Joy L. Herndon

Bio: Joy L. Herndon is an academic researcher from Centers for Disease Control and Prevention. The author has contributed to research in topics: Abortion & Public health. The author has an hindex of 11, co-authored 15 publications receiving 1977 citations.

Pregnancy-related mortality surveillance--United States, 1991--1999.

Abstract: Problem/condition The risk of death from complications of pregnancy has decreased approximately 99% during the twentieth century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982. However, since 1982, no further decrease has occurred in maternal mortality in the United States. In addition, racial disparity in pregnancy-related mortality ratios persists; since 1940, mortality ratios among blacks have been at least three to four times higher than those for whites. The Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; substantial improvements are needed to meet the same objective for Healthy People 2010. Reporting period covered This report summarizes surveillance data for pregnancy-related deaths in the United States for 1991-1999. Description of system The Pregnancy Mortality Surveillance System was initiated in 1987 by CDC in collaboration with state health departments and the American College of Obstetricians and Gynecologists Maternal Mortality Study Group. Health departments in the 50 states, the District of Columbia, and New York City provide CDC with copies of death certificates and available linked outcome records (i.e., birth certificates or fetal death certificates) of all deaths occurring during or within 1 year of pregnancy. State maternal mortality review committees, the media, and individual providers report a limited number of deaths not otherwise identified. Death certificates and relevant birth or fetal death certificates are reviewed by clinically experienced epidemiologists at CDC to determine whether they are pregnancy-related. Results During 1991-1999, a total of 4,200 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 11.8 deaths per 100,000 live births and ranged from 10.3 in 1991 to 13.2 in 1999. The pregnancy-related mortality ratio for black women was consistently higher than that for white women for every characteristic examined. Older women, particularly women aged >/= 35 years and women who received no prenatal care, were at increased risk for pregnancy-related death. The distribution of the causes of death differed by pregnancy outcome. Among women who died after a live birth (i.e., 60% of the deaths), the leading causes of death were embolism and pregnancy-induced hypertension. Interpretation The reported pregnancy-related mortality ratio has substantially increased during 1991-1999, probably because of improved ascertainment of pregnancy-related deaths. Black women continued to have a 3-4 times higher pregnancy-related mortality ratio than white women. In addition, pregnancy-related mortality has the largest racial disparity among the maternal and child health indicators. Reasons for this difference could not be determined from the available data. Public health actions Continued surveillance and additional studies should be conducted to monitor the magnitude of pregnancy-related mortality, to identify factors that contribute to the continuing racial disparity in pregnancy-related mortality, and to develop effective strategies to prevent pregnancy-related mortality for all women. In addition, CDC is working with state health departments, researchers, health-care providers, and other stakeholders to improve the ascertainment and classification of pregnancy-related deaths.

Abortion surveillance--United States, 1999.

Abstract: PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions and to monitor unintended pregnancy. REPORTING PERIOD COVERED: This report summarizes and describes data reported to CDC regarding legal induced abortions obtained in the United States in 1999. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. From 1973 through 1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. Beginning in 1998, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these areas were not estimated. The availability of data regarding the characteristics of women who obtained an abortion in 1999 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions is reported by state of residence and also by state of occurrence for most areas; characteristics of women obtaining abortions in 1999 are reported by state of occurrence. RESULTS: A total of 861,789 legal induced abortions were reported to CDC for 1999, representing a 2.5% decrease from the 884,273 legal induced abortions reported by the same 48 reporting areas for 1998. The abortion ratio, defined as the number of abortions per 1,000 live births, was 256 in 1999, compared with 264 reported for 1998; the abortion rate for these 48 reporting areas was 17 per 1,000 women aged 15-44 years for 1999, the same as in 1997 and 1998. The highest percentages of abortions were reported for women aged or = 21 weeks. A total of 27 reporting areas submitted data stating that they performed medical (nonsurgical) procedures (two of these areas categorized medical abortions with "other" procedures), making up < 1.0% of all procedures reported from all reporting areas. In 1998 (for which data have not been published previously and the most recent year for which such data are available), nine women died as a result of complications from known legal induced abortion; no deaths were associated with known illegal abortion. INTERPRETATION: From 1990 through 1997, the number of legal induced abortions gradually declined. In 1998 and in 1999, the number of abortions continued to decrease when comparing the same 48 reporting areas. In 1998, as in previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTION: Abortion surveillance in the United States should continue so that trends and characteristics of women who obtain legal induced abortions can be examined and efforts to prevent unintended pregnancy can be enhanced.

Homicide: A Leading Cause of Injury Deaths Among Pregnant and Postpartum Women in the United States, 1991–1999

Abstract: OBJECTIVES: We identified risk factors for pregnancy-associated homicide (women who died as a result of homicide during or within 1 year of pregnancy) in the United States from 1991 to 1999. METHODS: Pregnancy-associated homicides were analyzed with data from the Pregnancy Mortality Surveillance System at the Centers for Disease Control and Prevention. RESULTS: Six hundred seventeen (8.4%) homicide deaths were reported to the Pregnancy Mortality Surveillance System. The pregnancy-associated homicide ratio was 1.7 per 100000 live births. Risk factors included age younger than 20 years, Black race, and late or no prenatal care. Firearms were the leading mechanism for homicide (56.6%). CONCLUSIONS: Homicide is a leading cause of pregnancy-associated injury deaths.

Detection of aberrations in the occurrence of notifiable diseases surveillance data.

Abstract: The detection of unusual patterns in the occurrence of diseases and other health events presents an important challenge to public health surveillance. This paper discusses three analytic methods for identifying aberrations in underlying distributions. The methods are illustrated on selected infectious diseases included in the National Notifiable Diseases Surveillance System of the Centers for Disease Control. Results suggest the utility of such an analytic approach. Further work will determine the sensitivity of such methods to variations in the occurrence of disease. These methods are useful for evaluating and monitoring public health surveillance data.

Application of multiple time series analysis to the estimation of pneumonia and influenza mortality by age 1962–1983

Abstract: We employed multiple time series analysis to estimate the impact of influenza on mortality in different age groups, using a procedure for updating estimates as current data become available from national mortality data collected from 1962 to 1983. We compared mortality estimates that resulted from a multivariate model for epidemic forecasting with those obtained from univariate models. We found more accurate prediction of deaths from all age groups using the multivariate model. While the univariate models show an adequate fit to the data, the multivariate model often enables earlier detection of epidemics. Additionally, the multivariate approach provides insight into relationships among different age groups at different points in time. For both models, the largest excess mortality due to pneumonia and influenza during influenza epidemics occurred among those 65 years of age and older. Although multiple time series models appear useful in epidemiologic analysis, the complexity of the modelling process may limit routine application.

Food-related illness and death in the United States.

Abstract: To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.

Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock

Abstract: To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A–E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. Participants included 44 critical care and infectious disease experts representing 11 international organizations. A total of 46 recommendations plus pediatric management considerations. Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available.

Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults

Abstract: John G. Bartlett,1 Scott F Dowell,2 Lionel A. Mandell,6 Thomas M. File, Jr.,3 Daniel M. Musher,4 and Michael J. Fine5 'Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Centers for Disease Control and Prevention, Atlanta, Georgia, 3Northeastern Ohio Universities College of Medicine, Cleveland, Ohio, 4Baylor College of Medicine and Veterans Affairs Medical Center, Houston, Texas, and 5University of Pittsburgh, Pennsylvania, USA; and 6McMaster University, Toronto, Canada

Food-related illness and death in the United States.

Abstract: correctly identified E. faecium and E. faecalis to the species level, most (4 of 5) did not correctly identify E. gallinarum (three misidentified it as E. casseliflavus and one as E. faecalis). The results of this study are consistent with those of previous studies in the United States (4,5), South America (6), Spain (7), and Mexico (8). Although in countries like Chile, disk diffusion is practical and reliable for most susceptibility testing, detecting low-level vancomycin resistance in enterocci is difficult without supplementary testing. In Chile, as in other countries, strategies should be implemented to improve detection of these strains, including improvement of phenotypical and genotypical methods for VRE detection and species identification. Documentation of proficiency in detecting VRE is important for improving laboratory performance, detecting clinical isolates, and accurate and reliable reporting to local, national, and international surveillance systems.

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.

Abstract: CONTEXT: Many pregnancies are unintended, particularly in certain population groups. Determining whether unintended pregnancy rates and disparities in rates between subgroups are changing may help policymakers target reproductive health services to those women most in need. METHODS: To calculate rates of unintended pregnancy and related outcomes, data on pregnancy intendedness from the 2002 National Survey of Family Growth were combined with birth, abortion and population data from federal, state and nongovernmental sources. RESULTS: In 2001, 49% of pregnancies in the United States were unintended. The unintended pregnancy rate was 51 per 1,000 women aged 15–44, meaning that 5% of this group had an unintended pregnancy. This level was unchanged from 1994. The rate of unintended pregnancy in 2001 was substantially above average among women aged 18–24, unmarried (particularly cohabiting) women, low-income women, women who had not completed high school and minority women. Between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates and the wealthiest women, but increased among poor and less educated women. The abortion rate and the proportion of unintended pregnancies ending in abortion among all women declined, while the unintended birth rate increased. Forty-eight percent of unintended conceptions in 2001 occurred during a month when contraceptives were used, compared with 51% in 1994. CONCLUSIONS: More research is needed to determine the factors underlying the disparities in unintended pregnancy rates by income and other characteristics. The findings may reflect a need for increased and more effective contraceptive use, particularly among high-risk groups.