Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group.

Background: Women who deliver preterm infants are at a much greater risk for repeating a preterm birth (PTB), compared to women without a history of PTB. However, little is known about the prevalence of the risk factors which account for this markedly increased risk. Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions.

Subjective social status and maternal health in a low income urban population.

Appropriate measurement of socioeconomic status (SES) in health research can be problematic. Conventional SES measures based on 'objective' indicators such as income, education, or occupation may have questionable validity in certain populations. The objective of this investigation was to determine if a relatively new measurement of SES, subjective social status (SSS), was more consistently and strongly associated with multiple health outcomes for low income mothers.

Incident smoking during pregnancy and the postpartum period in a low-income urban population.

Objectives: We determined the prevalence of first lifetime use of cigarettes during pregnancy or in the early postpartum period (incident smoking) and identified sociodemographic and health-related characteristics of incident smokers.

Methods: We used statistics based on data from a longitudinal study of a large cohort of pregnant, low-income, urban women (n = 1,676) to describe the timing of first-time use and to compare incident smokers with those who had never smoked and those who had already smoked prior to pregnancy.

Results: About one in 10 (10.

Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project.

Background: Recruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants.

Methods: Design of the PCPPP incorporated strategies to maximize recruitment and retention.

Perceived discrimination and depressive symptoms, smoking, and recent alcohol use in pregnancy.

Background: Perceived discrimination is associated with poor mental health and health-compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low-income pregnant women.

Methods: Face-to-face interviews were conducted in English or Spanish with 4,454 multiethnic, low-income, inner-city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004.

Estimating prevalence of overweight and obesity at the neighborhood level: the value of maternal height and weight data available on birth certificate records.

Objective: To determine the value of maternal height and weight data on birth certificate records when estimating prevalence of overweight and obese adults at the neighborhood level.

Research Design And Methods: Regression analysis was used to determine how much variation in the percentage of the adult population with a body mass index (BMI) of >/= 25 (based on survey data) could be accounted for by the percentage of mothers with BMI >/= 25 (based on birth certificate data) -- alone and in combination with other sociodemographic characteristics of census tracts.

Results: Alone, the percentage of mothers with BMI >/= 25 explained more than half (R2 = .

Beyond marital status: the quality of the mother-father relationship and its influence on reproductive health behaviors and outcomes among unmarried low income pregnant women.

In populations where the majority of pregnancies occur to unmarried women, exploring the quality of partner relationships and reproductive health is warranted. This study assesses differences in psychosocial characteristics, health behaviors, and birth outcomes between unmarried pregnant women who reported having a 'good' relationship with their baby's father, compared to those who reported having a 'fair' or 'poor' relationship with their baby's father. This research was part of a prospective study of low-income urban women.

Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being.

Background: Postpartum physical health problems are common and have been understudied. The purpose of this investigation was to explore the associations among reported physical symptoms, functional limitations, and emotional well-being of postpartum women.

Methods: The study included data from interviews conducted at 9 to 12 months postpartum from 1,323 women who had received prenatal care at nine community health centers located in Philadelphia, Pennsylvania, United States, between February 2000 and November 2002.

Do public health clinics reduce rehospitalizations?: the urban diabetes study.

Safety-net health clinics have been shown to reduce hospitalizations for ambulatory care-sensitive conditions. Their impact on rehospitalization after hospital discharge is unknown. We hypothesized that use of publicly-funded safety-net health clinics would reduce rates of rehospitalization among patients with diabetes.

Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study.

Objective: We evaluated the association of different types of educational visits for diabetic patients of the eight Philadelphia Health Care Centers (PHCCs) (public safety-net primary care clinics), with hospital admission rates and charges reported to the Pennsylvania Health Care Cost Containment Council.

Research Design And Methods: The study population included 18,404 patients who had a PHCC visit with a diabetes diagnosis recorded between 1 March 1993 and 31 December 2001 and had at least 1 month follow-up time.

Results: A total of 31,657 hospitalizations were recorded for 7,839 (42.

Hospital admission rates for a racially diverse low-income cohort of patients with diabetes: the Urban Diabetes Study.

Objective: We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics.

Methods: Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity.

Diagnosing diabetes and preventing rehospitalizations: the urban diabetes study.

Background: Patients with diabetes frequently are hospitalized, and quality of inpatient care for diabetes is of great concern. Rehospitalization after hospital discharge is a frequent adverse outcome experienced by patients with diabetes.

Objectives: We assessed the frequency of and risk factors for rehospitalization among all Philadelphia residents with diabetes.

Cardiovascular comorbidities among public health clinic patients with diabetes: the Urban Diabetics Study.

Background: We sought to determine the frequency and distribution of cardiovascular comorbidities in a large cohort of low-income patients with diabetes who had received primary care for diabetes at municipal health clinics.

Methods: Outpatient data from the Philadelphia Health Care Centers was linked with hospital discharge data from all Pennsylvania hospitals and death certificates.

Results: Among 10,095 primary care patients with diabetes, with a mean observation period of 4.

Neighborhood poverty, mortality rates, and excess deaths among African Americans: Philadelphia 1999-2001.

We used vital statistics and census data to determine whether mortality rates in Philadelphia were associated with neighborhood poverty, and to what extent excess mortality among African Americans was associated with neighborhood poverty. Gender-specific, age-adjusted mortality rates for 1999-2001 were strongly associated with neighborhood poverty among both women and men overall, and among both African Americans and non-Hispanic whites. The actual number of deaths among African Americans was 5,305 higher than it would have been if African Americans had had the same gender- and age-specific mortality rates as the average for non-Hispanic whites in Philadelphia, and 1,944 higher than if African Americans had had the same gender- and age-specific rates as non-Hispanic whites in the same neighborhood poverty categories.

Nighttime call in house vs. out of house: a comparison of obstetric procedure rates.

Objective: To evaluate the effect of in-house vs. out-of-house nighttime call coverage on obstetric practice.

Study Design: A retrospective analysis was performed on nighttime deliveries.

The discrepancy between self-reported smoking status and urine continine levels among women enrolled in prenatal care at four publicly funded clinical sites.

The discrepancy between self-reported smoking behavior and actual urine cotinine values among prenatal patients at four municipally operated clinical sites was examined. Face-to-face interview and birth certificate information about smoking behavior during pregnancy was compared with laboratory urine cotinine values for 74 patients. Almost three of every four (73%) self-reported nonsmokers had continine values greater than 80 ng/mL; one-half (48%) had values exceeding 100 ng/mL.

Dental participants in mass disasters--a retrospective study with future implications.

Mass casualty incidents continue to require the services of forensic dentists to determine the identity of victims. Across North America and Europe. teams of forensic dentists train, using mock disaster exercises, to prepare for such duties.

Forensic implications of biting behavior: a conceptually underdeveloped area of investigation.

Within the context of a criminal investigation the human bitemark traditionally provides the forensic dentist with both physical and biological evidence. In recent years, however, examples exist where in addition to discussing physical and biological evidence, expert witnesses have also testified in court regarding the behavioral aspects of biting behavior. Interested in this additional source of evidence, the authors reviewed the research literature from which biting behavior could be explained.

Hospital variation in episiotomy use and the risk of perineal trauma during childbirth.

Background: Episiotomies are the most frequently performed surgical procedure among United States women, but there are no published epidemiological studies of the extent of variation in episiotomy use among different obstetrical providers, or the outcomes associated with different levels of use. The objective of this study was to assess the extent of hospital variation in the use of episiotomy and the relationship between hospital episiotomy use and the incidence and risk of perineal trauma among women residing in a large urban area in the United States.

Methods: Linked birth certificate and hospital discharge data pertaining to births to nulliparous women without prolonged labor or obstructed deliveries, and with infants weighing between 2500 and 4000 g, were analyzed for 18 major maternity hospitals.