Parity Variables Research Articles

Design of fast fault tolerant reversible signed multiplier

Reversible logic circuits are emerging as a promising technology for power minimization. Parity preserving reversible circuits design will be very important for development of fault tolerant reversible systems in nanotechnology. In this paper, a fast fault tolerant reversible signed multiplier is proposed. In order to construct the multiplier, five variables parity preserving gate (F2PG) and modified new fault tolerant (MNFT) are designed, which are parity preserving reversible gates. The most significant aspect of F2PG is that it can work independently as a reversible fault tolerant full adder. Meanwhile, it can implement all Boolean functions. MNFT can reduce cross redundancy. The quantum implementations of F2PG and MNFT are also given. Otherwise, a new quantum implementation of the modified Islam gate (MIG) is presented. The Wallace tree is applied to improve the operating speed of the multiplier, which can implement the multiplication of two 5-bit binary signed numbers. Simulation and evaluation results indicate that the multiplier logic structure is correct with excellent performance. Key words: Parity preserving reversible gate, fault tolerant, five variables parity preserving gate (F2PG), modified new fault tolerant (MNFT), reversible signed multiplier.

Do ultradiscrete systems with parity variables satisfy the singularity confinement criterion?

Ultradiscrete singularity confinement test, which is an integrability detector for ultradiscrete equations with parity variables, is applied to various ultradiscrete equations. The ultradiscrete equations exhibit singularity structures analogous to those of the discrete counterparts. Exact solutions to linearisable ultradiscrete equations are also constructed to explain the singularity structures.

Clinical score for the outcome of external cephalic version: A two‐phase prospective study

To design a score based on clinical parameters to predict the outcome of external cephalic versions (ECVs) at term. A two-phase study was conducted (analysis/design and prospective validation) regarding 1000 versions performed between March 2002 and November 2010. The variables considered in the score were selected based on the results of multiple logistic regression models and multiple correspondence analyses published by our group. The predictive capacity was estimated through the area under the ROC curve. The success rates for ECV in phases 1 and 2 were 52.2 and 51.2%, respectively, making the overall success rate 51.7%. The score was designed with the variables parity, placental location, breech variety and amount of amniotic fluid giving a value for each one. A clinical recommendation, based on the result of the score, was the estimated success rate with the 95% confidence interval. The predictive capacity of the score for the outcome of ECV at term was 70.1% (95% CI 66.9-73.4). A score composed of four easily measurable variables enabled us to predict the outcome of ECV at term.

Ultradiscrete Painlevé II equation and a special function solution

Ultradiscretization with parity variables, which keeps the information of original variables’ sign, is applied to the q-Painlevé II equation of type A6 (q-PII). A special solution of the resulting ultradiscrete system, which corresponds to the special function solution of q-PII, is constructed. Ultradiscrete analogues of the q-Airy equation and its special solutions are also discussed in the process.

High prevalence of polycystic ovary syndrome in women born small for gestational age

There is evidence that intrauterine growth restriction, resulting in newborn girls that are small for gestational age (SGA), may be related to the onset of polycystic ovary syndrome (PCOS). Thus, we studied whether women born SGA have a higher prevalence of PCOS than women born appropriate for gestational age (AGA). This was a prospective birth cohort study of 384 women born at term between June 1, 1978, and May 31, 1979, in Ribeirão Preto, Brazil. After exclusion, 165 women effectively participated in this study, of whom 43 were SGA and 122 were AGA. The prevalence of PCOS was analysed. At a mean age of 29 years, the women agreed to follow the study protocol, which included: anamnesis, physical examination, serum tests [follicle stimulating hormone, luteinizing hormone, total and free testosterone, dehydroepiandrostenedione sulphate, 17-OH-progesterone, fasting insulin, sex steroid-binding globulin (SHBG) and fasting glucose] and pelvic ultrasound. Data regarding gestational age, birthweight, age at menarche and maternal data were obtained from the files of the cohort. The adjusted relative risk (RR) values of the SGA, insulin resistance, body mass index, maternal smoking and parity variables were analysed using Poisson regression with robust adjustment of variance for the prediction of PCOS. The prevalence of PCOS was higher in the SGA group than in the AGA group [adjusted RR = 2.44, 95% CI (1.39-4.28)]. Hyperandrogenism was more prevalent in the SGA women than in the AGA women (P = 0.011). Circulating SHBG was lower in the SGA women than in the AGA women (P = 0.041), but fasting insulinemia was similar in both groups. The prevalence of PCOS in SGA women was twice as high as in AGA women in our study population.

Changing maternity leave policy: Short-term effects on fertility rates and demographic variables in Germany

Changes in reproductive behaviour and decreasing fertility rates have recently led to policy actions that attempt to counteract these developments. Evidence on the efficacy of such policy interventions, however, is limited. The present analysis examines fertility rates and demographic variables of a population in Germany in response to new maternity leave regulations, which were introduced in January 2007. As part of a population-based survey of neonates in Pomerania (SNiP), all births in the study region from the period 23 months prior to January 1st, 2007 until 23 months afterwards were examined. Crude Birth Rates (CBR) per month, General Fertility Rates (GFR) per month, parity and sociodemographic variables were compared using bivariate techniques. Logistic regression analysis was performed. No statistically significant difference in the CBR or GFR after Jan. 1st, 2007 was found. There were statistically significant differences in other demographic variables, however. The proportion of mothers who (a) were employed full-time before pregnancy; (b) came from a higher socioeconomic status; and (c) had higher income levels all increased after January 1st, 2007. The magnitude of these effects was higher in multigravid women. Forward stepwise logistic regression found an odds ratio of 1.79 for women with a family income of more than 3000 euro to give birth after the new law was introduced. This is the first analysis of population-based data that examines fertility rates and sociodemographic variables in response to new legal regulations. No short-term effects on birth rates were detected, but there was a differential effect on the subgroup of multigravidae. The focus of this policy was to provide financial support, which is certainly important, but the complexity of having a child suggests that attitudinal and motivational aspects also need to be taken into account. Furthermore, these analyses were only able to evaluate the short-term consequences of the policy; further studies are needed to assess for different, long-term effects.

Detection of Stationarity in Nonlinear Processes: A Comparison between Structural Breaks and Three-Regime TAR Models

The three-regime threshold autoregressive (TAR) model with a unit root process in the middle regime and the structural breaks (SB) model with level shifts are important and popular models for studying economic theories such as purchasing power parity (PPP) and economic variables with regime shifts. These nonlinear models have a significant influence on unit root tests. It is possible that the persistence of a variable becomes higher and the power of the unit root tests develops distortions if the form of the regime shifts is misspecified. This paper investigates the ability of unit root tests to detect stationarity in misspecified SB and three-regime TAR models. We show that the misspecified SB model has high persistence, similar to an autoregressive (AR) model, when the true process is a three-regime TAR process. On the other hand, unlike the AR model, the misspecified three-regime TAR model does not have persistence, when the true process is one with SB. The results of the Monte Carlo simulations demonstrate that a unit root test performed in the misspecified three-regime TAR model has more power even under processes with SB, whereas a unit root test undertaken in the misspecified SB model does not perform well under three-regime TAR processes. We also provide some instances of applications in economic variables that would have regime shifts.

Assess the Knowledge Regarding Pre-eclampsia and Its Self-care Measures among Antenatal Women Attending Antenatal Outpatient Department of KLES Dr Prabhakar Kore Hospital, Belgaum

ABSTRACT The objectives of study were to assess the knowledge regarding pre-eclampsia and self-care measures among pregnant woman. Find out an association between knowledge regarding pre-eclampsia and self-care measures and selected variables, develop an informational booklet on pre-eclampsia and self-care measures. Methods The design selected for the study is descriptive design. The study was conducted on 108 antenatal mothers below 20 weeks of gestational age and who are attending antenatal outpatient department of Dr KLES Prabhakar Kore's Hospital, Belgaum. Non- probability purposive sampling technique was used. The tool included background proforma, knowledge and self-care measures questionnaire on preeclampsia. The data was analyzed in terms of both descriptive and inferential analysis. Results Data analysis of level of knowledge revealed majority of mothers 80(74.07%) had average knowledge, 14(12.96%) had good and poor knowledge; and with regards to self-care measures (60.18%) had average knowledge, 41(37.96%) had good knowledge and 2(1.85%) had poor knowledge, association between the knowledge of mothers and selected variables revealed that the variables age, educational status, occupational status, income, religion, parity and area of residence shows an association with knowledge scores at 0.05 level of significance. Association between the self-care measures scores of mothers and selected variables revealed that the variables age, educational status, occupational status, income, religion and parity shows an association with knowledge scores at 0.05 level of significance. The variable type of family and area of residence in relation with knowledge scores of mothers are independent of each other. Conclusion The world has come a long way from the times when a woman surviving childbirth was considered to be blessed with a 'second life’ to the present. Application of appropriate prenatal care and management has largely eliminated maternal mortality frequently at the cost of preterm delivery. Based on the findings of the study, it is concluded that most of the subjects had average knowledge regarding preeclampsia and its self-care measures.

Term Labor Induction Compared With Expectant Management

To determine whether changing the definition of the group to which induction is being compared (ie, noninduced delivering during the same week as those induced compared with two definitions of expectant management) changes the association of labor induction and increased cesarean risk. A New York State birth-certificate database was used to estimate odds ratios for cesarean delivery associated with labor induction at term. The analyses used three definitions of controls: cesarean delivery after induction compared with after spontaneous labor by week (week-to-week), induction at a given gestation age compared with expectant management of all other women after gestational age (all above), or induction at a given gestational age compared with expectant management of all other women at or after that gestational age (at or above). Chi-square logistic regression was used for comparisons and adjustment for possible confounders. All variations of comparison groups were associated with increased unadjusted cesarean risk after induction, although not after 39 weeks in the all-above group. After adjustment, increased risk persisted from 37 to 41 weeks using the week-to-week group and from 38 to 41 weeks in the at-or-above group (odds ratios 1.24 to 1.45) but was no longer significant in the all-above group. The excess cesarean delivery risk associated with labor induction is between 1 and 2 per 25 inductions. Labor induction is associated with increased cesarean risk whether using a week-to-week comparison group or an expectant group that includes women the same week or beyond that of the index induction, even after adjustment for parity, high-risk factors, and demographic variables. Although the magnitude of increased risk for a given woman undergoing induction is not large, women nonetheless should be informed of this increased risk. II.

Singularity confinement test for ultradiscrete equations with parity variables

We present a new ultradiscretization method which does not require that the solutions of the discrete equation have a fixed sign. We construct an ultradiscrete analogue of the singularity confinement test using this method and thereby propose an integrability test for ultradiscrete equations.

Family-planning practices among women with diabetes and overweight and obese women in the 2002 National Survey For Family Growth.

OBJECTIVETo examine contraceptive practices among diabetic women and obese women.RESEARCH DESIGN AND METHODSWe analyzed the responses of 5,955 participants aged 20–44 years in the 2002 National Survey for Family Growth. Diabetes, BMI, desire for pregnancy, history of infertility treatment, sexual activity, parity, and demographic variables (age, race/ethnicity, education, marital status, income, insurance, and smoking history) were obtained by self-report. Lack of contraception was defined as absence of hormonal-, barrier-, or sterilization-based methods. Associations among contraception, diabetes, and BMI category were assessed in multivariable logistic regression models in nonsterile, sexually active women.RESULTSIn unadjusted comparisons among sexually active women who were not sterilized, women with diabetes were more likely to lack contraception than women without diabetes (odds ratio [OR] 2.61 [95% CI 1.22–5.58]). Women with BMI ≥35 kg/m2 were more likely to lack contraception than women with BMI <25 kg/m2(1.63 [1.16–2.28]), but associations between contraception use and lesser degrees of overweight and obesity were not significant. In multivariable models, women who were older (aged ≥30 vs. 20–29 years), were of non-Hispanic black race, were cohabitating, had a history of infertility treatment, and desired or were ambivalent about pregnancy were significantly more likely to lack contraception. The associations among diabetes, BMI, and contraception were no longer significant after these adjustments.CONCLUSIONSOlder women with diabetes and obesity who desire pregnancy, regardless of pregnancy intention, should be targeted for preconceptive management.

On Probabilistic Techniques for Data Flow Analysis

We present a semantics-based technique for analysing probabilistic properties of imperative programs. This consists in a probabilistic version of classical data flow analysis. We apply this technique to pWhile programs, i.e programs written in a probabilistic version of a simple While language. As a first step we introduce a syntax based definition of a linear operator semantics (LOS) which is equivalent to the standard structural operational semantics of While. The LOS of a pWhile program can be seen as the generator of a Discrete Time Markov Chain and plays a similar role as a collecting or trace semantics for classical While. Probabilistic Abstract Interpretation techniques are then employed in order to define data flow analyses for properties like Parity and Live Variables.

Smoking and Other Lifestyle Factors and the Risk of Graves’ Hyperthyroidism

Hyperthyroidism caused by Graves' disease is common in women, yet little is known about risk factors for the disease. We sought to determine whether lifestyle factors, including smoking, alcohol consumption, physical activity level, and body mass index, are risk factors for Graves' hyperthyroidism. This analysis was conducted using data from the Nurses' Health Study II, among 115109 women aged 25 to 42 at entry. Incident reports of women with Graves' hyperthyroidism, confirmed to have the disorder, were included. During 1 328 270 person-years of follow-up, incident diagnoses of Graves' hyperthyroidism were confirmed in 543 women; the 12-year incidence was 4.6 per 1000 women. Cigarette smoking was a predictor of Graves' hyperthyroidism. The hazard ratio among current smokers was 1.93 (95% confidence interval [CI], 1.54-2.43), and among past smokers it was 1.27 (95% CI, 1.03-1.56), after adjusting for recent pregnancy, parity, and other variables. Among current smokers, the hazard ratio increased with the intensity of smoking and was 2.63 (95% CI, 1.71-4.04) among women who smoked 25 or more cigarettes daily. Obesity was associated with a decreased risk of Graves' hyperthyroidism. The hazard ratio for the disorder among women with a body mass index of 30 kg/m(2) or higher was 0.68 (95% CI, 0.49-0.92). Alcohol intake and physical activity level were not associated with risk of Graves' hyperthyroidism. Smoking is a risk factor for Graves' hyperthyroidism in women. Obesity may be associated with a reduced risk, although weight loss as the first manifestation of hyperthyroidism cannot be excluded.

Early anthropometric measures and reproductive factors as predictors of body mass index and obesity among older women

To examine whether early anthropometric measures and reproductive factors were associated with body mass index (BMI), overweight, and obesity. Cross-sectional, observational study. In all, 18 109 healthy women who participated in the Swedish Mammography Cohort aged 49-83 y. Early anthropometric (birthweight and body shape at age 10 y) and reproductive (age at menarche, age at the birth of the first child, and parity) variables were our predictors and current BMI, overweight (BMI 25-29.99 kg/m(2)), and obesity (BMI > or =30 kg/m(2)) were our outcomes. In multivariate-adjusted polytomous logistic regression analysis, risk of overweight and obesity increased with increasing body shape at age 10 y and decreased with increasing age at menarche and age at first birth (P for trend <0.0001). A U-shaped relation with birthweight was observed. In our tests for effect modification of the relation with overweight/obesity (ow/ob; BMI > or =25 kg/m(2)), we detected significant interactions between body shape at 10 y and age (P<0.0001); body shape at 10 y and physical activity (P<0.0001); age at first birth and smoking (P=0.02); and parity and physical activity (P=0.004). The increased risk of ow/ob among women who reported a larger childhood body shape was reduced as women moved from the lowest to highest quartile of physical activity in adulthood. Likewise, the increasing risk of ow/ob among women with greater parity was reduced with increased physical activity. Early anthropometric measures and reproductive factors are significantly associated with BMI, overweight, and obesity among older women. The effects of childhood body weight, age at first birth, and parity may be modified by adult lifestyle choices, as well as age.

P02.14: Continuous vacuum depression vs. syringe amnioreduction for polyhydramnios: a prospective randomised study

Objectives: To prospectively compare the efficacy and tolerance of two techniques of amniodrainage used in the treatment of symptomatic polyhydramnios: syringe aspiration (SA) and continuous vacuum depression (VD). Patients and Methods: Prospective randomised study, performed over 37 months. The main comparison criterion was maternal pain, blindly assessed by a midwife using a visual quantitative scale (EVA from 0 to 100 points). Comparison also included: duration and volume of fluid drained, need to stop the procedure because of maternal pain, uterine activity after drainage, foetal tolerance controlled with CTG (FHR blindly analysed by 2 obstetricians) and absence of placenta abruption controlled by histological examination of the placenta. We calculated that 35 patients would be necessary in each group to show a 20 points difference on the EVA with a power of 80% (alpha: 0.05). Results: 80 amnioreductions were performed in 53 patients. The two groups were comparable for the tested variables (age, parity, term, deepest pool and amniotic fluid index before drainage, uterine contractility, tocolysis) as well as for the aetiology of polyhydramnios. Drained volume was significantly higher in the VD group (2540 ml +/− 860 versus 1250 ml +/− 530; p < 0.01) and the drainage duration significantly shorter (12 mn +/− 10 versus 38 mn +/− 25; p < 0.01). Maternal pain was significantly lower in the VD group compared to the SA group (25 +/− 12 vs. 55 +/− 22; p < 0.01). No significant difference was noted in uterine contractility or FHR abnormalities between the two groups and they were no occurrence of clinical placental abruption. In four cases, histological analysis of the placentas revealed the presence of old placental infarctions (three in the SA group and one in the VD group). Conclusion: Continuous vacuum depression appears to be faster and has a better maternal tolerance than syringe aspiration.

Systematic clinical examinations for identification of latent udder health types in Danish dairy herds.

A cross-sectional study was conducted to explore the applicability of systematic clinical examinations of udders as an additional tool for the evaluation of udder health status on dairy farms. During 2000, each of the 16 dairy farms was visited 5 times; 20 cows per farm were chosen at random at each visit for clinical udder examination immediately after milking. The clinical examination included both pathological and morphological variables. One examination per cow was included in the analysis (n = 707 cows). Principal component analysis (PCA) was performed in 3 steps. First, 19 variables characterizing udder and teats were analyzed (PCA 1). Second, the variables parity and stage of lactation were included (PCA 2). Finally, somatic cell count (SCC) and milk yield (PCA 3) were included. The PCA resulted in 4 components that explained 30% of the variation of the data: 1) small udder, 2) distressed udder, 3) mastitis udder, and 4) soiled udder. Variables with high positive correlation to the "small udder" were small udder shape, short teats, and first parity. Impaired teat surface, hard udder texture, and a long udder shape were related to the "distressed udder." The "mastitis udder" was characterized by the clinical variables asymmetry between front quarters, asymmetry between hind quarters, knotty tissue, and acute clinical mastitis. Reduced milk yield and high SCC were related to the "mastitis udder," whereas low SCC was related to the "small udder." The "soiled udder" was related to early lactation. Including this information in the assessment of udder health may be of substantial value for data analysis in farms with suspected under-reporting of clinical mastitis.

MSJAMA. Maternal-fetal attachment.

MATERNAL-FETAL ATTACHMENT (MFA) IS A TERM USED TO DEscribe the relationship between a pregnant woman and her fetus. Qualitative descriptions of maternal attitudes and adaptation to pregnancy indicate that MFA is based on cognitive representations of the fetus. These may include imagined scenarios between mother and child, as well as a mother’s attribution of physical and emotional characteristics to the fetus. MFA is manifested in behaviors that demonstrate care and commitment to the fetus and include nurturance (eating well, abstaining from harmful substances, such as alcohol), comforting (stroking the belly), and physical preparation (buying baby clothes and equipment). The concept of MFA is relatively new and has not been well studied or defined. Inquiry into a woman’s psychological reaction and adjustment during pregnancy began in the 1970s. Prior to that time, there are few scientific data available on women’s thoughts or feelings about their pregnancies. Historical and literary accounts of women’s experiences in childbirth prior to the 20th century reveal that women were primarily concerned with enduring and surviving pregnancy. Letters written by women in the 19th century show evidence of maternal projections about the expected child as well as feelings of loss from a miscarriage or infant death. Writings of their own physical suffering and fear of death were more common. The declining mortality rate and technological developments in western nations over the past 30 to 40 years have changed conceptions about pregnancy and the fetus. Women can detect pregnancy earlier and are able to view highresolution images of their fetus at earlier dates. This knowledge may serve to allow women to adopt optimal health practices earlier. The implications of MFA for maternal and fetal health are now studied in other countries and across cultures of developed nations, including China, Germany, Sweden, Israel, and Japan. MFA has not been studied in developing nations in which the mortality rate for women and infants remains at or above 40%. A broad spectrum of MFA has been observed during pregnancy. The frequency and intensity of MFA behaviors increase with advancing gestational age, particularly after quickening at approximately 18 to 22 weeks of gestation. The rate and degree of MFA development appears to be influenced by gestational age at quickening, amount of fetal movement, pregnancy history, and the mother’s own attachment history. Three scales measuring psychometric properties have been developed to quantify MFA. While original versions of the 3 scales may be limited in their sensitivity to cultural experience, revisions in other countries suggest that adequate adaptation of these scales may be possible. MFA as measured by these scales is consistently related to pregnancy planning, strength of the marital relationship, gestational age, and maternal depressed mood. The variables of maternal age, parity, self-esteem, and socioeconomic status are inconsistently related to MFA across studies. Social support of family members and peers is a significant predictor of MFA. Perceived support of prenatal care providers was correlated with MFA at 0.74, providing further evidence that psychosocial support is a critical component of prenatal care. Maternal mood state has also been consistently related to ratings of MFA. It has been reported that depression during pregnancy is related to poor prenatal health demonstrated by poor weight gain, drug abuse, and smoking. The relative paucity of research on MFA is limited due to methodological problems, including inadequate operational definition of the construct; small, homogeneous samples; and lack of sensitivity to cultural issues. Little is known about the process by which MFA develops, including psychological and physiological mechanisms that could shape the development of MFA. Future studies should focus on improved measurement of MFA in large, diverse samples.

Anal sphincter electromyography after vaginal delivery: neuropathic insufficiency or normal wear and tear?

The study was performed to evaluate the potential role of vaginal delivery on innervation of the external anal sphincter (EAS) muscle. Forty-four women, 18 nulliparous and 26 of varying parity (1-4), without genitourinary prolapse, major urogynecological, anorectal, or neurological dysfunction were included. Participants' histories were evaluated by a questionnaire. Quantitative concentric needle electromyography (EMG) using multi-MUP analysis for sampling motor unit potentials (MUPs) in all volunteers, and "turn/amplitude" analysis for interference pattern (IP) analysis in 13 nulliparous and 23 parous women were applied. Pools of MUPs and IPs of parous and nulliparous women were formed and compared using the Mann-Whitney U test. Multiple linear regression analysis was used for evaluation of parity and obstetric variables. No difference between the groups was found in any MUP parameter, while a significant difference was found in two of five IP parameters. On multiple linear regression analysis, the number of deliveries was related to several MUP and IP parameters: the time elapsed since last delivery to MUP, and slight stress urinary incontinence to IP parameters. A group of parous women with (slight) stress incontinence had less "pathologic" MUP parameters, compared to those without. Vaginal delivery is indeed related to EAS muscle EMG abnormalities. However, these are minor and seem not to indicate loss of sphincter function. Our study casts some doubt on the commonly accepted preconception that significant damage to peripheral innervation of the EAS occurs even during uncomplicated deliveries.

Clinical outcomes and maternal perceptions of an updated model of perinatal care.

Postpartum hospital stays seem likely to remain limited even under new laws which mandate that insurers cover 48-hour hospitalization after uncomplicated delivery. Clinicians, who are increasingly practicing in capitated arrangements, need better information to maximize clinical benefit to mothers and newborns using finite resources. OBJECTIVE AND INTERVENTIONS: This study's aim was to evaluate the clinical outcomes, patient perceptions, and costs of a revised model of perinatal care services. In this model, a new postpartum care center was established for routine follow-up of newborns within 48 hours after hospital discharge, educational efforts were shifted from the postpartum hospitalization to the prenatal period, and lactation consultant hours were increased. Controlled, nonrandomized (double cohort) study that compared mothers and newborns with hospital stays of 48 hours or less during the Baseline Care (preintervention) study period (N = 344) with those under the Revised Care (postintervention) study period (N = 456). The Hayward, California, medical center of Kaiser Permanente, a nonprofit health maintenance organization. Telephone interviews were attempted with all mothers 3 weeks after delivery. Data on rehospitalizations, emergency department (ED) and clinic visits, and costs during the first 14 postpartum days were collected from computerized databases and chart review. The combined clinical outcome was defined as any undesirable health event, including rehospitalization, an ED visit, or an urgent clinic visit by either the mother or newborn within the first 14 days postpartum, or breastfeeding discontinuation within the first 21 days postpartum. Maternal satisfaction and costs were also studied. Of 876 attempted interviews, 800 were completed (91%). Analyses were adjusted for age, race, education, parity, breastfeeding experience, and other relevant variables. Among the interviewed mother-newborn pairs, 45% in the Revised Care group experienced the combined clinical outcome, compared with 52% in the Baseline Care group. Newborns in the Revised Care group (29%) were significantly less likely to make urgent clinic visits during the first 14 days of life than those in the Baseline Care group (36%). There were no differences between groups in newborn ED visits or rehospitalizations, maternal clinical outcomes, or breastfeeding continuation. Mothers in the Revised Care group expressed higher satisfaction with the newborn's care, the amount of information they received about newborn care and breastfeeding, and the amount of help they received with breastfeeding. Planned hospital care, planned follow-up visits, and unplanned care costs decreased by $149 per delivery, while the new prenatal class and increased lactation consultant services cost $58 per delivery, for an estimated overall reduction in cost. We conclude that the revised model of perinatal care in this health maintenance organization medical center improved clinical outcomes and maternal satisfaction for low-risk mothers and newborns without increasing costs.

Indications for episiotomy at public maternity clinics in Nequén, Argentina

Indications for performing episiotomy during vaginal births are a controversial topic requiring worldwide review. In Neuquén Province, Argentina, when standards for low-risk childbirth were developed in 1995, they included the provision to limit episiotomies to cases at high risk for spontaneous laceration. The present retrospective cohort study was designed for comparing the criteria applied in 1996 as indications for episiotomy in public maternity services of Neuquén Province, as well as the effect of parity and other variables on its frequency. The Perinatal Data System yielded 7,513 medical records for review, which represented 70% of all the institutional births during the year. Of these records, 830 dealing with cesarean sections did not qualify for the study. The remaining 6,683 records were divided into eight groups according to hospital location. Episiotomy incidence rates were estimated for those eight groups and the Poisson regression was applied in order to adjust for birthweight, number of siblings, mother's age, and type of birth presentation and outcome. Taking the Neuquén Hospital data as baseline because of its higher complexity and large number of births taking place there, two hospitals had episiotomy incidence rates equal to 70% (95% CI: 62%-79%) and 67% (95% CI: 57%-78%) of the Neuquén Hospital rates. Two other hospitals had incidence rates which were higher by 28% (95% CI: 13%-45%) and 17% (95% CI: 2-35%), while the remaining hospitals showed no significant differences. Stratified regression by number of previous vaginal births showed parity to be the strongest influencing variable on indications for episiotomy. Rates for nulliparous women showed no differences by hospital, but rates for primiparous women did, with even stronger differences shown for multiparous women. The authors concluded that all institutions included in the study performed episiotomies as a virtually routine procedure on nulliparous women, that there are significant differences in their indications for primiparous women, and that those differences increase along with parity. These differences seem to show that maternity clinics in the Province of Neuquén vary widely in their criteria for episiotomy indications.