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Context: In 2009, the National Association of Chronic Disease Directors published desirable competencies for professionals in public health chronic disease programs. Assessing the training needs of these professionals is an important step toward providing appropriate training programs in chronic disease prevention and control competencies., Objectives: Conduct a survey of the chronic disease workforce in state and local health departments to identify professional training needs., Design: We conducted a cross-sectional survey of state, territorial, and local public health professionals who work in chronic disease programs to identify their self-reported training needs, using the membership lists of 3 professional organizations that included practitioners in chronic disease public health programs., Setting: The survey was national, used a convenience sample, and was conducted in 2011., Participants: The survey was developed using an algorithm to select anonymous participants from the membership lists of the National Association of Chronic Disease Directors, the Directors for Health Promotion and Education, and the National Association of County & City Health Officials., Outcome Measures: The survey included questions about professional background, chronic disease activities, confidence about skills, and needs for training., Results: The survey had 567 responses (38% response ratio). The majority of the respondents were female, non-Hispanic white, and 40 years or older. Respondents were not confident of their skills in health economics (38%) and technology and data management (23%). The most requested training topics were assessing the effects of policies, laws, and regulations (70%) and health economics (66%)., Conclusions: This survey included local, territorial, and state public health professionals who work in chronic disease programs. These reported training needs in quantitative measurement methods and policy-related topics suggest key subjects for future training and education curricula.

Objective: To determine risk factors for pregnancy after tubal sterilization with bipolar electrocoagulation., Methods: A total of 2267 women who had bipolar electrocoagulation were followed for up to 8 to 14 years as part of a multicenter, prospective, cohort study conducted in medical centers in nine United States cities. We used proportional hazards analysis and cumulative life-table probabilities to assess pregnancy risk in these women., Results: The 5-year cumulative probability of pregnancy for women sterilized in 1978-1982 was 19.5 per 1000 procedures (95% confidence interval [CI], 12.2, 26.9); the comparable probability for women sterilized in 1985-1987 was significantly lower, 6.3 per 1000 procedures (95% CI, 0.0, 13.5) (one-tailed P = .01). Women enrolled in 1985-1987 who had fewer than three sites of coagulation had a probability of failure of 12.9 per 1000 procedures (95% CI, 0.0, 38.0); by contrast, women who had three or more sites coagulated had a probability of failure of 3.2 per 1000 procedures (95% CI, 0.0, 9.6) (one-tailed P = .01)., Conclusion: The long-term probability of pregnancy after tubal sterilization with bipolar coagulation was very low when three or more sites of the fallopian tube were coagulated. Bipolar coagulating systems can be highly effective for sterilization when the fallopian tube is coagulated adequately.

Objective: To analyze reproductive-tract disorders that resulted in hospitalization of reproductive-age women in the United States., Methods: Data from the National Hospital Discharge Survey for 1988, 1989, and 1990 were used to study women 15-44 years old who had any gynecologic diagnoses noted in their discharge summaries., Results: Based on average annual discharge rates per 10,000 women, the five most frequent diagnostic groups were pelvic inflammatory disease (PID) (average annual rate 49.3, 95% confidence interval [CI] 43.6-55.0), benign cysts of the ovary (average annual rate 32.7, 95% CI 28.8-36.6), endometriosis (average annual rate 32.4, 95% CI 28.5-36.3), menstrual disorders (average annual rate 31.4, 95% CI 27.6-35.2), and uterine leiomyomas (average annual rate 30.4, 95% CI 26.7-34.1). The highest rates for PID were among women 25-39 years old and for women of races other than white. Highest rates for uterine leiomyomas were among women 40-44 years old and for women of races other than white. Highest rates for endometriosis were among women 40-44 years old and white women. Racial difference existed among all ages in the uterine leiomyoma and endometriosis groups. Average annual rates of benign cysts and menstrual disorders increased with age, but there were no statistically significant differences according to race in these two diagnostic groups., Conclusions: Our findings confirmed the importance of PID as a common cause of hospitalization among reproductive-age women and identified additional gynecologic conditions as causes for hospitalization as well. We found significant age and racial differences not only among women with discharge diagnoses of PID but also among those with discharge diagnoses of uterine leiomyomas and endometriosis.

Objective: To describe patient characteristics and diagnoses associated with hysterectomy in the United States from 1988-1990 using data from the National Hospital Discharge Survey., Methods: We analyzed data from the National Hospital Discharge Survey, an annual probability sample of discharges from nonfederal, short-stay hospitals in the United States. A population-based sample of all women aged 15 years or older in the United States civilian population who had a hysterectomy during 1988-1990 was examined to characterize factors associated with hysterectomy: patients' age and race, diagnoses, surgical approach, and oophorectomy., Results: Approximately 1.7 million women had a hysterectomy during 1988-1990. The highest rates--100.5 hysterectomies per 10,000 women--were for women aged 30-54 years. Total rates of hysterectomy for black women were similar to those for white women (61.7 and 56.5 per 10,000 women, respectively); uterine leiomyoma ("fibroid tumor") was reported as the primary diagnosis for 61% of black women and 29% of white women. Abdominal surgery was used for 75% of all hysterectomies. Concomitant bilateral oophorectomy was done for 37% of the women under 45 years old and 68% of the women 45 years or older., Conclusions: Two-thirds of all hysterectomies for noncancerous conditions were performed for uterine leiomyoma or endometriosis--conditions that are most common before the age of menopause. Future assessments of the appropriateness of hysterectomy will require better understanding of these disorders. Continued monitoring of hysterectomy rates is critical to understanding the appropriate use of hysterectomy, alternative therapies for uterine disorders, and future trends in women's health care.

Objective: To examine the characteristics of women in the 1988 National Survey of Family Growth who reported having obtained medical services for impaired fecundity., Methods: From a national sample of 8450 women between the ages of 15-44, drawn from the civilian, noninstitutionalized population of the entire United States in 1988, we estimated the use of infertility services in the United States. Multivariate statistical modeling was used to identify the characteristics associated with use of infertility services among the 770 women who reported impaired fecundity in this survey., Results: Of all women with impaired fecundity, 43% had obtained some form of infertility service and 24% had obtained specialized infertility treatment--ovulation drugs, treatment of fallopian tubes, artificial insemination, or in vitro fertilization. Older, white, married women of higher socioeconomic status were most likely to have obtained specialized services, and a history of endometriosis was also strongly associated with having received such services., Conclusion: Most women with impaired fecundity had not obtained infertility services. Use of specialized services was strongly associated with certain sociodemographic variables or a history of endometriosis.

The Collaborative Review of Sterilization is a prospective study of women undergoing tubal sterilization at selected medical centers in the United States. This analysis examined 5817 study participants who were asked whether they had sought information on tubal reanastomosis after their sterilizations and whether they had actually obtained reanastomosis surgery. Characteristics that predicted the likelihood of seeking reanastomosis information were examined in multivariate, logistic regression models that included age, race, number of living children, history of abortion, education, timing of sterilization in relation to pregnancy, initial marital status, and change in marital status. Among the women studied, 6.2% reported that they had sought information on reanastomosis. Women who were younger than 30 years old at the time of sterilization were twice as likely to seek such information as women aged 30-34, and women who had experienced changes in martial status after sterilization were 2.8 times as likely to seek information as women with unchanged marital status. Thirteen women had actually obtained reanastomosis. Compared with the overall study population, these women were more likely to be white, to have lower gravidity, to be younger, and to have experienced changes in marital status.