was a great deal of variability among the nine states with respect to the presence of the components of effective MCH epidemiology. Components on which the states appeared weakest overall were the presence of adequately trained personnel, the presence of adequate management information systems to support MCH programs, and whether the state health agency's epidemiologic unit understands the MCH planning cycle. States with an MCHEP assignee had a higher overall mean score than non-MCHEP states across all components. There were seven components on which the two groups of states differed. These include whether the MCH director is empowered in the state health agency, whether the state health agency has identified internal epidemiologic capacity building as a priority, and whether analytic leadership is available for MCH epidemiologic activities.

CONCLUSIONS

Building and maintaining MCH epidemiologic capacity in state health agencies requires attention to a variety of factors. While the presence of an MCH epidemiologist is important, this is only one of many components that must be considered as both the federal and state governments seek to promote and institutionalize effective MCH epidemiology in state health agencies.

Final report on public health practice linkages between schools of public health and state health agencies: 1992-1996

Since 1988 there has been a call for enhanced linkages between schools of public health and public health agencies that has prompted schools of public health to develop public health practice initiatives. The University of Illinois at Chicago School of Public Health conducted surveys of schools of public health and of state public health agencies in 1992 to collect baseline data on practice initiatives undertaken by academe and governmental public health agencies to enhance collaboration; follow-up surveys were undertaken in 1993, 1994 and 1996. This article describes the trends and implications of this survey of practice linkages involving schools of public health and state health agencies.

Assessing prenatal hepatitis B screening in Illinois with an inexpensive study design adaptable to other jurisdictions

OBJECTIVES

This study estimated, using an economical survey design adaptable to other jurisdictions, the proportion of birth admissions in Illinois hospitals in which mothers were not screened for hepatitis B surface antigen prior to delivery. It also identified factors associated with lack of screening.

METHODS

Based on a cluster sampling design, 1372 birth records were sampled, and data were abstracted by local personnel at 56 hospitals. Selected data elements were reabstracted on a subsample to evaluate recording errors.

RESULTS

Reabstracted data demonstrated 95% agreement among reviewers. Hepatitis B surface antigen screening was documented for 90.7% of mothers; 11% of responding hospitals accounted for 45% of nonscreened mothers. Risk factors for not being screened included no prenatal care, Medicaid or no insurance, and delivery at a hospital lacking a written hepatitis B surface antigen policy.

CONCLUSIONS

In Illinois, prenatal hepatitis B surface antigen screening rates were high and similar to those in other states. Births without screening or transferred information clustered in a few hospitals. The methods used here can economically identify underscreened populations by sampling a large number of hospitals within designated areas.

African-American mothers' perception of their residential environment, stressful life events, and very low birthweight

We performed a hospital-based case-control study of African-American mothers to explore the relation between a mother's perception of her own residential environment and very low birthweight. We administered a structured questionnaire to mothers of very-low-birthweight (<1,500 gm; N = 28) and critically ill non-low-birthweight (>2,500 gm; N = 52) infants. The groups had similar sociodemographic characteristics. The vast majority of participants were unmarried and had no private medical insurance. The odds ratios of very low birthweight fluctuated between 1.7 and 3.2 for African-American mothers who rated their neighborhoods (in terms of police protection, protection of property, personal safety, friendliness, delivery of municipal services, cleanliness, quietness, and schools) unfavorably. Additionally, the odds ratio of very low birthweight for mothers exposed to three or more stressful life events during pregnancy was 3.1 (95% confidence interval = 1.2-8.2). We conclude that African-American mothers' perception of their residential environment and frequency of stressful life events are associated with very low birthweight in their infants.

Health care characteristics associated with women's satisfaction with prenatal care

OBJECTIVES

The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients.

METHODS

African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction.

RESULTS

For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women.

CONCLUSIONS

Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.

Wantedness of pregnancy and prenatal health behaviors

This study examined the relationships between wantedness of pregnancy and the initiation of prenatal care as well as smoking and drinking alcohol during pregnancy. Three hundred and eighty post-partum women were interviewed in a randomly selected sample of Chicago area hospitals. Approximately half of the women said that they had wanted their recently completed pregnancy. Unadjusted analyses revealed that women who wanted their pregnancies were more likely to begin prenatal care in the first trimester and were less likely to smoke while there was no relationship between wantedness and alcohol use during pregnancy. After adjustment for sociodemographic variables, women who wanted their pregnancies were less likely to have smoked cigarettes or drunk alcohol during pregnancy, but were not more likely to have initiated prenatal care in the first trimester. These results suggest that positive health behaviors during pregnancy are influenced by wantedness of pregnancy as well as sociodemographic characteristics. Therefore, efforts to reduce unwanted pregnancies are an important strategy to improve the health of women and children.

Measuring satisfaction among low-income women: a prenatal care questionnaire

OBJECTIVE

To evaluate the reliability and construct validity of a prenatal care satisfaction scale.

METHOD

A prenatal care satisfaction scale that included six dimensions of care based on the literature was tested during a telephone interview with 101 first-time African-American and Mexican-American mothers 18 and over who receive Medicaid.

RESULTS

The scale exhibited high reliability (Cronbach's alpha = 0.95), as well as good construct validity. The correlation between the scale and rating of the quality of care overall was 0.74 (p < 0.001); the correlation between the scale and whether the women would recommend this provider to a friend was 0.67 (p < 0.001). Results from correlation and factor analysis suggested a different set of dimensions than those described in the literature.

CONCLUSION

The 22-question satisfaction with prenatal care scale has excellent reliability and construct validity and taps six established dimensions of satisfaction, including the art of care, technical quality, access, physical environment, availability, and efficacy. The multidimensional scale allows for alternative groupings of the domains of satisfaction as our understanding of prenatal care satisfaction increases.

Prospective recruitment of women receiving prenatal care from diverse provider arrangements: a potential strategy

OBJECTIVES

This study describes the use of a Medicaid managed care list to prospectively recruit into a research project pregnant women receiving care from a variety of providers.

METHOD

A list of women enrolled in Medicaid managed care was used to recruit pregnant African-American and Latina women into a study of prenatal care satisfaction. Due to privacy concerns, the researchers were not able to directly access names from the list. Instead, a managed care contract agency sent recruitment letters to 1009 pregnant African-American and Latina Medicaid recipients. Response rates by ethnicity and several other key variables are calculated. The biases associated with this method of recruiting pregnant women from a variety of providers are discussed.

RESULTS

Thirty-five percent of the women contacted returned consent forms and agreed to have researchers approach them; the response rate for African-American women was 43% and for Latinas was 29% (p < 0.0001). Respondents were younger and later in their pregnancies than nonrespondents, but did not differ from them by zip code of residence. The women recruited into the study obtained prenatal care from a diverse group of providers.

CONCLUSIONS

While the use of a prospectively generated list of pregnant Medicaid recipients to recruit low-income pregnant women into a research study may be associated with some selection bias, the potential cost savings, decreased effort, and diminished recall bias may make their use a feasible sampling alternative, particularly when the researcher desires to recruit women seeking care from a variety of provider arrangements.

Public health practice linkages between schools of public health and state health agencies: results from a three-year survey

Several recent examinations of the state of public health have called for enhanced linkages between schools of public health and public health agencies, prompting federal health agencies and schools of public health to develop practice initiatives. Surveys of schools of public health and of state public health agencies were conducted in 1992 to collect baseline data on practice links between the two agencies; follow-up surveys were undertaken in 1993 and 1994. Responses reveal that a substantial amount of interaction between schools and agencies has been occurring for some time, but that until recently much of the interaction has been informal and between individuals or departments rather than institution-wide. Both frequency and formalization of such collaborations have increased, reflecting a growing emphasis on public health practice activities at schools of public health together with public health agencies.

Evaluation of internal alpha-particle radiation exposure and subsequent fertility among a cohort of women formerly employed in the radium dial industry

This study examined the effect of internal exposure to alpha-particle radiation on subsequent fertility among women employed in the radium dial industry prior to 1930, when appreciable amounts of radium were often ingested through the practice of pointing the paint brush with the lips. The analysis was limited to women for whom a radium body burden measurement had been obtained and who were married prior to age 45 (n = 603). Internal radiation dose to the ovary was calculated based on initial intakes of radium-226 and radium-228, average ovarian mass, number and energy of alpha particles emitted, fraction of energy absorbed within the ovary, effective retention integrals and estimated photon irradiation. Time between marriage and pregnancy, number of pregnancies and number of live births served as surrogates for fertility. Radiation appeared to have no effect on fertility at estimated cumulative ovarian dose equivalents below 5 Sv; above this dose, however, statistically significant declines in both number of pregnancies and live births were observed. These trends persisted after multivariable adjustment for potential confounding variables and after exclusion of subjects contributing a potential classification or selection bias to the study. Additionally, the high-dose group experienced fewer live births than would have been expected based on population rates. There were no differences in time to first pregnancy between high- and low-dose groups. These results are consistent with earlier studies of gamma-ray exposures and suggest that exposure to high doses of radiation from internally deposited radium reduces fertility rather than inducing sterility.

Is public health ready for reform? The case for accrediting local health departments

Reform of the governmental public health system in the United States has been stymied by changes in political, economic, and medical care landscapes since public health was called to action by the Institute of Medicine report in 1988. Despite a new national health objective calling for 90 percent of the population to be served by a local health department effectively addressing public health's three core functions by the year 2000, capacity building initiatives have not been deployed extensively, and there is little likelihood of reaching the year 2000 objective. A national program of accrediting local and state health departments could energize public health capacity building. Accreditation would build on recent initiatives in states like Washington and Illinois, promote wider use of the Assessment Protocol for Excellence in Public Health, and facilitate reform of the public health system around public health's core functions. Key questions addressing the why, how, and who of such an initiative set the stage for consideration of a national accreditation program.

Does parental involvement make a difference? The impact of parent interactive activities on students in a school-based AIDS prevention program

OBJECTIVES

In this study, we test the effectiveness of involving parents in school-based AIDS education with respect to altering AIDS-related knowledge, attitudes, behavioral intentions, communications patterns, and behavior of students.

METHODS

Fifteen high risk school districts (pre-test N = 2,392) were randomly assigned to one of three conditions: parent-interactive (classroom curricula + parent-interactive component); parent non-interactive (classroom curricula only); control (basic AIDS education ordinarily provided by the school). Students were tested over time in grades 7, 8 and 9.

RESULTS

Results indicate that both treatment conditions (parent-interactive and non-interactive) had a strong positive impact in enhancing student's knowledge, attitudes, communication patterns and behavioral intentions. Further, results indicate that there were no behavioral outcome differences between the treatment groups and the control condition. Results demonstrate few outcome differences between the two experimental conditions.

CONCLUSIONS

In the two treatment groups (parent-interactive and parent non-interactive), the program effects appear to be the result of school-based curricula and of student self-determined intentions and behaviors, rather than the presence or absence of planned parental involvement. Whether or not structured or planned parental involvement becomes part of a school-based educational activity should perhaps be determined by (a) the existing level of parent-school interaction based on the nature of the community, (b) the amount of money readily available to follow through on a program of parent involvement without compromising on student programs, (c) the age of the child and the sensitivity of the issue, and (d) the ability of the parent/family to be involved effectively without extraordinary expense or sacrifice by either parent or school. Our findings speak to the positive role of the school regardless of parent participation.

Preterm delivery and perinatal death among black and white infants in a Chicago-area perinatal registry

OBJECTIVE

To explore associations between race, preterm delivery, etiologic classification of preterm delivery, and perinatal mortality.

METHODS

The study population consisted of 13,010 black and 19,007 white mother-infant pairs delivered at Chicago-area hospitals in 1988-1989 categorized as term or preterm births. Preterm births were further divided by severity and etiology. Black-white differences in perinatal mortality within groups were calculated and adjusted for birth weight and other potential confounding variables.

RESULTS

Black women were nearly twice as likely as whites to experience preterm (before 37 weeks' gestation) and very preterm (before 32 weeks' gestation) delivery associated with premature rupture of membranes (PROM) or classified as idiopathic. Although black infants were also found to have twice the perinatal mortality risk of white infants (relative risk [RR] 2.1, 95% confidence interval [CI] 1.7-2.5), the overall preterm perinatal mortality rates did not differ between black and white women (RR 1.0, 95% CI 0.8-1.2). However, among preterm births, perinatal mortality was not uniform within categories of medical etiology. The mortality risk was the same for black and white infants born preterm following polyhydramnios or placental complications (RR 1.1, 95% CI 0.6-1.9), the same for black and white infants born preterm after labor induction (RR 1.1, 95% CI 0.6-1.9), and higher for black infants classified as idiopathic preterm deliveries (RR 1.6, 95% CI 1.1-2.3). In contrast, mortality rates tended to be lower for black infants born preterm following PROM-amnionitis (RR 0.8, 95% CI 0.5-1.2). The idiopathic disparity was explained by a differential birth weight distribution (adjusted RR 1.1, 95% CI 0.7-1.9); however, the apparent survival benefit among black infants born preterm following PROM increased even further after adjustment for birth weight (adjusted RR 0.4, 95% CI 0.2-0.7).

CONCLUSION

Black infants born preterm after PROM appear to have a survival advantage compared with their white counterparts, an effect not observed within other etiologic categories of preterm delivery.

Cocaine and cigarettes: a comparison of risks

In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non-smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n = 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n = 13,043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0-9.3], small-for-gestational age (SGA) [RR 4.2, 95% CI 2.4-7.3], prematurity [RR 4.0, 95% CI 2.3-7.0], abruptio placentae [RR 10.0, 95% CI 3.5-29.0], placenta praevia [RR = 2.4, 95% CI 0.3-17.8] and perinatal death [RR = 5.3, 95% CI 1.9-15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support the current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.

Women's satisfaction with prenatal care settings: a focus group study

BACKGROUND

Patient satisfaction is considered, together with health status, to be an outcome of the delivery of health care services as well as a measure of its quality. A focus group study of 50 low-income Mexican-American Puerto Rican, African-American, and white women in Chicago, Illinois, explored the characteristics of prenatal care that affect women's satisfaction.

METHODS

Transcripts from the focus groups were analyzed using researcher-derived coding categories to develop broad themes.

RESULTS

Despite their diverse ethnic backgrounds, participants revealed few differences with respect to what they value in prenatal care. Aspects of care that appeared to affect women's satisfaction included the "art of care, " the technical competence of the practitioner, continuity of caregiver, and the atmosphere and physical environment of the care setting. The one characteristic that did not appear to affect satisfaction was the caregiver's ethnicity.

CONCLUSION

Knowledge of how the characteristics of prenatal care affect women's satisfaction can help increase use of care and ultimately improve perinatal outcomes.

Capacity-building influences on Illinois local health departments

Illinois local health departments (LHDs) were surveyed in 1992 and again in 1994 in order to assess changes in, influences on, and results of practice performance during this two-year period. Illinois LHDs serving both small and large populations were found to have greatly increased the extent to which they carry out practice measures related to public health's core functions. The Assessment Protocol for Excellence in Public Health (APEXPH) and its Illinois adaptation were cited as the most positive influences on practice performance. LHDs viewed the most significant consequences of participation in needs assessment and planning processes as increased understanding of internal strengths and weaknesses and of community health problems. These findings and implications suggest that significant improvements in LHD practice performance can result from widespread implementation of APEXPH and its derivatives.

Perinatal screening for illicit drugs: policies in hospitals in a large metropolitan area

More data are needed regarding the screening policies of perinatal units for illicit drugs, especially in states where positive drug test results are linked with child neglect. The process by which pregnant women and infants are selected for illicit drug testing has caused concern because it may lead to bias and overrepresentation of certain populations in the drug-using groups. To examine hospital policies for screening women and newborn infants in prenatal, labor, and newborn hospital units, we conducted a telephone and follow-up mail survey of 49 Chicago-area hospitals. Nurse administrators or clinical specialists were questioned about the criteria used to select mothers and infants for testing, the extent to which written informed or oral consent was obtained for drug tests, and the actions taken by hospitals in response to positive drug test results in infants. Variations in policy among hospitals and hospital units were evident. The most frequently cited criteria for testing mothers and infants for drug use were verbal admission of drug use, the health provider's suspicion of drug use, a positive diagnosis of human immunodeficiency virus or a sexually transmitted disease in the mother, or a combination of these criteria. Universal drug screening may be a viable option when sanctions are the consequence of perinatal drug testing. The removal of sanctions, however, and a return to disclosure within a supportive client-caregiver relationship are the preferred options.

A longitudinal comparison of the AIDS-related attitudes and knowledge of parents and their children

As part of an evaluation of an experimental school-based AIDS risk-reduction program, data from 2,392 middle-school students in 15 high-risk school districts and from 1,627 of their parents were compared to examine how young adolescents and their parents differ with respect to AIDs-related knowledge and attitudes. At the time of the seventh-grade pretest, parents knew significantly more about AIDS than their children did. At the eighth-grade posttest, students who participated in the program knew either more than or at least as much as their parents in several subject areas, while among those not exposed to the program, parents still knew more than their children in most areas. The intervention had a positive impact on students' attitudes toward people with AIDS and on their degree of comfort about discussing with their parents such issues as drug use and sexuality.

Building bridges between schools of public health and public health practice

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.

Attitudes toward people with AIDS and implications for school-based youth AIDS education

This study examines attitudes toward people with AIDS (PWAs) of a group of 853 7th, 8th, and 9th graders living in high-risk communities in the suburbs of a large Midwestern city. Females appear to be more tolerant than males, and whites appear to be more tolerant than other racial/ethnic groups with respect to attitudes toward PWAs. Although knowledge about actual modes of human immunodeficiency virus (HIV) transmission is not correlated with attitudes toward PWAs, students with greater knowledge about HIV transmission through casual contact, transmission of HIV through blood products, ways of preventing HIV infection, and myths about HIV prevention have more tolerant attitudes toward PWAs. Students who have ever had sexual intercourse are significantly less tolerant of PWAs. Implications of these findings for youth AIDS education are presented.

Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome

OBJECTIVES

The effects of antepartum urinary tract infection on adverse maternal and perinatal outcomes were examined. Antepartum urinary tract infection has been previously implicated as a risk factor for numerous outcomes.

METHODS

Crude and multivariable analyses were performed with a perinatal registry cohort of 25,746 mother/infant pairs.

RESULTS

Elevated risks were observed for exposure to urinary tract infection and low birthweight, prematurity, preterm low birthweight, premature labor, hypertension/preeclampsia, maternal anemia, and amnionitis. Urinary tract infection was associated with perinatal death only among subjects 20 to 29 years of age.

CONCLUSIONS

These findings underscore the importance of antepartum urine screening to identify patients at risk for adverse outcomes.

Local health department effectiveness in addressing the core functions of public health

Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and least for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than 40 percent of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.

Implementing and assessing organizational practices in local health departments

One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been effective. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public's health.

Young adolescent attitudes toward sex and substance use: implications for AIDS prevention

This paper explores differences in adolescents' attitudes, beliefs, and resistance skills regarding sexual behaviors and use of substances in the context of AIDS prevention. A total of 553 7th and 8th grade students completed a self-administered questionnaire as baseline data collection for a human immunodeficiency virus (HIV) prevention project. Students' attitudes about sexual behavior and substance use differed markedly. Teens in this sample reported feeling significantly more comfortable discussing substance use with their parents than discussing sex; they also reported that it is easier to say "no" to alcohol or marijuana than to resist pressures to have sex. Furthermore, these young adolescents believed that their parents would be less upset to discover that they were sexually active than to find out they were using drugs. Among students who had ever had sex and who had ever used alcohol, young adolescents indicated that their parents would be much less upset to find out they were having sex than to discover they were smoking, drinking alcohol, or using drugs. Implications of the findings for HIV/AIDS prevention efforts are discussed.

Improving pregnancy outcomes: public versus private care for urban, low-income women

This study describes the characteristics of women who received maternity care from the Chicago Department of Health or from private practitioners in 1988 and the first half of 1989, and who delivered at the University of Illinois Hospital or Cook County Hospital. The risk of preterm low birthweight for the infants of these women was compared according to source of prenatal care. The likelihood of giving birth to a preterm, low-birthweight infant was significantly greater (odds ratio 3.1, 95% confidence interval 2.3-4.0) for women who received care only from private physicians (n = 530) compared with those who received care entirely from the Chicago Department of Health (n = 2465). This relationship remained after adjustment for race, age, parity, history of adverse pregnancy outcomes, smoking, and use of drugs during pregnancy. We examined alternative explanations for these findings, and concluded that although the role of urban public health departments in the direct delivery of maternity care services continues to be a source of controversy, these institutions remain an important provider of such care for low-income women.

Mortality of American Indian and Alaska native infants

Accurate determination of infant mortality rates among Indians in seriously hampered by variations in the identification of Indian persons and use of different subsets of the Indian population for various purposes. Lack of consistency in the reporting of racial origin on birth and death records is a source of substantial error. Because of these factors, more than the usual care must attend comparisons and inferences drawn from data in which these differences are present. At present, it would seem prudent to regard all data about American Indians as provisional. Even though Indian infant mortality remains higher than that for US all races, regardless of techniques used for estimates, the decline of Indian infant mortality by more than 80% since the establishment of the IHS is a truly remarkable achievement. This success has been ascribed to a combination of activities, including the provision of safe drinking water, especially as an integral part of the IHS program; the nearly universal immunization of Indian children; and emphasis upon comprehensive, community-oriented programs focused on maternal and child care. These successes have contributed to changes in the distribution of the leading causes of Indian infant mortality, so that the most prominent causes now are SIDS, congenital anomalies, injuries, and various infections. Because of these changes and advances in knowledge, the IHS has recently revised its five-year plan for dealing with infant mortality to provide greater attention to injuries and infections and has embarked upon a series of discussions with the American Academy of Pediatrics to address postneonatal deaths and the difficult problem of SIDS. Low socioeconomic conditions, so important in influencing mortality rates (7, 14, 29), have thus far proved to be intractable. In the meantime, success will depend upon ensuring optimal prenatal care, reducing those risk factors amenable to correction, and solving the problem of SIDS.

Cocaine use during pregnancy: perinatal outcomes

The relation between maternal cocaine use and perinatal outcomes was investigated among 17,466 non-Asian singleton deliveries in 1988 from the University of Illinois Perinatal Network data base in the metropolitan Chicago area. Elevated adjusted relative risks (RR) of low birth weight (RR = 2.8, 95% confidence interval (CI) 2.2-3.7), prematurity (RR = 2.4, 95% CI 1.9-3.1), abruptio placentae (RR = 4.5, 95% CI 2.4-8.5), and perinatal death (RR = 2.1, 95% CI 1.1-4.0) were observed for "any" cocaine users (n = 408) compared with women who did not use cocaine or any other drugs or alcohol (n = 17,058). There was an increased (although unstable) risk of intrapartum placenta previa not previously reported (RR = 2.3, 95% CI 1.0-5.1). The relative risk of small-for-gestational-age births for cocaine users who did not smoke (RR = 3.4, 95% CI 1.8-6.5) was greater than that for cocaine users who did (RR = 2.1, 95% CI 1.1-4.1). Irrespective of smoking status, cocaine use during pregnancy increased the risk of small-for-gestational-age births.

A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal data base

In one regional perinatal network between 1982-1987, 101,506 women delivered infants greater than 500 g, of which 1253 were twin pregnancies (1.2%). This latter group was compared statistically with a 5% random sample of the singletons (N = 5119). The results showed that the women with twin pregnancies were slightly older, had a higher parity, gained more weight during the gestation, and had a heavier body weight at delivery. Twin pregnancies were complicated by increases in hypertension (odds ratio 2.5; 95% confidence interval 2.1-3.1), abruption (odds ratio 3.0; 95% confidence interval 1.9-4.7), and anemia (odds ratio 2.4; 95% confidence interval 1.9-3.0). There was no increased risk of pyelonephritis, placenta previa, or diabetes mellitus in mothers with twins. The twin pregnancies delivered earlier and the infants were smaller, had lower Apgar scores, and were at increased risk for congenital anomalies. Fetal and neonatal mortality rates were significantly increased in the twin infants; the perinatal mortality rates for twin A and twin B were 48.8 and 64.1, respectively, compared with 10.4 per 1000 births for the singleton controls. When the twin infants A and B were of similar weight, they had a similar perinatal mortality (odds ratio 1.0; 95% confidence interval 0.6-1.8). For infants less than 2500 g, twins A and B had lower fetal and neonatal mortality rates than did singletons, but twins heavier than 2500 g were at increased risk of perinatal death.

The relationship of smoking and ectopic pregnancy

A case-control study, using data abstracted between 1983 and 1987 from a large perinatal registry, was conducted to explore the relationship between smoking and ectopic pregnancy. Women with ectopic pregnancy (n = 634) seen at University of Illinois Perinatal Network Hospitals were compared to women who were delivered of a single live-born infant (n = 4287). Adjusted for age and race, women who reported smoking during pregnancy had a greater than twofold risk of ectopic pregnancy (Odds Ratio = 2.5, 95% confidence interval = 1.9, 3.2) compared to women who never smoked. The estimated relative risk rose from 1.4 (95% CI = 0.8, 2.5) for a woman smoking fewer than 10 cigarettes a day to 5.0 (95% CI = 2.9, 8.7) at one and a half or more packs of cigarettes per day (p-value for trend less than 0.001). Although further basic and epidemiologic research is necessary, the observed dose-response relation strengthens the argument that smoking may be a causal factor in the development of ectopic pregnancy.

Changes in discrimination learning and brain activity (ERP's) due to combined exposure to NO and CO in rats

Carbon monoxide (CO) and nitric oxide (NO) are air pollutants frequently appearing in combination. Information available on the mechanisms of NO intoxication suggests that in mixtures with CO additive effects should be assumed. In this study CO and NO-induced changes and their interaction were investigated at different levels of integration: carboxyhemoglobin (COHb) and methemoglobin (met-Hb) formation as well as centrally mediated effects were analyzed using evoked potential techniques and behavioral data from a complex discrimination learning experiment. Slight enhancements of COHb and met-Hb concentrations were seen for the combined CO + NO exposure conditions at low and high exposure levels when compared to isolated exposure conditions. The performance decrease was clearly higher under NO exposure than under CO exposure. Decrements were overadditive when simultaneous CO + NO exposure was used in higher concentration. Both gases affected early evoked potential components (P10, N30) in the same way: latencies were prolonged and amplitudes increased. Later potential components were differently influenced by CO and NO. Mainly the N150 amplitude was decreased in NO exposure and increased in CO conditions. N150 amplitude was also decreased after combined CO + NO exposure. At high levels this effect was overadditive indicating a dominant role of NO in the CO + NO combinations used in this experiment.