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OBJECTIVE: To investigate the relationship between prematurity and birth defects. STUDY DESIGN: In a population-based cohort study, infants with birth defects were ascertained through the Metropolitan Atlanta Congenital Defects Program, a surveillance system with active methods of ascertainment. Gestational age data were obtained from birth certificates of liveborn, singleton infants with and without birth defects born in the 5-county metropolitan Atlanta area. RESULTS: Among 264,392 infants with known gestational ages born between 1989 and 1995, 7738 were identified as having birth defects (2.93%). Premature infants (<37 weeks' gestation) were more than two times as likely to have birth defects than term infants (37-41 weeks) (risk ratio = 2.43; 95% CI 2.30-2.56). This relationship was evident for several categories of birth defects. The rate of birth defects varied by gestational age categories, with the highest risk in the 29- to 32-week gestational age category (risk ratio = 3.37). CONCLUSIONS: The risk for birth defects is increased in premature infants. Awareness of this relationship is important for clinicians caring for premature infants. The morbidity and mortality associated with a particular defect may be significantly altered by the presence of prematurity. Further study of this association may provide insight into the etiology of these relatively common problems.

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OBJECTIVES: Most Americans wish to live a long healthy life, but fear disease and dependency in their last years. Until recently, little has been known about the prevalence of opposite extremes of health in old age, particularly in the period leading up to death. METHODS: We used results from the 1986 National Mortality Follow-back Survey to estimate proportions of elderly decedents who were "fully functional" or "severely restricted" in the last year of life. Estimates were based on responses from proxies to questions regarding the decedent's functional status, mental awareness, and time spent in institutions. RESULTS: Approximately 14% of all decedents aged 65 years and older were defined as fully functional in the last year of life; 10% were defined as severely restricted. Proportions varied with the decedent's age and sex, the underlying cause of death, and the presence of other preexisting conditions. CONCLUSIONS: Results from this survey and future surveys can be used to learn more about "successful agers"--their medical histories, their life-styles, and whether their relative number is increasing or decreasing overtime.

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In 1981 the American Association of Gynecologic Laparoscopists and the Division of Reproductive Health, Centers for Disease Control, jointly conducted a study of vasectomies performed in outpatient facilities in 1980 in the United States. One hundred twenty-nine facilities that responded to either a mailed questionnaire or a telephone interview stated that vasectomies were performed there in 1980. The average cost was $273, with a range of $50-1,000. Facilities differed markedly in the use of anesthesia. Freestanding surgical centers reported the use of general anesthesia for 29% of the vasectomies. Other types of facilities were more likely to use local or regional anesthesia. Our data suggest areas for further research to improve the availability and safety of vasectomy.

PIP: In 1981 the American Association of Gynecologic Laparoscopists and the Centers for Disease Control conducted a survey of US clinics providing female and males sterilization procedures. This analysis provides new information on the numbers of vasectomies performed in 1980 in outpatient facilities, types of anesthesia used, cost, and lenght of postoperative stay. Results reveal that in 1980: 1) 10,394 vasectomies were performed in respondent facilities of all types; 70 freestanding surgical centers performed 4347 vasectomiew, and 32 family planning clinics performed 4163 vasectomies; 2) the average reported charge for a vasectomy in respondent facilities was $273, which included the physician's and anesthesia fees; 3) throughout the US, the average cost of a vasectomy was higher in freestanding surgical centers than in other facilities; 4) in all regions, 96% of the facilities other than freestanding surgical centers, reported only the use of local or regional anesthesia; 5) of the 11 facilities reporting that vasectomies cost more than $500, 82% reported that more than 75% of the vasectomies were done using general anesthesia; and 6) the mean postoperative stay for all reported vasectomies was 1.3 hours--facilities reporting higher percentages of general anesthesia use tended to have longer postoperative stays. This data address only 2% of the 520,000 vasectomies estimated to have been performed in the US in 1980. Although vasectomy is often considered a cheap, simple, safe, and effective outpatient procedure, in this study an unexpectedly high use of general anesthesia is found. In addition, vasectomy may be fairly expensive, sometimes costing as much of $1000, and the postoperative observation may not be as long as recommended.

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In 1981 the American Association of Gynecologic Laparoscopists and the Division of Reproductive Health, Centers for Disease Control, jointly conducted a study of tubal sterilizations performed in 141 freestanding, ambulatory-care surgical facilities in 1980 in the United States. Information was collected through mailed questionnaires and telephone interviews. Of 330 potential responding facilities, 141 we identified as freestanding, ambulatory-care surgical facilities. About 16,500 tubal sterilizations were performed in these facilities in 1980. The mean number of tubal sterilizations per freestanding, ambulatory-care surgical facility was 212. Sixty-seven percent of tubal sterilizations were performed in the south and west. General anesthesia was the anesthetic method used in 97% of the procedures. Nearly 91% of tubal sterilizations were done via laparoscopy, with bipolar electrocoagulation the tubal-occlusion method used most frequently. After tubal sterilization the patients were observed for an average of 2.4 hours before discharge. The average cost of laparoscopic tubal sterilization was $801; for nonlaparoscopic tubal sterilization it was $850.

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