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Biomedical subjects

M Kotelchuck

Publications and source records attributed to M Kotelchuck.

At least 37 records · Page 2Linked to original sources
PubMed1997

The influence of site of care on the content of prenatal care for low-income women.

OBJECTIVE: To assess whether site of prenatal care influences the content of prenatal care for low-income women. DESIGN: Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. PARTICIPANTS: A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. OUTCOME MEASURES: Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. RESULTS: The content of PNC provided for low-income women does not meet the recommendations of the U.S. Public Health Service, and varies by site of delivery. Low-income women in publicly funded clinics (health departments and community health centers) report receiving more total initial PNC procedures and total PNC advice and have greater participation in the WIC program than similar women receiving PNC in private offices. CONCLUSIONS: Publicly funded sites of care appear to provide more comprehensive prenatal care services than private office settings. Health care systems reforms which assume equality of care across all sites, or which limit services to restricted sites, may foster unequal access to comprehensive PNC.

Adolescent↗
PubMed1996

The postpartum period: the key to maternal mortality.

OBJECTIVES: To assess postpartum care at an international level, we reviewed published literature on postpartum maternal deaths. METHODS: Meta-analysis was used to summarize the literature reviewed. Postpartum deaths in developing countries were compared with those in the United States. RESULTS: In both developing countries and the United States, > 60% of maternal deaths occurred in the postpartum period; 45% of postpartum deaths occurred within 1 day of delivery, > 65% within 1 week, > 80% within 2 weeks. In developing countries, 80% of postpartum deaths caused by obstetric factors occurred within 1 week. CONCLUSIONS: The first 24 h postpartum and the first postpartum week is the high risk of postpartum deaths, and the risk remains significant until the second week after delivery. In developing countries, hemorrhage, pregnancy-induced hypertension complications, and obstetric infection are commonest causes of postpartum deaths. We suggest primary prevention, early detection, and secondary prevention of postpartum deaths.

Developing Countries↗
PubMed1995

The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States.

OBJECTIVE: To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children. DESIGN: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview. PARTICIPANTS: A total of 8129 children whose mothers were interviewed for the 1991 longitudinal Follow-up to the National Maternal and infant Health Survey. MAIN OUTCOME MEASURES: Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care. RESULTS: About one quarter of Us children were without health insurance for at least 1 month during their first 3 years of life. Over half of these children had a health insurance gap of more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care. CONCLUSIONS: Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development.

Child Health Services↗
PubMed1995

Tetanus immunization and prenatal care in developing countries.

OBJECTIVE: We sought to estimate the proportion of women immunized against tetanus while attending prenatal care in the developing countries. METHOD: We computed the ratio of the percentage of births to women immunized against tetanus to the percentage of births to women with prenatal care (TP ratio). A TP ratio is lower than 100% if not every woman attending prenatal care is immunized. We used 1986-1992 Demographic and Health Surveys data from 38 countries. RESULTS: The mean TP ratios were 86% in Africa (n = 23), 79% in Asia (n = 6) and 60% in Latin American and the Caribbean (n = 9). The TP ratio was lower than 75% in 15 countries. Of these, four had a TP ratio lower than 50%. CONCLUSION: In many countries the number of pregnant women immunized against tetanus is lower than the number of women attending prenatal care, suggesting that prenatal services are missing opportunities to immunize attending women.

Developing Countries↗
PubMed1994

Over-the-counter medication use among US preschool-age children.

OBJECTIVE: To estimate the prevalence of recent over-the-counter (OTC) medication use in a national sample of preschool-age children. DESIGN: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by telephone or personal interview. PARTICIPANTS: A total of 8145 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey. MAIN OUTCOME MEASURES: Report of any OTC medications given in the past 30 days and the type of medications that the child received. RESULTS: During the past 30 days, 53.7% of all 3-year-old children in the United States were given some OTC medications. Among OTC medication users, the most common medications reported were Tylenol (66.7%) and cough or cold medicine (66.7%). Most respondents reported that recent child illness episodes (70%) were treated with OTC medications. After adjustment for recent child illness, women who were white (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.13 to 1.55), were more educated (OR, 1.58; 95% CI, 1.24 to 2.00), and had higher incomes (OR, 1.75; 95% CI, 1.33 to 2.30) were more likely to have given their child OTC medications. Women without health insurance were also more likely to have given OTC medications (OR, 1.27; 95% CI, 1.04 to 1.55). Provider visits, but not telephone calls, were associated with a reduction in OTC medication usage. CONCLUSIONS: Over-the-counter medications are an important component of health care for treating illness in US preschool-age children. The high prevalence of use has occurred despite the dearth of scientific proof for the effectiveness of certain classes of OTC medications and the risks associated with improper use.

Acute Disease↗
PubMed1994

Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures.

OBJECTIVE: Numerous studies have found a relationship between the quantity of prenatal care received and birth outcomes. Few studies have had the opportunity to examine the content of prenatal care. This study examined the relationship between two components of the content of prenatal care: maternal reports of health behavior advice received and initial prenatal care procedures performed during the first two visits and low birth weight in a national sample of women. Advice and initial procedures were categorized based on the recommendations of the US Public Health Service Expert Panel on the Content of Prenatal Care. DESIGN: Interview survey of a nationally representative sample of women who had live births in 1988. PARTICIPANTS: A total of 9394 women, with data from the National Maternal and Infant Health Survey. MAIN OUTCOME MEASURE: Low birth weight (< 2500 g) as reported on the birth certificate. RESULTS: After controlling for other sociodemographic, utilization, medical, and behavioral factors, women who reported not receiving all the types of advice recommended by the Expert Panel on the Content of Prenatal Care were more likely to have a low-birth-weight infant compared with women who reported receiving the optimal level of advice (odds ratio = 1.38; 95% confidence interval, 1.18 to 1.60). There were no differences between women who reported receiving all the recommended initial prenatal care procedures and those who reported not receiving all recommended prenatal care (odds ratio = 1.00; 95% confidence interval, 0.87 to 1.14). CONCLUSION: These data suggest that women who report receiving sufficient health behavior advice as part of their prenatal care are at lower risk of delivering a low-birth-weight infant.

Female↗
PubMed1994

Racial disparities in reported prenatal care advice from health care providers.

OBJECTIVES: The relationship between certain maternal behaviors and adverse pregnancy outcomes has been well documented. One method to alter these behaviors is through the advice of women's health care providers. Advice from providers may be particularly important in minority populations, who have higher rates of infant mortality and prematurity. This study examines racial disparities according to women's self-report of advice received from health care providers during pregnancy in four areas: tobacco use, alcohol consumption, drug use, and breast-feeding. METHODS: Health care providers' advice to 8310 White non-Hispanic and Black women was obtained from the National Maternal and Infant Health Survey. RESULTS: After controlling for sociodemographic, utilization, and medical factors, Black women were more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. The difference between Blacks and Whites also approached significance for breast-feeding. No overall difference was noted in advice regarding cessation of drug use, although there was a significant interaction between race and marital status. CONCLUSIONS: These data suggest that Black women may be at greater risk for not receiving information that could reduce their chances of having an adverse pregnancy outcome.

Adolescent↗
PubMed1994

An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index.

OBJECTIVES: The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. METHODS: Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. RESULTS: The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. CONCLUSIONS: The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.

Algorithms↗
PubMed1994

The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight.

The proposed Adequacy of Prenatal Care Utilization Index is applied to data from the 1980 National Natality Survey to assess the adequacy of prenatal care utilization and its association with low birthweight in the United States. The index suggests that only 61.1% of women received adequate prenatal care, including 17.7% with more intensive care; 16.7% received inadequate care. More White women (63.4%) than Black women (51.9%) received adequate prenatal care. Low-birthweight rates were elevated among women with inadequate prenatal care and among those who received more intensive prenatal care.

Black or African American↗
PubMed1993

A comparison of prenatal care use in the United States and Europe.

OBJECTIVES: We sought to describe prenatal care use in the United States and in three European countries where accessibility to prenatal care has been reported to be better than it is in the United States. METHODS: We analyzed the 1980 US National Natality Survey, the 1981 French National Natality Survey, a 1979 sample of Danish births, and a survey performed from 1979 to 1980 in one Belgian province. RESULTS: The proportion of women who began prenatal care late (after 15 weeks) is highest in the United States (21.2%) and lowest in France (4.0%). This contrasts with the median number of visits, which is greater in the United States (11) than in Denmark (10) or in France (7). Across all maternal ages, parities, and educational levels, late initiation of prenatal care is more frequent in the United States, and median number of visits in the United States is equal to or higher than that in the other countries. CONCLUSIONS: In countries that offer nearly universal access to prenatal care, women begin care earlier during pregnancy and have fewer visits than women in the United States.

Adult↗
PubMed1993

Longitudinal observations on a selected group of local health departments: a preliminary report.

A study is in progress to document changes in selected public health departments over the past decade and to use those observations for proposing an assessment protocol that may be helpful in measuring progress toward achieving one of the Health Objectives for the Nation for the Year 2000. Objective no. 8.14 reads: "Increase to at least 90 percent the proportion of people served by a local health department that is effectively carrying out the core functions of public health." The study re-surveys a group of 14 departments that were the subjects of intensive case studies between 1979 and 1981. Some preliminary observations from follow-up study of these departments in 1992 include: growth in budget and staff and even larger growth in pressure for services, especially for personal health care; reorganization that splits away some programs of comprehensive ambulatory care and responsibility for public hospitals, while increasing the aggregation of human service agencies, including public health, under locally organized umbrella agencies; increase in preventive, screening, and categorical programs under public health sponsorship; drastic change in patterns of financing, featuring nearly total loss of direct federal grants, and increase in fee income; increase in the number of community and migrant health centers in the public health jurisdictions under study; diminished collaborative interaction with private practitioners; and continued close collaboration between health departments and community health centers in several communities. The implications of these changes are discussed. Subsequent reports will be based on efforts to measure the impact of specific events of the 1980s on public health performance, and will describe experience with a community-based surveillance approach for assessing public health performance.

Humans↗
PubMed1988

Infant mortality increase despite high access to tertiary care: an evolving relationship among infant mortality, health care, and socioeconomic change.

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

Birth Rate↗
PubMed1985

Racial and socioeconomic disparities in childhood mortality in Boston.

We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.

Accidents, Traffic↗
PubMed1984

The effect of WIC supplemental feeding on birth weight: a case-control analysis.

Extant data from prenatal patients in Massachusetts were analyzed to evaluate the effects of WIC supplemental feeding on birth outcomes. A total of 418 pairs of WIC and non-WIC women were directly matched for racial/ethnic group, age, parity, marital status, and income. Participation in WIC supplemental feeding appears to have a positive effect on pregnancy outcome. Participation in WIC is associated with a 107 g increase in mean birth weight (p = 0.012) and a 4.0% decrease in the incidence of low birth weight (p = 0.059). Teenage, Black, and Hispanic women show similar, if not stronger, benefits.

Adolescent↗
PubMed1984

WIC participation and pregnancy outcomes: Massachusetts Statewide Evaluation Project.

The effects of WIC prenatal participation were examined using data from the Massachusetts Birth and Death Registry. The birth outcomes of 4,126 pregnant women who participated in the WIC program and gave birth in 1978 were compared to those of 4,126 women individually matched on maternal age, race, parity, education, and marital status who did not participate in WIC. WIC prenatal participants are at greater demographic risk for poor pregnancy outcomes compare to all women in the same community. WIC participation is associated with improved pregnancy outcomes, including, a decrease in low birthweight (LBW) incidence (6.9 per cent vs 8.7 per cent) and neonatal mortality (12 vs 35 deaths), an increase in gestational age (40.0 vs 39.7 weeks), and a reduction in inadequate prenatal care (3.8 per cent vs 7.0 per cent). Stratification by demographic subpopulations indicates that subpopulations at higher risk (teenage, unmarried, and Hispanic origin women) have more enhanced pregnancy outcomes associated with WIC participation. Stratification by duration of participation indicates that increased participation is associated with enhanced pregnancy outcomes. While these findings suggest that birth outcome differences are a function of WIC participation, other factors which might distinguish between the two groups could also serve as the basis for alternative explanations.

Adolescent↗