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Elena Fuentes-Afflick

Publications and source records attributed to Elena Fuentes-Afflick.

18 recordsLinked to original sources
PubMed2007

Differences in neonatal mortality among whites and Asian American subgroups: evidence from California.

OBJECTIVE: To obtain information about health outcomes in neonates in 9 subgroups of the Asian population in the United States. DESIGN: Cross-sectional comparison of outcomes for births to mothers of Cambodian, Chinese, Filipino, Indian, Japanese, Korean, Laotian, Thai, and Vietnamese origin and for births to non-Hispanic white mothers. Regression models were used to compare neonatal mortality across groups before and after controlling for various risk factors. SETTING: All California births between January 1,1991, and December 31, 2001. PARTICIPANTS: More than 2.3 million newborn infants. MAIN EXPOSURE: Racial and ethnic groups. MAIN OUTCOME MEASURE: Neonatal mortality (death within 28 days of birth). RESULTS: The unadjusted mortality rate for births to non-Hispanic white mothers was 2.0 per 1000. The unadjusted mortality rate for births to Chinese and Japanese mothers was significantly lower (Chinese: 1.2 per 1000, P<.001; Japanese: 1.2 per 1000, P=.004), and for births to Korean mothers the rate was significantly higher (2.7 per 1000, P=.003). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For infants of Cambodian, Japanese, Korean, and Thai mothers, differences persist or widen after risk factors are considered. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates compared with infants born to non-Hispanic white mothers (adjusted odds ratios, 0.58 for infants of Cambodian mothers, 0.67 for infants of Japanese mothers, and 0.69 for infants of Korean mothers; all P<.05); infants of Thai mothers have higher neonatal mortality rates (adjusted odds ratio, 1.89; P<.05). CONCLUSIONS: There are significant variations in neonatal mortality between subgroups of the Asian American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian Americans as a homogeneous group may miss important opportunities for improving infant health in specific subgroups.

Adult↗
PubMed2006

Use of prenatal care by Hispanic women after welfare reform.

OBJECTIVE: The 1996 Personal Responsibility Work Opportunity Reconciliation Act (PRWORA, "welfare reform") changed immigrants' eligibility for publicly funded services such as Medicaid. However, implementation of the PRWORA varied by state. Florida implemented the eligibility restrictions, while California and New York preserved eligibility. Our objective was to compare the effect of state of residence and immigration status on use of prenatal care among Hispanic women in the period following the enactment of PRWORA. METHODS: In 1999-2001, we interviewed 3,242 postpartum Hispanic women in California, Florida, and New York. The dependent variable was use of prenatal care, dichotomized as adequate (initiated during the first trimester and > or = 6 visits, referent) or inadequate (initiated during the first trimester and < 6 prenatal visits or initiated after the first trimester). The primary independent variables were state of residence and maternal immigration status (U.S.-born citizens in New York, reference group). RESULTS: Thirteen percent of women were U.S.-born citizens, 8% were foreign-born citizens, 15% were documented immigrants, and 64% were undocumented immigrants. In Florida, women in all immigration subgroups were 2-4 times more likely to make inadequate use of prenatal care than U.S.-born citizens in New York. Documented immigrant women in New York were 90% more likely to make inadequate use of prenatal care than U.S.-born citizens in New York. CONCLUSION: Among Hispanic women in California, Florida, and New York, the state of residence, a measure of PRWORA policy changes, was associated with use of prenatal care. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2005

Prepregnancy health status and the risk of preterm delivery.

BACKGROUND: Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. OBJECTIVE: To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). MAIN OUTCOME MEASURE: Preterm delivery (<37 weeks' gestational age). RESULTS: Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. CONCLUSION: A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.

Adolescent↗
PubMed2005

Correlates of prescription drug use during pregnancy.

PURPOSE: To evaluate the extent of prescription drug use and the use of category D or X drugs during pregnancy and examine the maternal characteristics associated with use. METHODS: Medical record and survey data from an observational cohort of pregnant women from 2001 to 2003 (n=1626) were analyzed to examine the use of prescription drugs and the use of category D or X drugs. RESULTS: A majority of these pregnant women were prescribed a prescription drug (56%), and 4% of women were prescribed a category D or X drug. The most common classes of medications prescribed were antibiotics (62%), analgesics (18%), asthma medications (18%), and antiemetics (17%). After adjustment for sociodemographic and clinical characteristics, African American women were more likely to use a prescription drug than white women. Lower levels of educational attainment were also associated with greater use of prescription drugs compared with women who had graduated from college. Women with a chronic health condition, gestational diabetes, a prenatal hospitalization, a history of infertility, or symptoms of acid reflux were also more likely to use a prescription drug than women without these conditions. Nulliparous women and women who were married or living with a partner were less likely to use category D or X drugs during pregnancy than women without these characteristics. Women with a history of infertility and those with a chronic health condition were more likely to use a category D or X drugs during pregnancy than those without these conditions. CONCLUSIONS: The common use of prescription drugs during pregnancy supports the importance of expanding the evidence about the risks and benefits of prescription drug use during pregnancy and suggests the need for systems to safeguard prescribing practices for women of reproductive age.

Adult↗
PubMed2005

Changes in health status experienced by women with gestational diabetes and pregnancy-induced hypertensive disorders.

OBJECTIVE: To examine changes in health status among women with gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH). METHODS: We examined perceived health status changes from the prepregnancy, as recalled at 12-20 weeks gestation, to the postpartum period in women with GDM (n = 64) vs. unaffected gravidas (n = 1233) and women diagnosed with PIH (n = 148) vs. unaffected gravidas. We used patient survey and medical record data from a prospective cohort study. Health status measures included the Short Form-36 scales for physical function, vitality, and self-rated health and the Center for Epidemiologic Studies-Depression Scale (CES-D). Multivariate logistic regression models controlled for age, parity, race, education, prepregnancy body mass index (BMI) and exercise levels, food insufficiency, and GDM or PIH during a prior pregnancy. RESULTS: Women with PIH more often reported a significant decline in vitality (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.02-2.23) and self-rated health (OR 2.12, 95% CI 1.19- 3.77) and an increase in depressive symptoms from prepregnancy to postpartum compared with unaffected women (OR 1.84, 95% CI 1.11-3.05). Decline in self-rated health was partially mediated by cesarean birth and preterm delivery. Similar proportions of women with GDM and unaffected women reported declines in health status measures. CONCLUSIONS: Women with PIH, but not GDM, more often experience significant declines in health status from prepregnancy to postpartum than unaffected women.

Adult↗
PubMed2005

Body mass index, provider advice, and target gestational weight gain.

OBJECTIVE: To study the relationships among prepregnancy body mass index (BMI), women's target gestational weight gain, and provider weight gain advice. METHODS: Project WISH, the acronym for Women and Infants Starting Healthy, is a longitudinal cohort study of pregnant women in the San Francisco Bay area. We excluded subjects with preterm birth, multiple gestation, or maternal diabetes. RESULTS: Among overweight women (prepregnancy BMI 26.1-29.0), 24.1% reported a target weight gain above the Institute of Medicine (IOM) guidelines, compared with 4.3% of normal weight women (P < .001). Among women with a low prepregnancy BMI (< 19.8), 51.2% reported a target weight gain below the guidelines, compared with 10.4% of normal weight women (P < .001). These patterns persisted in a multivariate analysis. Latina ethnicity, lower maternal education, low prepregnancy BMI (< 19.8), lack of provider advice about weight gain, and provider advice to gain below guidelines were all independently associated with a target weight gain below IOM guidelines. Prepregnancy BMI more than 26, multiparity, lower age, and provider advice to gain above guidelines were all associated with a target gain above IOM guidelines. CONCLUSION: Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.

Body Mass Index↗
PubMed2005

Changes in the health status of women during and after pregnancy.

OBJECTIVE: To characterize the changes in health status experienced by a multi-ethnic cohort of women during and after pregnancy. DESIGN: Observational cohort. SETTING/PARTICIPANTS: Pregnant women from 1 of 6 sites in the San Francisco area (N=1,809). MEASUREMENTS AND MAIN RESULTS: Women who agreed to participate were asked to complete a series of telephone surveys that ascertained health status as well as demographic and medical factors. Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third trimester (0-100 scale, where 100 represents better health), and improved during the postpartum period (mean score, 90.7). The prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2% during the third trimester, and then declined to 14.2% during the postpartum period. Insufficient money for food or housing and lack of exercise were associated with poor health status before, during, and after pregnancy. CONCLUSIONS: Women experience substantial changes in health status during and after pregnancy. These data should guide the expectations of women, their health care providers, and public policy.

Adolescent↗
PubMed2005

Ethnic differences in neonatal and postneonatal mortality.

OBJECTIVE: Ethnic disparities in infant mortality have been consistently documented in the United States, but these disparities are poorly understood. Although the infant mortality rate in the United States has fallen to record low rates, since 1971 the ethnic disparity between black and white infants has remained unchanged or increased. In 2001, the infant mortality rate among black infants was approximately 2.5 times higher than the rate among white and Hispanic infants. The objective of this study was to identify ethnic differences in neonatal and postneonatal mortality as well as the causes and risk factors among infants born in California. METHODS: Secondary analysis was performed of 1,277,393 singleton infants live-born to black, Latina, and white women from the California linked birth-infant death certificate from 1995 to 1997. The dependent variables were infant death (defined as an infant who died in the first year of life [death <365 days]), neonatal death (death during the first 27 days of life), and postneonatal death (death between 28 and 364 days of life). Cause-specific neonatal and postneonatal infant mortality rates (per 100,000 live births) were calculated for each ethnic group. Chi(2) and exact test statistics were used to compare the distribution of maternal and infant characteristics and cause-of-death rates by maternal ethnicity. Logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationship between maternal ethnicity, maternal and infant factors, and risk of infant mortality. RESULTS: In both the neonatal and postneonatal periods, black women had higher infant mortality rates than Latina or white women for conditions originating in the perinatal period (including respiratory distress syndrome) and symptoms, signs, and ill-defined conditions (including sudden infant death syndrome). After adjusting for maternal and infant characteristics, there were no significant ethnic differences for neonatal mortality. For postneonatal mortality, black women had a higher risk (OR: 1.25; 95% CI: 1.10-1.42) and Latina women had a lower risk (OR: 0.80; 95% CI: 0.71-0.89) compared with white women after adjusting for maternal and infant factors. In analyses of all ethnic groups combined, as well as ethnic-specific analyses, the strongest predictors of neonatal and postneonatal death were infant birth weight of <2499 g and gestational age of <33 weeks. CONCLUSIONS: Causes of infant mortality and risk factors for infant mortality differed by maternal ethnicity, indicating a need to tailor prevention and education efforts, especially during the postneonatal period. To achieve national infant mortality goals, health professionals and policy makers should continue to emphasize the importance of early and continuous prenatal care and develop new strategies to reduce the incidence of low birth weight and premature infants. Ethnic-specific approaches may be needed to further reduce infant mortality rates and achieve our national goal to eliminate ethnic disparities in perinatal outcomes.

Adolescent↗
PubMed2004

Smoking cessation counseling with young patients: the practices of family physicians and pediatricians.

OBJECTIVE: To investigate family physicians' and pediatricians' practice of and perceived barriers to smoking cessation counseling among patients 18 years and younger. DESIGN: Cross-sectional mail survey conducted between November 1, 1997, and January 31, 1998. PARTICIPANTS: A stratified random sample selected from the 1997 American Medical Association Physician Masterfile of 1000 family physicians and pediatricians who practice in urban California, work at least 10% of the time in ambulatory care, and have at least 10% of patients 18 years and younger. MAIN OUTCOME MEASURES: Physicians' adherence to 5 components of the National Cancer Institute's smoking cessation counseling recommendations (anticipate, ask, advise, assist, and arrange) and their perceived barriers to smoking cessation counseling. RESULTS: A total of 429 physicians participated in the study. Physicians of both specialties were more likely to anticipate, ask, and advise patients about smoking than to assist with and arrange cessation activities. Family physicians were more likely than pediatricians to assist and arrange, including scheduling follow-up visits to discuss quitting (25.1% vs 11.7%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.22-7.73) and directing nursing staff to counsel patients (17.1% vs 10.9%; OR, 3.70; 95% CI, 1.30-10.60). The most common perceived barrier to counseling was the belief that children would provide inaccurate responses due to either the presence of parents (86.4%) or the fear that parents would be notified of their answers (74.0%). Pediatricians reported lack of counseling skills as a barrier to providing smoking interventions in greater proportion than did family physicians (24.9% vs 54.8%; OR, 0.29; 95% CI, 0.14-0.63; P<.001). CONCLUSION: Improvement in smoking cessation counseling skills and practices is needed among physicians treating children and adolescents.

Adolescent↗
PubMed2004

Depressive symptoms in the immediate postpartum period among Hispanic women in three U.S. cities.

The aim of this was to examine rates and determinants of depressive symptomatology in the immediate postpartum period among Hispanic women in the United States. A total of 3952 Hispanic women who had delivered infants (parturients) were interviewed in postpartum wards in Miami, New York City and San Francisco. Symptoms of depression were regressed onto a series of social, psychological, and socioeconomic variables. Results showed that 42.6% of participants were probable cases of depression (CES-D > or = 16). Depression was negatively associated with perceived level of social support (adjusted OR = 0.59, 95% CI: 0.53-0.67) and health insurance coverage (adjusted OR = 0.68, 95% CI: 0.49-0.95), but not with the degree of acculturation or immigration status. It was found that depressive symptoms are common among Hispanic parturients. Pregnant Hispanic women should be carefully monitored for signs of depression and appropriate preventive measures are needed.

Adolescent↗
PubMed2004

Reduced risk of inadequate prenatal care in the era after Medicaid expansions in California.

BACKGROUND: To improve perinatal outcomes in the United States, access to prenatal care was expanded through Medicaid and women were encouraged to enter prenatal care early. OBJECTIVE: The objective of this study was to determine if expanded eligibility for Medicaid increased use of prenatal care and reduced ethnic differences in use of prenatal care. RESEARCH DESIGN: We conducted secondary analysis of California birth certificate data for 1990, 1995, and 1998. SUBJECTS: We studied live-born singleton infants born to black, Asian, Latina, and white women (n = 1,483,951). MAIN OUTCOME MEASURES: Inadequate utilization of prenatal care. RESULTS: The proportion of live-born infants whose mothers had inadequate prenatal care decreased from 20% in 1990 to 14% in 1995 and 12% in 1998. In addition, the proportion of pregnant women with no insurance or who were self-paying fell from 13.1% in 1990 to 4.2% in 1995 and 3.6% in 1998 (P <0.001). Reductions in overall prevalence of inadequate use of prenatal care and ethnic disparities in use of prenatal care were not fully explained by increases in Medicaid coverage. CONCLUSIONS: Since California expanded access to Medicaid-funded prenatal care, there has been a substantial reduction in inadequate use of prenatal care and fewer women have no insurance or are self-paying. To further reduce ethnic disparities in use of health services, new policies must be developed to remove nonfinancial barriers to early and continuous use of prenatal care.

Adolescent↗
PubMed2002

The health of Latino children: urgent priorities, unanswered questions, and a research agenda.

Latinos recently became the largest racial/ethnic minority group of US children. The Latino Consortium of the American Academy of Pediatrics Center for Child Health Research, consisting of 13 expert panelists, identified the most important urgent priorities and unanswered questions in Latino child health. Conclusions were drawn when consensus was reached among members, with refinement through multiple iterations. A consensus statement with supporting references was drafted and revised. This article summarizes the key issues, including lack of validated research instruments, frequent unjustified exclusion from studies, and failure to analyze data by pertinent subgroups. Latino children are at high risk for behavioral and developmental disorders, and there are many unanswered questions about their mental health needs and use of services. The prevalence of dental caries is disproportionately higher for Latino children, but the reasons for this disparity are unclear. Culture and language can profoundly affect Latino children's health, but not enough cultural competency training of health care professionals and provision of linguistically appropriate care occur. Latinos are underrepresented at every level of the health care professions. Latino children are at high risk for school dropout, environmental hazards, obesity, diabetes mellitus, asthma, lack of health insurance, nonfinancial barriers to health care access, and impaired quality of care, but many key questions in these areas remain unanswered. This article suggests areas in which more research is needed and ways to improve research and care of Latino children.

Asthma↗
PubMedDate not supplied

Lower agreement on behavioral factors than on medical conditions in self-reported data among pregnant Latina women.

BACKGROUND: Agreement between self-reported data and data obtained from medical records is far from perfect and few studies have analyzed the element of language when self-reported data are given in one language and this information is recorded in another language in the medical record. Our objective was to assess agreement between self-reported data and medical record data with regard to prenatal risk factors in pregnant Latina women. METHODS: We interviewed 350 Latina women at >or =20 weeks' gestation regarding alcohol use, tobacco use, use of prenatal vitamins, age, education, use of prenatal care, and medical conditions. Kappa statistic (kappa) and 95% confidence intervals (95% CIs) were used to calculate agreement between self-reported responses and medical record data. Multiple logistic regression analysis was used to evaluate effect of maternal characteristics on likelihood of disagreement. RESULTS: Agreement between self-reported and medical record data was generally lower for behavioral factors (alcohol kappa=0.37 and prenatal vitamin use kappa=0.09) than for medical conditions (anemia kappa=0.63, gestational diabetes kappa=0.83, and hypertension kappa=0.68). In general, maternal characteristics did not significantly predict patterns of disagreement. CONCLUSIONS: Among pregnant Latina women, self-reported data on behavioral factors had lower agreement than self-reported data on medical conditions. Further study is needed to define the effect of other factors, such as social norms, on accuracy of self-reported data during pregnancy.

Adolescent↗
PubMedDate not supplied

Pain during Mogen or PlastiBell circumcision.

UNLABELLED: Routine neonatal circumcision can be a painful procedure. Although analgesia for circumcision has been studied extensively, there are few studies comparing which surgical technique may be associated with the least pain and discomfort when carried out by pediatric trainees. OBJECTIVE: We studied two commonly used techniques for circumcision to determine which was associated with less pain and discomfort. STUDY DESIGN: In a randomized, prospective, but not blinded study, newborns were circumcised either by Mogen clamp or by PlastiBell. All received dorsal nerve blocks with lidocaine. Fifty-nine well, term, newborn infants at San Francisco General Hospital were studied from 1997 to 1998. Circumcisions were carried out mostly by interns and residents in family practice and pediatrics. Pain was assessed by measuring duration of the procedure and by a simple behavioral score done sequentially. RESULTS: Dorsal nerve blocks were judged to be fully effective in over 70% of cases. Neither Mogen nor PlastiBell was associated with greater pain per 3-minute time period, but the PlastiBell technique on average took nearly twice as long as the Mogen procedure (20 vs 12 minutes). We judged that 60% of the infants had pain or discomfort associated with the procedure that was excessive. Residents and interns universally preferred the Mogen technique over the PlastiBell because of the former's simplicity. CONCLUSION: During the procedure, Mogen circumcision is associated with less pain and discomfort, takes less time, and is preferred by trainees when compared with the PlastiBell.

Circumcision, Male↗
PubMedDate not supplied

Association of breastfeeding with maternal depressive symptoms.

PURPOSE: To identify risk factors for lack of breastfeeding initiation and duration of <1 month among a racially diverse cohort of women. In particular, our interest was to examine depressive symptoms during pregnancy as a potential risk factor for not initiating or continuing breastfeeding. METHODS: Survey and medical record data from a cohort of pregnant women from the San Francisco Bay area who delivered a singleton infant (n = 1448) were analyzed to examine lack of breastfeeding initiation and duration of <1 month. RESULTS: In this study, 5.6% of women did not initiate breastfeeding, and 11.1% of women who initiated breastfeeding had a duration of breastfeeding of <1 month. There were no racial or ethnic differences in initiation of breastfeeding after adjusting for demographic and clinical characteristics. At 1 month postpartum, African American women were more likely than white women to have a duration of breastfeeding lasting <1 month. Depressive symptoms during or prior to pregnancy had no effect on initiation of breastfeeding even when symptoms were persistent. Women with persistent depressive symptoms (symptoms at two time points, including one prior to delivery) were more likely to have breastfeeding duration of <1 month (odds ratio [OR] 1.77, 95% confidence interval [95% CI] 1.10-2.86), whereas depressive symptoms at a single time point were not associated with breastfeeding duration of <1 month. CONCLUSIONS: Addressing depressive symptoms experienced by women both during and after pregnancy may improve the duration of breastfeeding.

Adult↗