Search PubMed⌕ Search

Biomedical subjects

M Kotelchuck

Publications and source records attributed to M Kotelchuck.

50 records · Page 3Linked to original sources
PubMed1984

Personal health maintenance for children.

The foundations for lifelong responsibility for personal health maintenance are laid down in childhood. Personal health maintenance for children is important for a healthy childhood, for a healthy adulthood and for the development of positive values about health, personal health responsibility and the use of health services. Present knowledge in this area is weak but growing. Five areas of development are highlighted: (1) the cognitive understanding of health and disease, (2) a psychological sense of control over health, (3) parental and media influences on health behaviors, (4) school health education and (5) training by health professionals about self-management of childhood illness and health services usage patterns. Implications for current practice are developed.

Adolescent↗
PubMed1978

Child abuse and dentistry: orofacial trauma and its recognition by dentists.

Orofacial trauma was found in 49% of 260 documented cases of child abuse seen during of five-year period at the Children's Hospital Medical Center, Boston. An additional 16% of the cases involved head trauma; the total percentage of head and facial trauma was 65%. Head or facial trauma was the principal reason for admission to the hospital in 45% of the cases. A survey of 537 dentists in Massachusetts showed that the majority were unaware of their legal and social responsibilities to report suspected cases of child abuse. Eleven percent of all dentists surveyed saw orofacial trauma cases that were of a suspicious nature, by only 22 confirmed cases of child abuse were noted by the dentists. Of these, only four were reported to social agencies. In general, oral surgeons and pedodontists saw a higher percentage of these cases and were more aware of their responsibilities than were general practitioners.

Child↗
PubMed1975

Infant reaction to parental separations when left with familiar and unfamiliar adults.

The results of two experiments examining infants at 6, 9, 12, 15, 18, and 21 months of age and varying levels of father interaction are summarized to show that separation protest is more a function of a strange person remaining in an unfamiliar laboratory situation with the infant than the temporary loss of a specific parent. The use of protest as an index of infant-parent attachment seems undesirable.

Age Factors↗
PubMedDate not supplied

Midwives, physicians, and the timing of maternal postpartum discharge.

Hospitalization for childbirth has traditionally provided the opportunity to assure that infants and mothers have adjusted to the birth and that ongoing care has been arranged, but economic and social pressures have resulted in a dramatic decrease in the duration of hospitalization. Using a sample of mothers who delivered well infants from the 1988 nationally representative National Maternal and Infant Health Survey, this study examines how midwives and physicians used an extra day of hospitalization in response to demographic, economic, behavioral, health status, and health care risk factors. Although midwives were much more likely to discharge mothers early (OR = 2.29) there were marked differences between risk factors and discharge timing for midwives and physicians. For the patients of midwives, the only factor associated with early discharge timing was attendance at childbirth classes. For the patients of physicians, less than a high school education, inadequate prenatal care, receipt of Medicaid or lack of insurance, and no childbirth classes were associated with early discharge. In spite of the intense pressures to discharge patients early, midwives appear to have been more attentive to potential risk factors in making discharge decisions in 1988. Because brief hospitalization is now prevalent, attention to maternal and newborn adjustment after birth, as apparently practiced by midwives, is crucial.

Adaptation, Physiological↗
PubMedDate not supplied

Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.

Evidence-Based Medicine↗
PubMedDate not supplied

Validity of the Maternal and Child Health Services Block Grant as an indicator of state infant mortality reduction initiatives.

Since state Maternal and Child Health Services Block Grant applications represent the most comprehensive source of information about community and state needs assessment, policy development, and program assurance for the population of mothers and children, these documents have the potential to play a central role in state accountability to Congress and the Maternal and Child Health Bureau. To measure the validity of block grant applications as a reporting mechanism, we assessed the sensitivity of the applications from seven states to strategies for reducing infant mortality. We used the independent coding of infant mortality strategies from the Healthy Futures/Healthy Generations Program intensive evaluation as the standard. Overall, the sensitivity of the block grant applications was only 45%. Since the open-ended design of the block grant applications does not appear to reflect the extent of state activity in infant mortality reduction, a uniform application should be adopted that will facilitate clear and systematic reporting of state activities.

Child↗
PubMedDate not supplied

Comparing mothers' reports on the content of prenatal care received with recommended national guidelines for care.

The Public Health Service's Expert Panel on the Content of Prenatal Care Report in 1989 provided detailed guidelines for the components of each prenatal visit. However, the extent to which women were receiving the recommended care when the guidelines were being formulated has yet to be determined. The 1988 National Maternal and Infant Health Survey results permit an examination of the proportion of women who reported receiving some of the recommended procedures. Women were asked if they received six of the recommended procedures (blood pressure measurement, urine test, blood test, weight and height taken, pelvic examination, and pregnancy history) in the first two visits, and whether they received seven types of advice or counseling (nutrition; vitamin use; smoking, alcohol, and drug use cessation; breastfeeding; and maternal weight gain) any time during their pregnancy. Only 56 percent of the respondents said they received all of the recommended procedures in the first two visits, and only 32 percent of the respondents said they received advice in all of the areas. Logistic regression analysis indicated that women receiving their care from private offices were significantly less likely to receive all the procedures and advice than women at publicly funded sites of care. This study suggests that recommendations of the Public Health Service's expert panel were not being met.

Chi-Square Distribution↗
PubMedDate not supplied

Racial differences in late prenatal care visits.

The purpose of this study was to examine potential racial disparities in the use of prenatal care beyond what could be measured by the Kessner Index. The data were obtained from the 1986 Massachusetts Prenatal Care Survey, a follow-back study of 2587 postpartum women, which had as its primary objective the identification of barriers to adequate use of prenatal care. This investigation examined the number of prenatal visits reported for each month of pregnancy and found that white women reported significantly more visits than black women only in the eighth and ninth months of pregnancy. This racial difference remained after we controlled for gestational age, sociodemographic factors, reported barriers to care, payor status, and access to care. This study suggests that racial differences in use of late prenatal visits need direct attention if the gaps in use of prenatal care and adverse birth outcomes are to be lessened.

Adolescent↗
PubMedDate not supplied

Back transfer: capability of community hospitals to serve chronically ill and convalescing infants.

Severe crowding in neonatal intensive care facilities may prevent many critically ill newborn infants from receiving optimal care. Crowding could be alleviated by back transferring chronically ill or convalescing infants to intermediate-level community hospitals where community-based care can be delivered. The purpose of this study was to assess the ability of such hospitals in North Carolina to care for these children. A telephone survey was administered to all 35 intermediate-level community hospitals that had > or = 600 births per year. Hospital resources were assessed on the first call, and a 1-day census was taken for three successive months. Total daily nursery census was 288. Back-transferred infants (32) and infants whose stay exceeded 5 days (32) constituted 24% of the nursery population. Each hospital had a pediatric medical director and necessary equipment to care for back transfers, and 80% of the hospitals could accept a back-transferred infant who was in a neonatal incubator, tube fed, receiving oxygen, 1400 gm, with mild and infrequent apnea and bradycardia--a common clinical picture in such infants. The most severe limitation to accepting infants for back transfer was the shortage of nursing staff appropriately trained to care for this population. These data have implications for effective discharge planning and the development of appropriate community-based, service-delivery systems.

Chronic Disease↗
PubMedDate not supplied

Quantifying the adequacy of prenatal care: a comparison of indices.

OBJECTIVES: In spite of the widespread use of prenatal care utilization indices in the scientific literature, little attention has been given to the extent to which these indices are comparable. This investigation contrasts the way five indices classified cases into categories of prenatal care use. METHODS: From the 1989-1991 South Carolina Public Use data files, single live births to resident mothers were selected for analysis (N = 169,082). Five prenatal care indices were compared: (a) the modified Institute of Medicine (Kessner) index, (b) a variation of the IOM index using the full American College of Obstetrics and Gynecology visit recommendation, (c) an index derived from the recommendations of the U.S. Public Health Service Expert Panel on Prenatal Care, (d) the GINDEX, and (e) the APNCU index. RESULTS: The proportion of cases assigned to prenatal care utilization categories by each index varied markedly, ranging from 33.6% to 58.1% for adequate care, 9.2% to 20.3% for inadequate care, and 7.4% to 22.6% for intensive utilization. CONCLUSIONS: The selection of a prenatal care utilization index for research and policy development purposes requires a careful consideration of the intent, criteria for defining adequacy, and coding assumptions of each index. As these indices are conceptually distinct in their measurement approach, they are likely to yield different patterns of prenatal care use in a population and cannot be used interchangeably. Recommendations for their use are provided.

Algorithms↗