bluuebunny/crossref_metadata_2025_split huggingface dataset:
Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta‐analysis
Authors: de Kroon Cornelis D. , de Bock Geertruida H. , Dieben Sandra W.M. , Jansen Frank Willem 
Published: December 2003

Objective
To assess the diagnostic accuracy of saline contrast hysterosonography in the evaluation of the uterine cavity in women complaining of abnormal uterine bleeding.Design
A systematic review and meta‐analysis of diagnostic studies that compared saline contrast hysterosonography to a gold standard diagnosis based on either hysteroscopy with or without histological sampling or to hysterectomy.Setting
University Hospital.Sample
Twenty‐four studies (including 2278 procedures).Methods
Electronic databases were searched for relevant studies and references were cross checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated, studies were plotted in an ROC area and data were pooled. Subgroup analysis was performed according to the validity area.Main outcome measures
The success rate of saline contrast hysterosonography. The pooled sensitivity, specificity, likelihood ratio's and post‐test probabilities of saline contrast hysterosonography on the prediction of uterine cavity abnormality.Results
The largest population of homogeneous data were the studies with complete verification. In these studies, the pooled sensitivity and pooled specificity of saline contrast hysterosonography in uterine cavity evaluation were respectively 0.95 (95% CI 0.93 to 0.97) and 0.88 (95% CI 0.85 to 0.92), the likelihood ratios were respectively 8.23 (95% CI 6.2 to 11) and 0.06 (95% CI 0.04 to 0.09) and the post‐test probabilities were respectively 0.91 (95% CI 0.89 to 0.94) and 0.07 (95% CI 0.04 to 0.10). The overall success rate of saline contrast hysterosonography was 93% (95% CI 92% to 94%). The feasibility of saline contrast hysterosonography in postmenopausal women (success rate 86.5%, 95% CI 83.2 to 89.8) is significantly lower (P < 0.01) compared with premenopausal women (success rate 95%, 95% CI 94% to 96%).Conclusion
Saline contrast hysterosonography is accurate in the evaluation of the uterine cavity in pre‐ and postmenopausal women suffering from abnormal uterine bleeding. The feasibility of saline contrast hysterosonography is high, although significantly better in premenopausal women compared with postmenopausal women. We conclude that saline contrast hysterosonography, in combination with an endometrium aspiration if necessary, can become the standard diagnostic procedure in women with abnormal uterine bleeding.
Assessment of fetal liver volume and umbilical venous volume flow in pregnancies complicated by insulin‐dependent diabetes mellitus
Authors: Boito Simona M. , Struijk Piet C. , Ursem Nicolette T.C. , Stijnen Theo , Wladimiroff Juriy W. 
Published: December 2003

Objectives
To determine fetal liver volume and its relation with umbilical venous volume flow and maternal glycosylated haemoglobin (HbA1c) in pregnancies complicated by diabetes mellitus type I.Design
A cross sectional matched control study.Setting
Obstetric out patient clinic, Erasmus MC—University Medical Centre, Rotterdam.Population
Data from fetuses of diabetic women (n = 32; 18–36 weeks) were compared with data from normal controls (n = 32) matched for gestational age.Methods
Umbilical venous cross sectional area (mm2) and time‐averaged velocity (mm/s Doppler) were determined for calculation of volume flow (mL/min) and flow per kilogram fetal weight (mL/min/kg). Umbilical artery pulsatility index was determined. Fetal liver volume measurements were obtained using a Voluson 530‐D.Main outcome measures
Fetal liver volume, umbilical venous volume flow and downstream impedance.Results
A statistically significant difference between fetuses of diabetic women and normal controls was found for liver volume (mean [SD]: 45.9 [34.0] vs 38.3 [28.7] mL), abdominal circumference (22.2 [6.6] vs 21.3 [5.6] cm), estimated fetal weight (1162 [898] vs 1049 [765] g) and fetoplacental weight ratio (0.22 vs 0.19) and liver volume/estimated fetal weight ratio (4.13% [0.007] vs 3.62% [0.009]). Umbilical venous volume flow (mL/min) and umbilical artery pulsatility index were not essentially different between the two study groups, but umbilical venous volume flow per kilogram fetal weight was lower (P < 0.05) in the diabetes group (94.3 [26.1] mL/min kg) compared with normal controls (109.5 [28.0] mL/min/kg). A positive correlation existed between fetal liver volume and maternal HbA1c (P = 0.002).Conclusions
Measurement of fetal liver volume by three‐dimensional ultrasound may play a role in identifying fetal growth acceleration in diabetic pregnancies. Fetal liver volume increase is positively related to maternal HbA1c levels reflecting degree of maternal glycemic control. Fetal liver volume normalised for estimated fetal weight is significantly higher in the fetuses of diabetic women. In the present study, umbilical venous volume flow and fetoplacental downstream impedance are not different between diabetic and normal pregnancies.
Assessment of a structured in‐hospital educational intervention addressing breastfeeding: a prospective randomised open trial
Authors: Labarere Jose , Bellin Valerie , Fourny Magali , Gagnaire Jean‐Claude , Francois Patrice , Pons Jean‐Claude 
Published: December 2003

Objective
To determine whether a single one‐to‐one in‐hospital education session could increase the rate of breastfeeding at 17 weeks.Design
A prospective, randomised, parallel group, open trial.Setting
A level two maternity hospital in France.Sample
Breastfeeding mothers who were employed outside the home prenatally and were delivered of a healthy singleton.Intervention
A structured one‐to‐one in‐hospital education session.Methods
One hundred and six mother–infant pairs were allocated to the intervention group and 104 to the control group (receiving usual verbal encouragement). A total of 93 mother–infant pairs in the intervention group and 97 in the control group provided complete data for final evaluation of efficacy.Main outcome measure
Rate of breastfeeding at infant age of 17 weeks.Results
There was no significant difference between the two groups in the rate of any breastfeeding (34.4% in the intervention group vs 40.2% in the control group, relative risk = 0.86 [0.52–1.40]), and in the rate of exclusive breastfeeding (14.0% in the intervention group vs 14.4% in the control group, relative risk = 0.97 [0.42–2.22]).Conclusion
Our findings suggest that a single in‐hospital educational intervention has no effect on the breastfeeding rate at four months. Guidance provided by maternity staff should be reinforced by a long term multifaceted support programme in countries with a low to intermediate rate of breastfeeding.
Maternal mortality: only 42 days?
Authors: Høj Lars , da Silva Domingos , Hedegaard Kathryn , Sandström Anita , Aaby Peter 
Published: December 2003

Objective
A maternal death is defined by WHO as ‘the death of a woman while pregnant or within 42 days of termination of pregnancy…’. The origin of the 42 days is no longer clear. In developing countries, the burden imposed by pregnancy and birth on a woman's body may extend beyond 42 days as pregnancy‐related anaemia can persist for longer and vaginal haemorrhaging and risk of infections are not necessarily over after six weeks. We therefore examined duration of excess mortality after delivery in rural Guinea‐Bissau.Design
In a prospective cohort study, we followed 15,844 women of childbearing age with biannual visits over a period of six years, resulting in a total of 60,192 person‐years‐at‐risk. To establish cause and timing in relation to termination of pregnancy, verbal autopsy was carried out for all deaths. Mortality rates were calculated for short time intervals after each delivery or miscarriage.Results
During the observation period we registered 14,257 pregnancies and 350 deaths. One hundred and ninety‐four deaths followed termination of a registered pregnancy and thus were eligible for the analysis. Eighty‐two deaths occurred during the first 42 days after delivery/miscarriage. A further 16 women died in the period from 43 to 91 days after parturition, 16 between 92 and 182 days and 18 between 183 and 365 days after delivery. Compared with baseline mortality 7–12 months after delivery, women who had recently delivered had 15.9 times higher mortality (95% CI 9.8–27.4). From days 43 to 91 the mortality was still significantly elevated (RR = 2.8 [1.4–5.4]).Conclusion
Where living conditions are harsh, pregnancy and delivery affect the health of the woman for more than 42 days. Using the WHO definition may result in an under‐estimation of the pregnancy‐related part of the reproductive age mortality. Extending the definition of maternal death to include all deaths within three months of delivery may increase current estimates of maternal mortality by 10–15%.
Was Breast Conserving Surgery Underutilized for Early Stage Breast Cancer? Instrumental Variables Evidence for Stage II Patients from Iowa
Authors: Brooks John M. , Chrischilles Elizabeth A. , Scott Shane D. , Chen‐Hardee Shari S. 
Published: December 2003

Objective. To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989–1994.Data Sources/Data Setting. Secondary linked Iowa SEER Cancer Registry—Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989–1994.Study Design. Observational instrumental variables (IV) analysis.Data Collection/Extraction Methods. Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989–1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts.Principal Findings. Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities.Conclusions. If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.
Competition, Payers, and Hospital Quality1
Authors: Gowrisankaran Gautam , Town Robert J. 
Published: December 2003

Objective. To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California.Data Source. Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989–1993.Study Design. Outcome variables are the risk‐adjusted hospital mortality rates for pneumonia (estimated by the authors) and acute myocardial infarction (AMI) (reported by the state of California). Measures of competition are constructed for each hospital and payer type. The competition measures are formulated to mitigate the possibility of endogeneity bias. The relationships between risk‐adjusted mortality and the different competition measures are estimated using ordinary least squares.Principal Findings. The study finds that an increase in the degree of competition for health maintenance organization (HMO) patients is associated with a decrease in risk‐adjusted hospital mortality rates. Conversely, an increase in competition for Medicare enrollees is associated with an increase in risk‐adjusted mortality rates for hospitals.Conclusions. In conjunction with previous research, the estimates indicate that increasing competition for HMO patients appears to reduce prices and save lives and hence appears to improve welfare. However, increases in competition for Medicare appear to reduce quality and may reduce welfare. Increasing competition has little net effect on hospital quality in our sample.
Does Aggressive Care Following Acute Myocardial Infarction Reduce Mortality? Analysis with Instrumental Variables to Compare Effectiveness in Canadian and United States Patient Populations
Authors: Beck Christine A. , Penrod John , Gyorkos Theresa W. , Shapiro Stan , Pilote Louise 
Published: December 2003

Background. Previous U.S. studies suggest that the incremental (“marginal”) use of the aggressive approach to care for acute myocardial infarction (AMI) in patients differing only in their distance to hospitals offering aggressive care may be associated with small mortality benefits. We hypothesized that the marginal benefits should be larger in Canada, as the country is operating on a lower margin because the approach to care is more conservative overall.Methods. This retrospective study used administrative data of hospital admissions and health services for all patients admitted for a first AMI in Quebec in 1988 (n=8,674). We used differential distances to hospitals offering aggressive care as instrumental variables when measuring mortality up to four years after AMI.Results. Of the 4,422 subjects who were ≥ 65 years old, 11 percent received cardiac catheterization within 90 days after admission. In a previous study that applied similar methodology to the 1987 U.S. Medicare population, 23 percent of subjects received catheterization within 90 days. As in the U.S. study, we found that subjects living closer to hospitals offering aggressive care were more likely to receive aggressive care than subjects living further away (26 percent versus 19 percent received cardiac catheterization within 90 days; 95 percent CI: 5 percent to 9 percent). Unlike the U.S. study, we found no differences in mortality across the “close” versus “far” differential distance groups (unadjusted differences at one year: 1 percent; 95 percent CI: −1 percent to 3 percent). This absence of association held in elderly (≥ 65 years) and younger age groups. Adjusted results also showed no differences between subjects receiving aggressive versus conservative care (at one year: 4 percent; 95 percent CI: −11 percent to 20 percent).Conclusions. Contrary to our hypothesis, but consistent with results from numerous randomized trials and observational studies, we cannot confirm that, on the margin, the aggressive approach to post‐AMI care is associated with mortality benefits in Canada.
Mental Health Services Use among School‐Aged Children with Disabilities: The Role of Sociodemographics, Functional Limitations, Family Burdens, and Care Coordination
Authors: Witt Whitney P. , Kasper Judith D. , Riley Anne W. 
Published: December 2003

Objective. To examine the use of mental health services and correlates of receiving services among community‐dwelling children with disabilities, ages 6 to 17 years.Study Design. Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS‐D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17‐year‐olds self‐reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care.Principal Findings. Among disabled children with poor psychosocial adjustment (11.5 percent), only 41.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning‐related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings.Conclusions. Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process.
Psychometric Properties of the Consumer Assessment of Health Plans Study (CAHPS®) 2.0 Adult Core Survey
Authors: Lee Hargraves J. , Hays Ron D. , Cleary Paul D. 
Published: December 2003

Objective. To estimate the reliability and validity of survey measures used to evaluate health plans and providers from the consumer's perspective.Data Sources. Members (166,074) of 306 U.S. health plans obtained from the National CAHPS® Benchmarking Database 2.0, a voluntary effort in which sponsors of CAHPS® surveys contribute data to a common repository.Study Design. Members of privately insured health plans serving public and private employers across the United States were surveyed by mail and telephone. Interitem correlations and correlations of items with the composite scores were estimated. Plan‐level and internal consistency reliability are estimated. Multivariate associations of composite measures with global ratings are also examined to assess construct validity. Confirmatory factor analysis is used to examine the factor structure of the measure.Findings. Plan‐level reliability of all CAHPS® 2.0 reporting composites is high with the given sample sizes. Fewer than 170 responses per plan would achieve plan‐level reliability of .70 for the five composites. Two of the composites display high internal consistency (Cronbach's alpha >=.75), while responses to items in the other three composites were not as internally consistent (Cronbach's alpha from .58 to .62). A five‐factor model representing the CAHPS® 2.0 composites fits the data better than alternative two‐ and three‐factor models.Conclusion. Two of the five CAHPS® 2.0 reporting composites have high internal consistency and plan‐level reliability. The other three summary measures were reliable at the plan level and approach acceptable levels of internal consistency. Some of the items that form the CAHPS® 2.0 adult core survey, such as the measure of waiting times in the doctor's office, could be improved. The five‐dimension model of consumer assessments best fits the data among the privately insured; therefore, consumer reports using CAHPS® surveys should provide feedback using five composites.
Sampling Patients within Physician Practices and Health Plans: Multistage Cluster Samples in Health Services Research
Authors: Adams John L. , Wickstrom Steven L. , Burgess Margaret J. , Lee Paul P. , Escarce José J. 
Published: December 2003

Objective. To better inform study design decisions when sampling patients within health plans and physician practices with multiple analysis goals.Study Setting. Chronic eye care patients within six health plans across the United States.Study Design. We developed a simulation‐based approach for designing multistage samples. We created a range of candidate designs, evaluated them with respect to multiple sampling goals, investigated their tradeoffs, and identified the design that is the best compromise among all goals. This approach recognizes that most data collection efforts have multiple competing goals.Data Collection. We constructed a sample frame from all diabetic patients in six health plans with evidence of chronic eye disease (glaucoma and retinopathy).Principal Findings. Simulations of different study designs can uncover efficiency gains as well as inform potential tradeoffs among study goals. Simulations enable us to quantify these efficiency gains and to draw tradeoff curves.Conclusions. When designing a complex multistage sample it is desirable to explore the tradeoffs between competing sampling goals via simulation. Simulations enable us to investigate a larger number of candidate designs and are therefore likely to identify more efficient designs.
The Association between Multiple Domains of Discrimination and Self‐assessed Health: A Multilevel Analysis of Latinos and Blacks in Four Low‐Income New York City Neighborhoods
Authors: Stuber Jennifer , Galea Sandro , Ahern Jennifer , Blaney Shannon , Fuller Crystal 
Published: December 2003

Objective.This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self‐assessed mental and physical health among Latinos and blacks.Data Source.Latino and black adult participants (n=873) identified by random digit dialing were interviewed by telephone in four low‐income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford‐Stuyvesant.Study Design.In this cross‐sectional study, generalized estimating equations were used to fit multilevel multivariable models to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood.Principal Findings.Discrimination due to race and discrimination due to other attributes were associated with poor self‐assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination.Conclusions.Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.