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Doody's Review ServiceReviewer: Thomas M Lock, MD (SUNY at Buffalo School of Medical Sciences)
Description: This is a sequel to the principal author's 1984 Epidemiology of the Cerebral Palsies, in which the authors incorporate new developments in epidemiology and evidence-based analysis to challenge traditional single-factor based concepts of causality of cerebral palsy.
Purpose: The purpose is to review changes in the epidemiology and methods of analysis since 1984. Over the past 15 years there have been major developments in the epidemiology of cerebral palsy, the amount of data available, perinatal care practices, paradigms of causation, and litigation, with little change in the prevalence of these disorders. These concerns are relevant to anyone concerned with the healthcare of women and children.
Audience: The book is written for researchers but will be useful to a much wider audience. The authors provide a conceptual basis for consumers of epidemiologic and clinical research data (students, residents, and practitioners) to analyze research in any healthcare field. The authors' previous book is a classic, and their Western Australia Cerebral Palsy Register has contributed much of the primary data in this field.
Features: After a review of the definition, classification, incidence, and prevalence of cerebral palsy, the authors develop the concept of causal pathways — sequences of events that lead to a clinical outcome. They then apply this analysis to the causes of cerebral palsy. The examples of hyperbilirubinemia and preterm birth clearly show how causal pathways can contribute to our understanding of medical outcomes. The description of the relationship of the recent increase in multiple births to the incidence of cerebral palsy is most timely. The references are complete, including references to online databases.
Assessment: This book is a review of what is known and what is not known about the epidemiology and causation of the cerebral palsies. The authors remind us that perinatal events may have multiple, complex causes leading to different outcomes and that "outcomes," such as cerebral lesions, may themselves be causes of perinatal events rather than effects.