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Biomedical subjects

D M Strobino

Publications and source records attributed to D M Strobino.

At least 37 records · Page 2Linked to original sources
PubMed1992

Trends in publicly financed prenatal and related services, 1975-1984.

We studied trends in Title V and health department financed prenatal and related services in U.S. countries from 1975-1984, years during which Medicaid and health insurance coverage for poor women were eroding. Information on prenatal services was obtained from background reports and telephone interviews with staff of State Maternal and Child Health programs. The number of counties providing prenatal care, particularly comprehensive care, rose considerably from 1975 to 1984; the largest rise occurred between 1982 and 1984. Federal initiatives accounted for about 25 percent of the increase in comprehensive care, while state-funded initiatives were responsible for the modest rise in counties offering routine care. The number of counties providing related components of care such as risk assessment and referral, obstetric or pediatric linkage with prenatal care, and outreach also rose markedly during the study years. Despite these secular trends, forty percent of U.S. counties did not offer prenatal care in health department operated or funded sites in 1984.

Adolescent↗
PubMed1991

Precision of umbilical artery Doppler studies. Intraobserver, interobserver, and biologic variability of fetal Doppler velocimetry.

The use of Doppler ultrasound to study fetal blood flow has become commonplace, despite the lack of detailed evaluation of the testing tool for precision. In evaluation of 25 patients, no significant intraobserver differences were found between readings on an individual waveform, nor were there significant differences between different observers on individual waveforms. Temporally separated waveforms within a 30-minute window gave the greatest variation. A multi-way analysis of variance noted significant differences in this category only. This study confirmed the precision of measurements by a single observer and between observers. Only biological alterations over time displayed significant variability.

Analysis of Variance↗
PubMed1991

Population differences affect nonstress test reactivity.

The nonstress test (NST) is the most widely used test of fetal well-being. Recently it has been suggested that race may play a role in NST reactivity. The objective of this research was to explore population variables in addition to race that may influence NST reactivity. Study subjects were 1263 black and 658 white women who underwent NST in the week preceding delivery at a tertiary facility. Retrospective analysis of data from a comprehensive database was conducted. It was found that the percentage of black women with a nonreactive NST was more than three times the percentage of white women, and that from 35 weeks' to 42 weeks' gestation there were significantly fewer reactive NSTs for blacks than for whites (P less than .05). Racial differences in NST results persisted in a logistic regression analysis controlling for several population variables including pregnancy complications and demographic and behavioral factors (odds ratio 3.81; 95% CI 3.03 to 4.78). Regression analysis also confirmed that gestational age, maternal education, epilepsy, and smoking significantly influenced NST reactivity. These results indicate that population differences in NST reactivity exist at our facility. Further prospective study of population determinants of NST reactivity is needed to determine how race, test indication, and other clinical, demographic, and behavioral variables should be used in interpretation of tests of fetal well-being. Standard criteria for NST testing may not be useful in all obstetrical populations.

Black People↗
PubMed1989

Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service.

This study examines the use of episiotomy and the frequency of perineal lacerations in a primary care maternity center staffed by certified nurse midwives (Booth Maternity Center) and a tertiary care teaching hospital where deliveries were performed by physicians (Thomas Jefferson University Hospital). The study sample (1262 women) was a stratified random selection of singleton live births in 1977 and 1978 at Booth Maternity Center and Thomas Jefferson University Hospital, with the demographic characteristics of women at Booth Maternity Center used as the sampling frame. Data were abstracted from medical records. Clinical and demographic factors that might be associated with the likelihood of having an episiotomy or experiencing a perineal laceration were examined using logistic regression. After controlling for other significant factors, women at Thomas Jefferson University Hospital were twice as likely to have an episiotomy as women at Booth Maternity Center. Use of an episiotomy was associated with a decrease in perineal lacerations of first- or second-degree, but a fourfold increase in the incidence of third-degree lacerations.

Episiotomy↗
PubMed1988

Variations in pregnancy outcomes and use of obstetric procedures in two institutions with divergent philosophies of maternity care.

Pregnancy outcomes were compared between a stratified random sample of 796 women delivering a live birth at a maternity center (BMC) and a frequency matched sample of 804 women delivering a live birth at a tertiary hospital (TJUH) in 1977-1978. The relationship of use of obstetric procedures with pregnancy outcomes was investigated within and between the two samples. The neonatal morbidity rate, as measured by Hobel's neonatal risk score, was significantly higher and mean birth weights were lower at TJUH than at BMC when adjusted for institutional differences in use of obstetric procedures, medical-obstetric risk, and demographic characteristics. Conversely, the proportion of newborns with low 1-minute Apgar scores (fewer than seven) was significantly greater at BMC. The relationship of use of obstetric procedures with each outcome varied between the two institutions as well as across the three measures of pregnancy outcomes. The relationship of use of some procedures with each outcome may be explained in part by use of the procedure because of a suspected poor outcome of pregnancy, rather than an elevated risk of poor outcomes because of use of the procedure. Self-selection of some patients to BMC cannot be ruled out as a possible explanation for institutional differences.

Anesthesia, Obstetrical↗
PubMed1986

The impact of the Mississippi Improved Child Health Project on prenatal care and low birthweight.

A quasi-experimental, nonequivalent control group design was used to evaluate the Improved Child Health Projects in northwest Mississippi (ICHP1 and ICHP2). Control counties were selected for each project that on average were similar to ICHP counties on racial composition, median family income in 1970 and 1980, and number of births in 1978-79. The study population comprised all resident births in the ICHP and control counties during a pre-ICHP period (1975-78) and the ICHP period (1979-81). The percentage of women with adequate prenatal care rose between the two periods for all counties; the rise was greater for the study than for the control counties for ICHP1; the reverse was found for ICHP2. For both projects, the low birthweight rate remained constant in the pre-ICHP and ICHP periods for the study and control counties. Adjustment for changes in the childbearing characteristics between the two periods did not alter these results. Community involvement in its development and coordination may explain ICHP1's impressive rise in the use of prenatal care.

Child Health Services↗
PubMed1984

Definitions of high risk in pregnancy and evaluation of their predictive validity.

The predictive validity of Hobel's criterion (score of 10 or more) for high prenatal and intrapartum risk and two alternative definitions was evaluated in two sociodemographically similar samples from two different institutions. At one institution, intrapartum risk was associated with neonatal morbidity independently of prenatal risk; at the second institution, both were related to neonatal morbidity, depending on the definition of high risk. Definition of high risk as a score of 15 or more improved the prognostic ability of Hobel's method at the first institution, but not at the second. Grouping prenatal and intrapartum risk as low (0 to 9), medium (10 to 19), and high (20 or more) provided a clearer understanding of the association between prenatal/intrapartum risk and neonatal morbidity, although differences between the two institutions persisted. Modifications and validation of risk assessment methods are necessary when used in populations other than the one for which they were originally developed.

Adult↗
PubMed1984

Evaluation of a measure of neonatal morbidity.

The neonatal risk score of Hobel et al. was evaluated as a measure of neonatal morbidity in a sample of 1,600 singleton infants born alive at two institutions. The score was evaluated for internal consistency, the appropriateness of weight assigned to factors, criterion validity, and conformity to the negative binomial distribution. The results are encouraging for the use of the score as a measure of neonatal morbidity. It appears internally consistent. All risk factors occur with some frequency with at least one other and, in most instances, with several others. With one exception, all factors distinguish infants with high and low scores. The neonatal score, defined by a weighted score and by the number of factors, is highly correlated with length of infant stay in the nursery. Correlations are higher for scores of events measured after birth than for scores of events measured directly at birth. The authors recommend that the number of risk factors be used in preference to the weighted neonatal score since it conforms to the negative binomial distribution and is simpler to calculate. The potential uses of a quantitative, comprehensive measure of neonatal morbidity ar discussed.

Apgar Score↗
PubMed1984

Utilization of child health clinics following introduction of a copayment.

The effect of introduction of a copayment on utilization of well child services was investigated in St. Mary's County, Maryland between 1975 and 1979. Utilization declined between the pre-copayment and post-copayment periods for White and non-White infants under six months of age. The deterrent impact of the copayment suggested by the results may be related to crossover to private care but may also represent a drop in use of preventive services.

Child Health Services↗
PubMed1984

Two methods of estimating the target population for public maternity services programs.

One difficulty in estimating the target population for public health programs is identifying a current and appropriate indicator of the low-income population. Using data from Mississippi and Maryland, we determined that educational attainment of women giving birth is a feasible substitute for census data in estimating the low-income maternity population, and that vital statistics data offer several advantages for estimating the maternity services target population over census data.

Educational Status↗
PubMed1984

Decomposition of the difference between two rates with hierarchical factors.

A decomposition method for the difference between two rates when data are classified by two factors, one of which may be considered as a more direct factor than the other for the event under consideration, is presented in this paper. The two factors are treated as hierarchical and thus this method is conceptually different from the decomposition methods of Kitagawa (1955) and Das Gupta (1978), in which two factors are treated as symmetrical. Our method is shown to be a balanced version of the Cho-Retherford (1973) decomposition method. Analyses of neonatal mortality rates using our method are presented as an example.

Adolescent↗
PubMed1984

Patterns of obstetric procedures use in maternity care.

The use of seven obstetric procedures was studied in two institutions that use different approaches to maternity care. The study population included 796 women delivering at Booth Maternity Center and 804 women with similar sociodemographic characteristics delivering at Thomas Jefferson University Hospital during 1977 and 1978. Several differences were found between the two institutions. The majority of selected procedures were used more often at Thomas Jefferson University Hospital than at Booth Maternity Center. The greatest differences were found for women at low intrapartum risk, while differences were smallest for women at high prenatal and intrapartum risk. The two institutions differed in their use of procedures for women at various levels of prenatal and intrapartum risk. The findings suggested that most of the differences did not reflect different levels of risk in the populations served, but were due to other unidentified factors.

Adult↗
PubMed1983

Birth weights among infants born to adolescent and young adult women.

Birth weights of 422 infants born to primigravid patients under the age of 16 years were compared with the birth weights of 422 infants born to a racially comparable group of primigravid patients 20 to 24 years old. No significant difference in birth weights was found between the two groups. Although infants of adolescents were born of shorter gestations than infants of older women, overall mean birth weights were similar, since the infants of adolescents were heavier at gestations of less than 37 weeks. Race and sex of the infant were more important predictors of birth weight among the adult group, whereas the maternal gain in weight was a more important factor among the adolescent group. Reduced birth weights reported in previous studies among infants of adolescents may have been due to overrepresentation of risk factors among these mothers rather than to maternal age, per se.

Adolescent↗
PubMedDate not supplied

Investigation of institutional differences in primary cesarean birth rates.

Differences in primary cesarean birth rates between a maternity center staffed by certified nurse-midwives (CNM) with physician backup on the premises and a university teaching hospital staffed by resident and attending physicians were studied. The study sample included 796 and 804 women, similar in demographics, who received their prenatal and intrapartum care in the respective sites in 1977 and 1978. Study results indicate a significantly lower rate of primary cesarean birth at the maternity center than at the university hospital that was independent of institutional differences in the indications for abdominal delivery. Although cesarean birth was related to contracted pelvis (at labor), fetal malpresentation, and placental bleeding at both institutions, it was significantly associated with preeclampsia, primiparity, fetal distress, and maternal age only at the university hospital. There were no noteworthy differences in pregnancy outcomes for women delivered vaginally or by cesarean, except for more newborns with low Apgar scores among primary cesarean births at the university hospital. A likely explanation for these findings is differing labor and delivery management styles between the providers of care at the two institutions.

Adolescent↗
PubMedDate not supplied

Nurse-midwifery care to vulnerable populations. Phase I: Demographic characteristics of the National CNM Sample.

The purpose of this article is to describe the extent to which certified nurse-midwives (CNMs) provide care to vulnerable populations in the United States and the source of reimbursement for this care. The data were obtained from the first phase of a national study to address the characteristics of women served and cost of care provided by CNMs. Results were analyzed nationally and by American College of Nurse-Midwives regions. Certified nurse-midwives in all types of practices are providing care to women from populations that are vulnerable to poorer than average outcomes of childbirth because of age, socioeconomic status, refugee status, and ethnicity. Ninety-nine percent of CNMs report serving at least one group of vulnerable women, and CNMs in the inner city and rural practices serve several groups. The vast majority of CNMs are salaried; only 11% receive their primary income from fee-for-service. Fifty percent of the payment for CNM services is from Medicaid and government-subsidized sources whereas less than 20% comes from private insurance. Source of income varies by type of setting in which the CNM attends births. The results suggest that CNMs, as a group, make a major contribution to the care of vulnerable populations.

Adult↗
PubMedDate not supplied

Development of an index of maternal transport.

The authors used a decision-analytic approach to develop a Maternal Transport Index (MTI) from ACOG guidelines for maternal transport. Data were obtained from three questionnaires administered to five perinatologists, practicing in facilities with various casemixes. Each questionnaire was based on a given level of hospital and contained scenarios describing indications for maternal transport. The MTIs, ratios of the logs of the proportions with given outcomes in Level III hospitals relative to Level I (or II) hospitals, ranged from 1.0 to 26.3 for newborn outcomes. They were greater for Level I hospitals (than Level II) and when newborn outcomes included severe disability as well as death. Within gestational age categories, the MTI was generally greatest for active preterm labor and, within complication categories, for 24-26 or 27-31 weeks' gestation. It was large for maternal outcomes only for two rare acute medical conditions. The MTI has potential use in setting priorities for maternal transport.

Adult↗