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Biomedical subjects

F A Connell

Publications and source records attributed to F A Connell.

At least 37 records · Page 2Linked to original sources
PubMed1994

Adequacy of well-child care and immunizations in US infants born in 1988.

OBJECTIVE: To determine adequacy of preventive care for US infants, including both well-child care visits and immunizations, and to identify risk factors for inadequate receipt of care. DESIGN: Analysis of the 1988 National Maternal and Infant Health Survey of the National Center for Health Statistics. SAMPLE: Nationally representative sample of all US children born in 1988. PARTICIPANTS: A total of 7035 infants from a live-birth subsample who were at least 8 months of age and living with their mothers at the time of the survey. MAIN OUTCOME MEASURES: Percentage of children receiving both adequate well-child visits and adequate immunizations by 8 months of age. RESULTS: Adequate visits were received by 82% of white infants and 75% of black infants; adequate immunizations were received by 46% and 34%, respectively. Forty-two percent of white infants and 29% of black infants received both. Sixty percent of infants who did not have adequate immunizations by 8 months of age had at least three well-baby visits. With adjustment for maternal education level, poor white children had a relative risk of 1.5 of receiving inadequate care compared with infants in families with income greater than 185% of the federal poverty level. Infants with Medicaid or other government assistance had significantly lower levels of adequate care than did infants with private insurance. CONCLUSIONS: This study demonstrates a wide gap between actual immunization coverage levels and recommended levels among US infants born in 1988. Public health agencies, Medicaid programs, and primary care providers should explore ways to take better advantage of well-child visits that are already occurring to achieve appropriate levels of immunization coverage.

Health Priorities↗
PubMed1994

Children in foster care in the state of Washington. Health care utilization and expenditures.

OBJECTIVE: To determine and compare health care utilization and expenditures of children in foster care with those of other children and to identify and describe high-cost children in foster care. DESIGN: Analysis of the Medicaid program claims data in the state of Washington. POPULATION: A total of 1631 children in foster care and 5316 children in the Aid to Families With Dependent Children (AFDC) program in 1990. The children were ages 0 through 7 years and eligible for Medicaid continuously during the study year. MAIN OUTCOME MEASURES: Health care utilization and expenditures classified by types of health service and health care provider; proportion of children with 1990 expenditures exceeding $10,000 and most prominent diagnoses associated with their health care utilization. RESULTS: Mental health services were used by 25% of children in foster care compared with 3% of AFDC children (P < .001), and supportive services of visiting nurses and physical therapists were used by 13% of children in foster care and 1% of AFDC children (P < .001). Twice as many children in foster care than AFDC children used medical equipment or specialist services or were hospitalized (P < .001). Mean health care expenditures in 1990 were $3075 for children in foster care and $543 for AFDC children (P < .001). High-cost children included 8% of children in foster care and 0.4% of AFDC children. Among the high-cost children in foster care (n = 106), 59% had mental disorders and 31% had congenital conditions. CONCLUSIONS: Results suggest a higher prevalence and greater complexity of illnesses, particularly mental disorders, among children in foster care. Despite the high utilization and cost of mental health services, previous research suggests there may be underutilization of these services compared with need. Appropriate allocation of resources is essential if foster care agencies are to adequately meet the diverse and compelling needs of children in foster care.

Child↗
PubMed1994

Effect of changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates.

OBJECTIVE: To examine the effect of maternal age on cesarean delivery risk and to quantify the impact of demographic changes since 1970 on primary cesarean delivery rates. DESIGN: A cohort study. SETTING: Nonfederal short-stay hospitals in Washington State. PARTICIPANTS: All women who delivered live singletons with linked birth certificate and hospital discharge data from 1987 through 1990. MAIN OUTCOME MEASURES: Maternal age-, birth weight-, and parity-specific primary cesarean delivery rates, Mantel-Haenszel relative risk estimates for primary cesarean delivery by 5-year age category stratified by parity, and direct standardization of 1987 through 1990 primary cesarean rates to 1970 Washington State maternal age, birth weight, and parity distribution. RESULTS: Primary cesarean rates ranged from 3.2% for multiparous teenage women who delivered infants weighing 3500 g through 3999 g to 58.9% for primiparous women 40 years of age or older who delivered infants weighing 4000 g or more. After adjustment, the risk of cesarean delivery increased with each 5-year age increment among women 20 years of age or older. We estimated that if the maternal age, parity, and birth weight distribution from 1987 through 1990 were identical to what existed in 1970, Washington State's primary cesarean rate from 1987 through 1990 would have been 12.2%, compared with the observed rate of 14.8%. CONCLUSION: The lower adjusted primary cesarean rate reflects the demographic changes in the childbearing population, which may be responsible for 18% of the 1987 through 1990 cesarean delivery rates. These findings suggest the importance of using maternal age-, birth weight-, and parity-specific primary cesarean delivery rates to compare populations and study temporal trends.

Adolescent↗
PubMed1993

Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989.

The authors abstracted a sample of 7,536 hospital medical records to validate the accuracy of the coding of obstetric information on 1) birth certificates, 2) a statewide computerized hospital discharge abstract data system, and 3) a linked file merging birth certificates and the hospital abstract data for Washington State deliveries occurring in 1989. Measures of accuracy of coding of delivery method and obstetric procedures varied greatly among the 23 hospitals that participated in the study. Computerized hospital discharge data were generally more complete and accurate than were birth certificate data. The linked file was more likely to identify obstetric procedures than was either source alone. For example, only 84.1% of cesarean deliveries noted in the hospital charts were identified on birth certificates (range among hospitals, 37-100%). Using the linked file, the authors identified 99.8% of cesarean deliveries (range, 97-100%). Linked birth certificate-hospital abstract files may become an excellent source of data for epidemiologic and health care studies; however, further training of medical record personnel and standardization of coding are needed to improve the quality of computerized data on obstetric events.

Birth Certificates↗
PubMed1992

Small area analysis of surgery for low-back pain.

Rates of spine surgery (discectomy, laminectomy, fusion) vary several-fold among "small areas" such as counties or hospital market areas. To ascertain why this is so, an analysis was conducted of variability in rates among counties in the State of Washington (N = 39). Since, unlike previous published reports, this study excluded patients with cancer, major trauma, and infection, as well as those with cervical and thoracic procedures, rates in this study pertain specifically to the problem of low-back pain. Six classes of variables to explain variability among county rates were defined: I) percentage of the labor force in heavy labor and transportation occupations; II) socioeconomic conditions; III) neurologic and orthopedic surgeon density; IV) occupancy rate of back surgery hospitals; V) primary payer and VI) health care availability. In all, the effect of 28 explanatory variables was tested. In doing so, the authors took into account the possibility of spurious correlation. The rate of surgery for low-back pain varied nearly 15-fold among counties. The explanatory variables that were tested, however, accounted for only a minor part of the variability. The hypothesis that "physician practice style factor" accounts for the major part is explored; potential properties of practice style factor are specified for further testing.

Back Pain↗
PubMed1992

Medicaid prenatal care: a comparison of use and outcomes in fee-for-service and managed care.

BACKGROUND: To control rising costs, state Medicaid agencies are enrolling recipients in managed care health plans (MCPs). We performed this study to assess this policy's impact on accessibility and outcomes of Medicaid-funded prenatal care. METHODS: We performed a retrospective, controlled study with three cohorts: a study group of 1106 Medicaid recipients enrolled in three MCPs, a matched comparison group of 4830 recipients receiving care in the fee-for-service (FFS) system, and a second matched comparison group of 4434 non-Medicaid enrollees of the same MCPs. Data on prenatal care use and birth outcomes were obtained through linkage of claims and discharge files with birth certificate files. RESULTS: Medicaid recipients enrolled in MCPs used prenatal care similarly to those in the FFS system and showed equal or modestly improved birth-weight distributions. However, Medicaid MCP enrollees showed poorer use of prenatal care and birth outcomes compared with non-Medicaid enrollees of the same plans. CONCLUSIONS: Enrollment in MCPs has a neutral or small beneficial effect on the prenatal care received by the Medicaid population. However, providing financial access and modifying the system of care for this population did not result in parity with the general population.

Birth Certificates↗
PubMed1992

Short, thin, or obese? Comparing growth indexes of children from high- and low-poverty areas.

This study compared the growth indexes of first-grade, white children living in geographic areas of high poverty (n = 281) and low poverty (n = 442) in the state of Washington. Obesity was the most common growth deviance observed in these children. In the low-poverty area, 18% of children had a weight for height greater than the 90th percentile on the National Center for Health Statistics (NCHS) growth standards, whereas only 12% of children from the high-poverty area were in this category. Neither area had high numbers of children with reduced weight for height (less than the 10th percentile on the NCHS growth standards), but children from the high-poverty area were almost twice as likely to be short for their age; 9% of children from the high-poverty area and 5% of children from the low-poverty area had height-for-age values less than the 10th percentile on the NCHS growth standards. Criteria used to determine students' eligibility for financial support for school lunch did not accurately identify children who were thin or short. The prevalence of obesity in these first-grade children suggests that school-based growth screening as well as weight management and physical fitness programs are needed to identify and avert childhood obesity.

Anthropometry↗
PubMed1991

Antecedents of macrosomia.

Antecedents of high birthweight (macrosomia) were studied using the state birth certificates of White singleton infants born in three large metropolitan counties of Washington State from 1984 to 1986. Cases consisted of 2082 live-born macrosomic infants, defined by a birthweight of over 4.5 kg. A random sample of 4440 live births with birthweights of 2.5-4.0 kg was selected as a comparison group. Estimates for the independent risks associated with gestational and established diabetes, male sex, parity, duration of gestation, maternal smoking during pregnancy, maternal age, and median income of maternal residential area were obtained and combined in a single logistic model. Maternal smoking was associated with a decreased risk of macrosomia (OR 0.4, 95% CI 0.3-0.5). Established diabetes (OR 6.4, 95% CI 2.7-15.4), gestational diabetes (OR 3.2, 95% CI 2.1-5.1) and male sex of the infant (OR 2.4, 95% CI 2.2-2.7) were associated with an increased risk. Increasing parity was related to an increasing risk from para one (OR 1.4, 95% 1.2-1.6) to para six and greater (OR 3.3, 95% CI 1.5-7.4). Increasing duration of gestation was associated with an increasing risk from 33-36 weeks (OR 0.8, 95% CI 0.5-1.2) to 43-45 weeks (OR 3.3, 95% CI 2.5-4.2). Maternal age, median income of maternal area of residence, and maternal marital status were not significantly associated with macrosomia.

Birth Certificates↗
PubMed1990

Access to obstetric care in rural areas: effect on birth outcomes.

Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion to number of births. Women from these high-outflow communities had a greater proportion of complicated deliveries, higher rates of prematurity, and higher costs of neonatal care than women from communities where most patients delivered in the local hospital.

Adolescent↗
PubMed1990

An evaluation of prenatal care utilization in a military health care setting.

An assessment of prenatal care and birth outcomes was performed for a sample of 7,599 births at a military hospital between 1982 and 1985. Prenatal care patterns were similar to a civilian Health Maintenance Organization study's. Less adequate levels of prenatal care were significantly associated with higher risks of neonatal mortality and low birth weight. Five independent risk factors for receiving less adequate care were identified by multivariate analysis: 1) young maternal age (less than age 20), 2) black race, 3) residence off post, 4) high risk combinations of age and parity, and 5) residence in low-income census tracts.

Female↗
PubMed1990

Lack of difference in neonatal mortality between blacks and whites served by the same medical care system.

To study the influence of health care systems on racial differences in low birthweight and neonatal mortality, an historical cohort analysis was conducted using birth and linked birth and death certificates of infants delivered in Pierce County, Washington, between 1982 and 1985. Overall, black infants had significantly higher rates of low birthweight than white infants. Black infants served by civilian medical care had approximately twice the neonatal mortality of white infants; however, black infants born in the military hospital had a neonatal mortality rate comparable to white infants. Controlling for marital status, age, parity, and income status did not appreciably change these patterns. Military care appeared to be associated with a protective effect for neonatal mortality for blacks. This effect was not due to differences in birthweight distribution or to the quantity of prenatal care received. The effect was most prominent for normal weight black infants, especially for those from low-income census tracts. The findings have possible implications for pediatric access issues for the poor and for the family practice model of perinatal care continuity.

Black or African American↗
PubMed1988

Sentinel health events surveillance in diabetes. Deaths among persons under age 45 with diabetes.

The pilot study for a sentinel health events surveillance system for deaths among persons under age 45 with diabetes was conducted in six states in 1984 and 1985. Two hundred and thirty-three events were identified. Information from death certificates, physicians, and families revealed that 22% died from acute complications of diabetes and 53% from chronic complications. Blood pressure measurement and urinalysis testing had been performed in the last year for almost all of the decedents, but other preventive practices were reported less frequently. Hypertension was present in 57% and of those, was not controlled in 73%. Forty-four percent were cigarette smokers at the time of death. Agreement between physicians and families was generally higher for clinical conditions than for care practices. This surveillance system appears to yield information about the health care of persons with diabetes not readily available from other sources, although modifications may be necessary before implementation.

Adolescent↗
PubMed1988

The preventability of 'premature mortality': an investigation of early diabetes deaths.

Certifying physicians were surveyed regarding the 40 diabetic deaths under 45 years of age occurring in Washington State between July 1 and December 31, 1984. At most, it is estimated that three deaths may have been prevented by more accessible, timely or careful medical management immediately prior to death. Over 50 per cent of decedents were reported to be financially disadvantaged and 81 per cent had significant psychological problems. The role of these psychosocial factors needs further delineation.

Adolescent↗
PubMed1987

The use of large data bases in health care studies.

The growing number of large health data bases available represents a valuable resource for health care research. Many available data bases, however, have subtle and/or complex defects in their design as well as in the quality of the data themselves. The apparent ease and economy of using pre-collected data cannot eliminate the need for careful selection, examination, and analysis of these data. Existing documentation should be critically reviewed to assess the appropriateness of the data base for its intended use. Once in hand, the completeness and coding of the data should be examined in detail before attempting to test hypotheses. In conducting data analysis, the investigator must be aware of the potential problems related to the size of the data base, the unit of analysis, and the sampling strategy--particularly if sampling involved stratification or clustering. Awareness of the potential pitfalls inherent in the use of large health data bases can help prevent many problems and disappointments, as well as improve the validity and efficiency of statistical analysis.

Computer Communication Networks↗
PubMed1985

Diabetes in pregnancy: a population-based study of incidence, referral for care, and perinatal mortality.

During 1979 and 1980 in Washington State, 260 infants (live births plus fetal deaths greater than or equal to 20 weeks' gestation) were born to women with preexisting diabetes mellitus, the equivalent to a population-based incidence of 2.1 per 1000 total births. One quarter of these women had non-insulin-dependent diabetes prior to pregnancy. The perinatal mortality rate for all infants of diabetic mothers in this series was 108 per 1000, which was eight times the state perinatal mortality rate. Only 45% of births occurred in the five tertiary centers in the state, whereas 39% occurred in hospitals that had fewer than six deliveries per year complicated by overt diabetes. The mortality rate was slightly, but not significantly, lower among infants born in referral hospitals than among those born in primary-level hospitals. Congenital malformations accounted for 43% of the 28 perinatal deaths, and fetal losses between 20 and 27 weeks' gestation accounted for another 21%. During the 2-year study period there were only three cases in which antepartum care in nonspecialty centers may have contributed to a perinatal loss.

Adult↗
PubMed1985

Measures of gain in certainty from a diagnostic test.

The authors propose several measures for quantifying the change in the clinical estimate of a patient's chances of having a disease that occurs as a result of diagnostic testing. Under most circumstances, the gain in clinical certainty from a positive test result is more affected by the specificity (T) of the test, while the gain from a negative test result is more affected by sensitivity (S). The prevalence of the disease in the tested population is also an important determinant of the magnitude of gain in certainty. Measures of the expected gain in certainty can be calculated by weighting the gains from a positive or negative result by the likelihood of the respective test outcome. Indices of expected gain depend directly on the quantity S + T, implying that sensitivity and specificity have equal importance in determining expected gain. When S + T = 1, the test provides no information; when S + T is greatest, the expected gain is maximized. Expected gain is also related to the receiver operating characteristic curve for a diagnostic test: the point on the receiver operating characteristic curve at which S + T is greatest corresponds to the point at which the distance from the major diagonal is greatest at which the slope of the receiver operating characteristic curve equals 1.

Coronary Disease↗
PubMed1985

Gestational diabetes. Incidence, maternal characteristics, and perinatal outcome.

Accurate estimates of the incidence of abnormal glucose tolerance during pregnancy are virtually nonexistent. Screening select populations of women with risk factors for the condition and the nonrandom, non-population-based nature of most studies have given rise to wide variances in reported incidence. We analyzed data from the states of Mississippi and Washington and from the National Natality and Fetal Mortality Surveys conducted in 1980 in an attempt to provide more accurate population-based estimates of the incidence of gestational diabetes mellitus (GDM). In the national surveys GDM was noted (screening and diagnostic criteria were unavailable) as a complication in 0.38% of all sampled pregnancies; overt (type I and type II) diabetes was noted in 0.78%. Mean maternal age for the GDM group was 28.4 yr; 85% were white (81% controls) and 15% non-white (19% controls). Prepregnancy weights were higher in the GDM group by an average of 20 lb. However, mean weight gain was less in this group than in controls (23 versus 29 lb). Perinatal mortality was noted in approximately 2.8% (1.3% in controls) of the offspring in GDM-complicated pregnancies and congenital malformations in 6.4% (7.9% in controls). Methodologic problems were encountered and included lack of screening and diagnostic criteria, underreporting, and underrecording.

Birth Weight↗