Parathyroid Hormone and Its Functional Anatomy
Parathyroid Hormone secretion, structure, synthesis, and regulation are crucial for calcium homeostasis. The histological structure, mechanism of action on bone, and its role in the endocrine system are explained.
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January 2005-December 2011 Laurie Lee, RN, BSN, CCM FIMR Coordinator Northeast Florida Healthy Start Coalition
The FIMR Case Review Team meets bimonthly Review process developed by the American College of Obstetrics & Gynecology is used. Information abstracted from birth, death, prenatal care, Healthy Start, WIC, hospital and autopsy records. Efforts are also made to interview the family. All information is de-identified. Purpose is to determine specific medical, social, financial and other issues that may have impacted the poor birth outcome. Recommendations for community action drafted annually based on findings. Prepared by Llee NEFL FIMR Healthy Start Coalition
The purpose of FIMR is to examine cases with the worst outcomes to identify gaps in services that might be addressed through community action. Cases selected for review based on specific criteria such as: Zip codes with high infant mortality rates Fetal losses over 36 weeks gestation or 2500 grams Deaths in outlying counties, etc. Prepared by Llee NEFL FIMR Healthy Start Coalition
20 NE FL FL US 18 16 14 12 10.4 9.8 9.5 10 8.9 8 7.9 7.3 8.2 7.2 8 7.5 7.2 7.2 6.5 7.1 7 6.9 6.5 6.4 6 4 2 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 114 infant deaths in 2011
20 NEFL FL 18 16 14 12 10 7.6 6.7 8 6.6 6.3 6.2 5.9 5.8 5.6 6 5.8 4.6 5.3 5.5 5.5 5.6 5.2 4.9 4 4.9 4.02 2 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 39 white infant deaths in 2011
20 18.8 NEFL FL Black 18 16.2 16.1 16 15.9 13.8 15.3 14 14.1 12.9 13.7 12.3 12.8 12 11.9 12.2 12.1 12 12 11.8 10.6 11.1 12.4 12.5 11.8 11.5 10.8 10 10.5 10.3 9.64 8 6 2003 2004 2005 2006 2007 2008 2009 2010 2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 75 nonwhite infant deaths in 2011- black
< 500 grams (< 1.1 pounds) 500-1499 grams (1.1-3.29 pounds) 1500-2499 grams (3.3 - 5.49 pounds) 2500+ grams (> 5.5 pounds) No info 2% 25% 26% 14% 33% 58% of the babies that died weighed < 3.3 pounds at birth Prepared by Llee NEFL FIMR Healthy Start Coalition
100% 22.2 90% 30.7 31.3 32.7 35.4 35.7 38.6 80% 70% 60% 50% 77.8 40% 69.3 68.8 67.3 64.6 64.3 61.4 30% 20% 10% 0% 2005 n=189 2006 n=158 2007 n=154 2008 n=165 2009 n=155 2010 n=127 2011 n=114 Neonates Postneonates 63% of the neonatal deaths occurred in the 1st 24 hours Prepared by Llee NEFL FIMR Healthy Start Coalition
Prematurity 50% 50% Congenital Anomalies 40% Sleep related RDS/BPD/Pulmonary Hypoplasia Infection 30% 20% 16% IVH 13% 13% 13% 10% NEC 5% 6% 4% 0% Multiple Organ Failure Cause of Death Prepared by Llee NEFL FIMR Healthy Start Coalition *records may have more than one cause of death listed
Northeast Florida Northeast Florida Sleep related deaths Sleep related deaths 2005 2005- -2011 2011 55035-bigthumbnail
2005 2006 2007 2008 2009 2010 2011 # 33 23 27 27 22 16 14 % of deaths 17.5% 14.6% 17.6% 16.4% 15.1% 12.6% 12.3% Prepared by Llee NEFL FIMR Healthy Start Coalition
Baker Clay Duval Nassau St Johns # 2 1 11 0 0 deaths Duval county detail: The following zipcodes had one sleep related death: 04, 06, 08, 10,11, 23, 25, 57, 77 The 06 zip was the only one with > 1 sleep related death and it had only 2 Prepared by Llee NEFL FIMR Healthy Start Coalition
2005 2006 2007 2008 2009 2010 2011 # NEFL SIDS cases 10 10 6 6 3 1 1 NEFL SIDS rate/1,000 live births .55 .53 .31 .32 .16 .06 .06 FL SIDS rate .38 .39 .34 .35 .32 .30 .20 # NEFL Undetermine d or other sleep related cases 23 13 21 21 19 15 13 NEFL sleeping infant death rate/1,000 live births 1.83 1.21 1.40 1.45 1.20 .90 .80 Prepared by Llee NEFL FIMR Healthy Start Coalition
Risk Factor 2005 2011 n=162 Unsafe sleep surface 80% Not on back to sleep 66% Not in an infant bed 69% Never breast fed 66% Unsafe items in bed 60% Second/third hand smoke 46% Sharing sleep surface 55% Prepared by Llee NEFL FIMR Healthy Start Coalition
79% in their 20s 71% single 63% white about had inadequate prenatal care 42% with no high school diploma about 1/3 are overweight or obese
12 10.5 10 8.5 State rate=6.8 8 5.9 6 5.2 4.1 4 2 0 Baker Clay Duval Nassau St. John's
29 total fetal and infant deaths; 20 infants/9 fetals Zip City Total Fetal and Infant Deaths 32063 MacClenny 13 32040 Glen St. Mary 12 61% single moms (highest) 40% infant deaths sleep related (highest) 39% with poor birth spacing (over 3 x higher) 38% all losses w/ congenital anomalies (highest) 32% with no HS diploma (highest) Second only to Duval for late or no pnc (32%) Low teen pregnancies and substance abuse
110 fetal and infant deaths; 58 infants/52 fetals Zip City Deaths 32068 Middleburg 30 32065 Orange Park 22 32073 Orange Park 30 66% w/ unhealthy BMI (highest) 55% single 25% with late or no pnc 12% teens (second highest) 12% Hispanic (highest) 32043 Green Cove 14 32003 Fleming Isl. 7
Zip City Deaths 46 total deaths: 23 infant and 23 fetal 32011 Callahan 10 89% white (highest) 27% w/out HS diploma (second to Baker) Highest substance abuse (33%-all tobacco) 57% w/ unhealthy BMI (96% of those high) Lowest congenital anomalies 32034 Fernandina 16 32097, 32041 Yulee 14
Zip City Deaths 32081 & 2 Ponte Vedra 10 32084 Downtown St Aug 33 32086 St Aug Shores 14 32092 Palmo 19 32145 Hastings 6 Maternal Demographics: 80% white 56% married (highest) 52.3.2% w/ some college (highest) Best pnc, birth spacing and healthy BMI s Highest underweight though-1/3 of those w/ unhealthy BMI s Highest cocaine use 92 total deaths: 37 infants 55 fetals (all other counties had fewer fetals than infants)
White 25 Total County Florida Target Area 20 20.1 Black 15.3 16.8 15.3 15.4 14.6 15.9 16.9 15 13.3 16.4 15.5 13.1 11.3 14 12.9 11.6 12.9 12.8 10.9 10.5 9.7 9.5 10 8.8 9 8.4 7.9 7.5 7.5 8 6.5 7.2 7.2 7.1 7.3 6.4 6.9 7 7.2 7.2 7.1 6.9 6.7 5 5.8 5.5 2.8 0 1 2003 2004 2005 2006 2007 2008 2009 2010 2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital stats 90 infant deaths in 2011
7894 8000 7777 7800 7600 7474 7400 7200 7128 7000 6889 6800 6600 6400 6200 2007 2008 2009 2010 2011 Prepared by Llee NEFL FIMR Healthy Start Coalition
6000 5900 5878 5800 5700 5657 5667 5600 5500 5416 5431 5400 5300 5200 5100 2007 2008 2009 2010 2011
Birth Cohort Death Cohort Race W=56%; B=43% W=30%; B=63% Age Teens trended down over last 3 yrs, currently at 8.3%; 20 s mid to high 50% Teens w/ slight trend up 12-13%; 20 year olds represent 55-60%; slight upward trend in 40 year olds Single Marital Status 48% last 3 years Decreased from 65% to 61% last 3 years Education-HS or higher 85% 68%
Birth Cohort Death Cohort Smoking 8% Trend 17 11% over last 3 yrs Unhealthy BMI 50% 61% Inadequate prenatal care 24% Trending down over last 3 yrs-40 to 36% Pregnancy Interval < 12 mos 14% 17%
See full size image Pre-existing conditions such as hypertension, diabetes, asthma, etc. 56% 60% 50% History of fetal or infant loss 40% 31% History of previous preterm or low birth weight baby 30% 20% 15% 20% History of STD or other GU infection 11% 10% History of elective termination 0% Maternal Medical and OB History
35% 30% Obesity 25% 20% Inadequate Nutrition (underweight BMI or anemia at 1st trimester pnc visit) 15% 10% 5% 0% Pre-existing Nutritional Issues Prepared by L.Lee Source: FIMR/CRT case reviews
Life Course Perspective Issues 45% 40% 41% 39% 35% Maternal Age < 21 or > 35 30% 25% 28% Poverty 20% 24% 15% 10% Other emotional stressors during pregnancy such as loss of job, loss of loved one, incarceration, divorce, natural disaster, etc.) 5% 0% Socioeconomic Prepared by L.Lee Source: FIMR/CRT case reviews reviews Prepared by L.Lee Source: FIMR/CRT case
60% Maternal Infections other than STD's 50% 52% 48% STD's 40% 30% Preterm Labor 28% 20% 23% 10% PROM/PPROM 0% Medical Conditions During Pregnancy Prepared by L.Lee Source: FIMR/CRT case reviews reviews Prepared by L.Lee Source: FIMR/CRT case
Contributing Factors in FIMR Cases 2009-2011 N=87 60% Inadequate pnc 67% 50% 53% 40% Kick counts; signs of decreased fetal movement and when to call MD 30% 30% 20% Family Planning 10% 13% 0% Substance abuse -10% Parental Knowledge/Compliance Issues Prepared by L.Lee Source: FIMR/CRT case reviews reviews Prepared by L.Lee Source: FIMR/CRT case
Contributing Factors in FIMR Cases 2009-2011 N=87 20% Medical and social services/community inadequate to meet needs 18% 16% 14% 11% 12% Medical and social services/community resources available, but not used 10% 8% 5% 6% 3% 4% Patient fear of/dissatisfaction with system 2% 0% Service Issues Prepared by L.Lee Source: FIMR/CRT case reviews reviews Prepared by L.Lee Source: FIMR/CRT case
Contributing Factors in FIMR Cases 2009-2011 N=87 60% 51% 50% 33% 40% Prematurity Infection 30% Cord Problem 20% 6% 10% 0% Fetal/Infant Medical Issues Prepared by L.Lee Source: FIMR/CRT case reviews reviews Prepared by L.Lee Source: FIMR/CRT case
Continue to focus on preventing sleep related deaths. Of the 114 infant deaths in Northeast Florida in 2011, 14were sleep related. This represents 12.3 % of all deaths and 58% of deaths after the first month of life. Focus on safe sleep surface and bedsharing. Develop additional Cribs 4 Kids programs in region and take advantage of cash matching program. Develop regional Safe Sleep Campaign in collaboration with TPC Advocacy Center at Wolfson Children s Hospital.
Focus on safe sex, STD prevention and family planning. Implement jail education program; take advantage of having a captive audience. Within the FIMR cases, STDs during pregnancy increased from 9% in 2009 to 35% in 2011. Duval County ranks 5th in the state based on 2012 data in STD rates. Contraception in the immediate postpartum period is a priority for action. In the FIMR reviewed cases, only one-third of the mothers received a Depo shot or prescription for contraceptives prior to hospital discharge. More than two-thirds (67%) of the FIMR cases involved family planning issues including unplanned pregnancies and inadequate birth spacing.
Continue to focus on dangers of smoking during pregnancy. In 2011, 13% of the mothers in the death cohort self-reported some type of substance abuse; 83% of these were tobacco users. In 2010, 17% of the death cohort self-reported some type of substance abuse. Ninety-three percent of these were tobacco users. The Community Action Team is implementing an anti-smoking campaign in the target area (Health Zone 1) based on prior recommendations. Healthy Start program in St. Johns County is also piloting SCRIPT, an evidence-based smoking cessation program for pregnant women. Based on pilot results, this program should be considered for replication throughout the region.
