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This study used Centers for Disease Control and Prevention methodology to analyze the costs of smoking-attributable mortality and morbidity within the Department of Defense (DoD) based on health care costs, characteristics of the beneficiary population, and disease characteristics. Direct health care costs attributed to smoking were estimated at $584 million. Smoking-attributable disease accounted for 16% of the deaths as well as approximately 10% of all hospital bed days and 1.5% of all active duty hospitalizations. Lost productivity among active duty personnel for hospitalization and smoke breaks was valued at $346 million. A significant portion of DoD health care resources is spent caring for smoking-attributable disease, which is preventable. This report reinforces the benefits possible from the new emphasis on wellness promotion within the DoD. Efforts are needed to prevent the initiation of smoking and encourage smoking cessation in order to reduce health care costs and increase the probability for long and healthy lives for DoD beneficiaries.

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The purpose of this prospective study was to analyze our experience with external cephalic version under tocolysis. This included an expected (1) high success rate of version, (2) infrequent occurrence of reversion, (3) reduction in the incidence of intrapartum breech presentation, avoiding the need for Caesarean delivery, and (4) predictors of success in our series. The study spanned the period from 1985 to 1993, enrolling 113 subjects who presented to our OB/GYN Department with any type of breech presentation at 37 weeks' gestation or greater and met the following criteria: (1) absence of labour or ruptured membranes, (2) singleton pregnancy, (3) absence of medical or obstetrical complications and amniotic fluid index of greater than 8 cm. After a reassuring fetal assessment, IV terbutaline was given prior to an attempt at version. The results revealed a 46% (53 or 113) version success rate with a 4% (2 of 53) reversion within a week after procedure. There was a 2% (2 of 113) complication rate, with 1 being a minor incident of fetal bradycardia that responded easily to intrauterine resuscitation. One major complication occurred with placental abruption during the attempt, which required immediate Caesarean delivery. Predictors of success in our series included: multiparity, fundal/posterior placenta, and fetal head and spine on the corresponding side of the maternal sagittal plane. External cephalic version in a controlled setting can be a safe procedure for residents in training that lowers Caesarean delivery rate for breech presentation.

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Use of surfactant and antenatal steroids are associated with improved survival and decreased incidence of severe intraventricular hemorrhage among the most premature infants delivered in our institutions.