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Biomedical subjects

M C McCormick

Publications and source records attributed to M C McCormick.

104 records · Page 6Linked to original sources
PubMed1980

Relevance of correlates of infant deaths for significant morbidity at 1 year of age.

This paper examines the issue of whether or not factors identified as risks for death in the first year of life also serve as risks for morbidity in surviving infants through data collected on 390,425 live births, 5,084 infant deaths, and 4,327 surviving 1-year-old children among singleton births in eight geographically defined regions in the United States. Factors which presented risks for neonatal death, such as advanced maternal age and maternal history of prior fetal loss, proved to present risks for congenital anomalies/severe developmental delay, whereas factors heavily influenced by environmental conditions, such as young maternal age and lower maternal educational attainment, were associated with higher postneonatal mortality rates and other significant illness, among both low-birth-weight and normal-birth-weight infants. The association of delivery by cesarean section with death and morbidity was also explored.

Adolescent↗
PubMed1980

Rehospitalization in the first year of life for high-risk survivors.

The first year of life is an age when morbidity and medical care use is high, and this is particularly true for low birth weight infants. Whether certain factors characterize subgroups at especially increased risk was examined for a large random sample (N = 4,989) of 1-year-old infants by using rehospitalization as the dependent variable. Overall, 9.1% of the infants had been rehospitalized, and this increased with decreasing birth weight to 38.2% of those less than or equal to 1,500 gm at birth. Low birth weight infants accounted for 6.4% of 1-year-olds, but 13.6% of those hospitalized and 20.0% of all hospital days among these infants. Factors affecting the chances of rehospitalization for low birth weight and normal birth weight infants, with and without congenital anomalies/developmental delay, were similar. Maternal hospitalization during pregnancy, prolonged postnatal stay of the infant, variables indicative of low socioeconomic status, and certain types of medical care use were associated with increased risk of hospitalization. The risk of hospitalization associated with some variables was high, but it was not possible to identify with precision a group where reduction in hospitalization would result in major decrease in overall hospital use by infants.

Analysis of Variance↗
PubMed1979

The relationship between infant mortality rates and medical care and socio-economic variables, Chile 1960-1970.

Infant mortality rates (IMR) have traditionally been considered useful as health status indicators, and changes in these rates are thought to reflect changes in both medical care services and socio-economic circumstances. In order to explore this relationship of IMR with medical core and socio-economic factors in a developing country, Chilean health zone data for the decade 1960--1970 were used to construct 25 variables which were then classified into groups representing antenatal-obstetric services, acute and preventive medical services and socio-economic variables. In an analysis which involved developing a series of linear multiple regression equations for each year of the decade 1960--1970 with IMR as the dependent variable, the percentage of births with professional attention proved to be the stronger variable.

Child Health Services↗
PubMedDate not supplied

The effectiveness of early intervention: examining risk factors and pathways to enhanced development.

In this paper we examine the effectiveness of early intervention, especially vis-à-vis (a) child and family risk factors and (b) the pathways to enhanced child and family development. To address these issues we draw on findings from the Infant Health and Development Program (IHDP) for low-birth-weight premature infants. The data we present reveal the considerable effectiveness of the IHDP intervention in enhancing several aspects of early and later child and family development. The findings also illustrate the importance of looking beyond intervention group differences to examine the extent to which early intervention effects are more pronounced for some children and families than others and to examine the processes underlying intervention effects (e.g., exactly how do early interventions change children and families?). For example, both initial and longer-term IHDP intervention effects varied by both characteristics of the children and characteristics of their families. Our data also provide some insight into the processes by which intervention effects may have occurred. We conclude our consideration of these many complexities with suggestions for practice, social policy, and future research.

Adolescent↗
PubMedDate not supplied

Patterns of service use in preschool children: correlates, consequences, and the role of early intervention.

This article explores service use broadly by examining the mix of educational, health, and psychosocial services that preschool children received in the fifth year of life. The sample included 869 children who participated in the Infant Health and Development Program, an early intervention program designed to evaluate the efficacy of a comprehensive early intervention for low-birth-weight, premature infants during the first 3 years of life and who were followed until age 5. Cluster analyses of services at age 5 yielded 4 service groups--basic health only (doctor visits; n = 114); basic health and educational services (doctor visits and school/preschool; n = 444); basic health, educational, and psychosocial services (or multiple services; doctor visits, school/preschool, and psychosocial services; n = 129); and specialized health and educational services (doctor visits, school/preschool, emergency room visits and special medical visits [ear and/or eye examinations]; n = 182). Results suggest that neonatal health conditions, maternal education at the time of the child's birth, child developmental status at age 3, and maternal health, family income, and insurance status at age 5 were associated with patterns of services at age 5. Patterns of use are consistent over time (the first 3 years of life to the 5th year of life). After covarying the correlates of the service patterns, participation in the early intervention was not associated with patterns of services at age 5, and service patterns were associated with child well-being (health, school readiness, mental health), but results differed by intervention status. Findings are discussed in terms of preventive, responsive, and deficit models of service use.

Child Health Services↗
PubMedDate not supplied

Annual report on access to and utilization of health care for children and youth in the United States--2000.

OBJECTIVE: This report provides an update on insurance coverage, use of health care services, and health expenditures for children and youth in the United States. In addition, the report provides information on variation in hospitalizations for children from a new 22-state hospital discharge data source. METHODS: The data on insurance coverage, utilization, and expenditures come from the Medical Expenditure Panel Survey. The data on hospitalizations come from the Database for Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both data sets have been prepared by the Agency for Healthcare Research and Quality. RESULTS: Few changes in insurance coverage occurred between 1996 and 1998. About two thirds of American children are covered by private insurance and 19% by public sources; the remaining 15% are uninsured. Of the 71.5% of children who have at least 1 doctor's office visit, the average number of visits was 3.9, but this ranged from 2.7 among the uninsured to 4.2 for those with private insurance. Slightly more than half of children had a prescription, and these averaged 5.4 prescriptions. The majority of children (85%) incur medical expenditures, averaging $1019 for children with any expenditure. Private health insurance was by far the largest payer of medical care expenses for children, even more so than among the general population. However, nearly 21% of expenditures for children's health care were paid out of pocket by children's families. The data also show substantial differences in average length of hospitalization across states, ranging from 2.7 to 4.0 days, and rates of hospital admission through the emergency department, which vary across states from 9% to 23%. Injuries are a major reason for hospitalization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. In the 10-17 age group, 1 in 7 hospital stays are due to mental disorders. Among 15- to 17-year-olds, more than one third of all hospital stays are related to childbirth and pregnancy. CONCLUSION: Children's use of health care services varies considerably by what type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may represent a significant burden on lower-income families. Substantial variation in hospitalization exits across states.

Adolescent↗
PubMedDate not supplied

Recent evidence on the effectiveness of prenatal care.

OBJECTIVE: To assess the evidence of effectiveness of prenatal care. DESIGN: A 2-day conference with commissioned papers with summary at the Agency for Healthcare Research and Quality. OUTCOME MEASURES: Effectiveness of prenatal care in preventing prematurity, intrauterine growth restriction, and birth defects and in improving women's health. CONCLUSIONS: Current technology provides limited ability to prevent adverse fetal outcomes but may do much to ameliorate morbidity. However, the latter is not well assessed in data systems. In contrast, the opportunity to improve women's health appears much greater, but doing so is hampered by a number of structural and attitudinal barriers.

Congenital Abnormalities↗
PubMedDate not supplied

The health and developmental status of very low-birth-weight children at school age.

OBJECTIVE: To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights. DESIGN: Inception cohort. SETTING/PARTICIPANTS: Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible. MAIN OUTCOME MEASURES: The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores. RESULTS: Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight. CONCLUSIONS: Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.

Activities of Daily Living↗
PubMedDate not supplied

Long-term follow-up of infants discharged from neonatal intensive care units.

A recent review of 20 years' experience with neonatal intensive care for very-low-birth-weight infants provides reassurance that such care saves lives and that an increasing proportion survive free of moderate to severe handicap. However, data on the health status of these survivors largely reflect status in infancy. An increasing literature suggests that such early findings may be insufficient to characterize later outcomes, particularly those problems encountered as the child enters school. Since the specific health and developmental problems that might be encountered are still being defined, a broad conceptual framework is applied to organize a review of the existing literature. Some areas of concern about longer-term outcomes emerge, as well as important areas for which data are lacking. Further definition of longer-term outcomes is critical at the policy level to assess the utility of neonatal intensive care unit interventions and at the individual level for counseling families as to the health and educational needs of these children.

Activities of Daily Living↗