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Biomedical subjects

C Brindis

Publications and source records attributed to C Brindis.

34 records · Page 2Linked to original sources
PubMed1995

A case management program for chemically dependent clients with multiple needs.

As part of a 3-year federal demonstration project, San Francisco health clinics provided case management services to chemically dependent individuals who were low-income and often homeless. Many of those participating in the project had also been diagnosed with HIV infection and/or mental illness. The intent of the demonstration project was to use case management as a mechanism for strengthening the linkages between substance abuse treatment and primary care systems. Case management was adopted as the catalyst for increased communication between medical personnel and other service providers to develop a more comprehensive approach to responding to the myriad of client needs. A specially designed management information system (MIS) was developed to help document client information and case management activities, as well as provide a tickler system to improve client continuity. This report integrates both qualitative and quantitative findings to provide a context for understanding case management activities, client problems and successes, and the systemic problems facing clients and case managers in linking primary care, substance abuse treatment, and mental health services.

Adolescent↗
PubMed1993

Health policy reform and comprehensive school health education: the need for an effective partnership.

This article offers a framework for considering how health care reform issues will impact the success of any national movement to implement Comprehensive School Health Education and the potential role that CSHE proponents can play in advocating reforms congruent with CSHE goals. The effectiveness of the CSHE movement within this arena will depend largely on its ability to critically self-diagnose its potential contributions to short-term and long-term positive health outcomes, and on its ability to join forces in ensuring that a variety of health, educational, and social services are made available in nontraditional sites--particularly schools--that are able to reach children and their families. An important step will be to expand the availability of Comprehensive School Health Education throughout the country: only one-half of all states currently mandate Comprehensive School Health Education programs, and implementation is spotty in some of these states. Another boost for the potential role of CSHE proponents can be found in the Year 2000 health objectives, of which more than one-third of 300 objectives geared to promoting health and disease prevention are devoted to the health behavior of school-age children and youth. Many of these objectives can be achieved directly or indirectly in schools, contingent upon appropriate financing and the establishment of CSHE goals as priorities at the policymaking level. An important factor will be the ability of the CSHE movement to provide its programs in the most cost-effective and cost-efficient manner, possibly including redeployment of staff and relocating resources as needed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Financing health care for adolescents: problems, prospects, and proposals.

Currently, one in every seven adolescents, aged 10-18, is uninsured. This translates to nearly 5 million uninsured adolescents nationwide. Uninsured adolescents, as opposed to insured adolescents, are more likely to be members of poor and minority families. In addition, adolescents without health insurance use fewer health services than their insured counterparts even after controlling for health status differences. Improving the health insurance status of adolescents is becoming an important public policy objective, although Congress recently rejected legislation that would have expanded Medicaid coverage for poor adolescents. Despite this setback, legislators and child health associates are increasingly striving for public and private insurance expansions for adolescents. These efforts are described, and the prospects for future improvements in health insurance coverage of adolescents are discussed.

Adolescent↗
PubMed1989

Birth weight outcomes in a teenage pregnancy case management project.

While many comprehensive health care programs for pregnant adolescents are designed to improve the birth weights of the babies born, few provide statistical evidence that they were able to do so. In this study, information was gathered prospectively on 411 mothers in a Teenage Pregnancy and Parenting Program (TAPP) that coordinated medical, educational, and social services through individual case management and agency-level coordination, information on the mothers, their pregnancy, and services received. The low birth weight rate for TAPP participants was significantly lower than the rate for San Francisco teens prior to the establishment of the program (8.1% versus 12.0% p less than 0.05). The mean weights of babies born to teens in TAPP were significantly higher than those in San Francisco after controlling for differences in the race, infant gender, parity, and age (p less than 0.0001). Participation in the TAPP program prior to delivery was more strongly associated with better birth weight outcomes than was race, age, parity, or gender. Participation in the TAPP program was associated with significantly better birth weights independent of receiving a minimal number of prenatal medical visits adequate for the gestational age of the baby at birth. Our results provide evidence of better health outcomes for the babies of teens who had case management that included continuous individual counseling and coordination of health, education, psychosocial, and nutrition services.

Adolescent↗
PubMed1987

Pew Memorial Trust policy synthesis: 3. Adolescent pregnancy: the responsibilities of policymakers.

In recent years, adolescent pregnancy and childbearing have emerged as major health and social policy issues, sparking debates in local and national forums. The concern is a response to rates of adolescent sexual activity, pregnancy, and out-of-wedlock childbirth that have risen sharply in the past 20 years. The deleterious effects of early parenthood, especially in poor communities, have been amply documented; education, future employment, and health status are among the areas affected. Efforts at intervention have ranged from preventing pregnancy by encouraging celibacy to trying to enhance the options available to those who are already parents. Many of these efforts have fallen short, proving unequal to the complexity of the issues being tackled. Relatively successful approaches have also been developed, however, and the synthesis describes several. Strategies addressing the needs of adolescents comprehensively and involving a multiplicity of concerned players appear to be most effective in the long term. There is a pressing need for more program documentation to substantiate this and other promising strategies.

Adolescent↗
PubMedDate not supplied

The interplay of national, state, and local policy in financing care for drug-affected women and children in California.

Recent prevalence studies in California indicate that perinatal alcohol and other drug use remains a serious issue for large numbers of women and their children. In response, national, state and local policymakers have taken steps to address the problem, including increasing funding for treatment services. To gauge the impact of policy attention to this problem, the Center for the Vulnerable Child at Children's Hospital, Oakland, California, surveyed state and local administrators of programs that serve drug-affected women and children in California. Information collected included the scope of program services, indicators of access, and sources of program funding. Surveyed programs were funded through federal, state, county, and foundation sources. Despite new policy and funding initiatives to serve this population, the study found wide gaps between the kinds of services that are believed to be appropriate for drug-affected women and children and the service system that currently exists. Problems in access to care included long waiting times, exclusion of women from programs based on their pregnancy or parenting status, and exclusion of drug-exposed children from programs with medically based eligibility criteria. Program funding sources appeared to impede access, as traditional federal, state, and county funding sources do not support programs that are comprehensive, family-centered, and easily accessible to these women and children. Analysis of the study data suggests that policymakers consider new approaches to promote access to care for these underserved women and children, particularly now as Congress and the states redesign health and social service funding mechanisms and delivery systems.

Adult↗
PubMedDate not supplied

Options for recovery: promoting success among women mandated to treatment.

In recent years imprisonment has been used increasingly for a wide range of nonviolent and petty offenses committed by women. Among incarcerated women, particularly those who are pregnant or parenting, substance use and its deleterious consequences are often exacerbated by imprisonment. Women who have been identified as chemically dependent are also at high risk for losing custody of their children. In California, the Options for Recovery (OFR) treatment program provided an alternative to incarceration or relinquishment of custody of children for chemically dependent pregnant and parenting women. This three-year pilot project offered alcohol and other drug abuse treatment and case management to these women, and included special training and recruitment of foster parents for their children. Findings from a three-year, multimethod evaluation study showed that women who were mandated to OFR treatment programs were more likely to successfully complete treatment than women who had enrolled in OFR voluntarily. An economic analysis of the costs associated with women in OFR compared with the combined costs of incarceration and alcohol and other drug abuse treatment produced a ratio in favor of OFR. Additionally, some innovative service alternatives for women mandated to treatment were developed during the project. The impact of such changes have implications for improving women's and family health.

Adult↗
PubMedDate not supplied

Differences and similarities in sexual and contraceptive knowledge, attitudes, and behavior among Latino male adolescent students in California, United States and Lima, Peru.

To identify the differences and similarities in sexual and contraceptive knowledge, attitudes, and behavior among Latino male adolescent students living in California and Lima. Self-administered, anonymous surveys were completed by Latino male students aged 12-19 participating in California, and by male adolescent students in four high schools in Lima. Both surveys contained similar questions allowing for comparisons regarding sexual activity and contraceptive behavior. The mean age of male students were 16 and 15 years, respectively. More California males reported having engaged in sexual intercourse (69% vs 43%. The sexual debut was 13 years in both samples. More students in California were aware of their risk of pregnancy at first sexual intercourse than in Lima (82% vs 50%). One-third of the California males reported communicating with their partner about sex and contraception to be "easy" as compared to 53% of males in Lima. More students in California reported knowing a place to obtain contraceptives if they need them (85% vs 63%), having ever gotten someone pregnant (29% vs 7%), and having fathered a child (67% vs 16%).

Adolescent↗
PubMedDate not supplied

Trends in rates of live births and abortions following state restrictions on public funding of abortion.

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.

Abortion, Legal↗
PubMedDate not supplied

High fertility among Indochinese refugees.

From 1975 to 1988, nearly 900,000 Indochinese refugees were resettled in the United States. This paper examines patterns of fertility among these refugees from Cambodia, Laos, and Vietnam who have exhibited high levels of reproduction since their arrival. Data are drawn from sample surveys in San Diego and San Francisco, CA. Fertility levels were found to exceed five children per ever-married woman, a level that is consistent with perceptions of ideal family size in the homeland. Fertility levels were significantly higher among rural second-wave refugees than in the more urban first-wave groups. One explanation for the high fertility is that couples have migrated from areas where fertility is high, and they have not yet adapted their reproductive behavior to the low fertility environment of the United States. This possibility is reinforced by a general gender preference for boys and exacerbated by the fact that, while a majority of women are aware of methods of fertility control, access is still limited by cultural and financial barriers, and the motivation to use family planning still appears to be relatively low. The data suggest that this refugee population will continue to put pressure on maternal and child health resources, and that continued residence in the United States could lead to desires to limit family size, thus increasing demand for methods of fertility control.

Adult↗
PubMedDate not supplied

Characteristics associated with contraceptive use among adolescent females in school-based family planning programs.

Among 162 young female family planning clients at four school-based health centers, a step-wise regression analysis shows that students' consistency of contraceptive use is associated with only a few specific service and provider characteristics. For example, clients who have more contacts with the family planning program use contraceptives more consistently than those with fewer contacts. On the other hand, young women whose follow-up visits are scheduled to occur within one month of their previous visit are less consistent contraceptive users than other clients. Contraceptive use is not related to whether contraceptives are dispensed on site, whether health education and counseling are provided by a health educator, whether contraceptive services are part of a comprehensive array of services that include medical or counseling services, or whether a family planning visit results in the dispensing of contraceptives or a prescription for contraceptives.

Adolescent↗
PubMedDate not supplied

[The reproductive characteristics of adolescents and young adults in Mexico City].

This article presents the preliminary findings of the Survey on Teenagers and Youth Reproductive Behavior in the Metropolitan Area of Mexico City, which contains information on 1,010 teenagers and young adults from 10 to 25 years of age interviewed in 1987. The average age was 17 years; 51.7 per cent of those interviewed were male and 48.3 per cent were female. A total of 14.6 per cent were married, being the average age at marriage 19.2 years for males and 17.8 years for females. Menarche occurred at an average age of 12.4 years, and spermarche at 14. Of those interviewed, 32.7 per cent have had sexual intercourse at least once in their lives. The average age at which sexual activity had begun, in the case of males, was 16 years and for females, 17 years. Of this group, 33.8 per cent stated that they had used some form of contraception during the first sexual intercourse; the contraceptive methods used most often were rhythm and withdrawal. The main source of supply of other methods is the pharmacy, in 67 per cent. 18.4 per cent of women had been pregnant, and 20.4 per cent of men's partners had presented this same condition. The first pregnancy occurred at 17.8 years for women and 18.7 for men. Of those men and women with a pregnancy experience 66.1 per cent and 57.3 per cent, respectively, stated that their first pregnancy was an unplanned one. Also, first pregnancy was related to their first marriage in 48.1 per cent of women and 82.4 per cent of male. The data presented here will reinforce current knowledge and will enable us to obtain a profile of the reproductive behavior of teenagers and young adults in the metropolitan area of Mexico City.

Adolescent↗
PubMedDate not supplied

A profile of the adolescent male family planning client.

CONTEXT: Family planning programs and policies increasingly focus on the male partner's roles and responsibilities in contraceptive decision-making and use. To effectively tailor services for males, policymakers and providers must refine their understanding of men's psychosocial and reproductive health needs. METHODS: Using self-administered questionnaires, 1,540 sexually active males aged 19 and younger who attended family planning clinics in California provided information about their sexual behavior, contraceptive use, pregnancy and parenting history, and psychosocial characteristics. Logistic regression was used to examine factors that contributed to effective contraceptive use. RESULTS: Although 73% of participants reported having used a birth control method at first intercourse, only 59% said that they or their partner had used an effective method at last intercourse, and 35% had used no method. If the client was uncomfortable with his method, the odds that he had used an effective method at last intercourse were reduced (odds ratio, 0.4). The likelihood of use at last intercourse was increased among males who agreed with their partner about their method and those who had never impregnated a partner (1.4 and 1.9, respectively). CONCLUSIONS: To adequately serve young males, clinics must take into account their sexual and contraceptive histories. But screening should go beyond traditional family planning techniques to discuss how to improve communication with partners and other lifestyle issues that may interfere with consistent use.

Adolescent↗
PubMedDate not supplied

Small-area analysis: targeting high-risk areas for adolescent pregnancy prevention programs.

CONTEXT: Traditional methods of identifying areas in need of adolescent pregnancy prevention programs may miss small localities with high levels of adolescent childbearing. METHODS: Birthrates for 15-17-year-olds were computed for all California zip codes, and the zip codes with birthrates in the 75th percentile were identified. Panels of local experts in adolescent pregnancy reviewed these "hot spots" for accuracy and grouped them into potential project areas, based on their demographics, geography and political infrastructure. RESULTS: In all, 415 zip codes exceeded the 75th-percentile cut-off point of 62.8 births per 1,000, and 210 of them differed significantly from the state average of 44.5 per 1,000 for 15-17-year-olds. While all had high adolescent birthrates, they varied greatly in racial and ethnic mix, poverty and educational attainment, and certain perinatal measures such as inadequate prenatal care and repeat pregnancy. CONCLUSIONS: The use of zip code-level data holds promise for more effective program planning and intervention.

Adolescent↗