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Biomedical subjects

L V Klerman

Publications and source records attributed to L V Klerman.

At least 19 recordsLinked to original sources
PubMed2001

A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women.

OBJECTIVES: This project investigated whether augmented prenatal care for high-risk African American women would improve pregnancy outcomes and patients' knowledge of risks, satisfaction with care, and behavior. METHODS: The women enrolled were African American, were eligible for Medicaid, had scored 10 or higher on a risk assessment scale, were 16 years or older, and had no major medical complications. They were randomly assigned to augmented care (n = 318) or usual care (n = 301). Augmented care included educationally oriented peer groups, additional appointments, extended time with clinicians, and other supports. RESULTS: Women in augmented care rated their care as more helpful, knew more about their risk conditions, and spent more time with their nurse-providers than did women in usual care. More smokers in augmented care quit smoking. Pregnancy outcomes did not differ significantly between the groups; however, among patients in augmented care, rates of preterm births were lower and cesarean deliveries and stays in neonatal intensive care units occurred in smaller proportions. Both groups had lower-than-predicted rates of low birthweight. CONCLUSIONS: High-quality prenatal care, emphasizing education, health promotion, and social support, significantly increased women's satisfaction, knowledge of risk conditions, and perceived mastery in their lives, but it did not reduce low birthweight.

Adolescent↗
PubMed2000

Infant mortality review as a vehicle for quality improvement in a local health department.

BACKGROUND: Many communities across the United States have established fetal and infant mortality review (FIMR) programs as a way of gaining insight into the causes of such deaths and of devising and implementing ways to improve the health of pregnant women and their infants. IMR PROCESS: The IMR process in the Jefferson County Department of Health in Birmingham, Alabama, evolved in a somewhat different fashion than that in other communities. A technical review team reviews all the infant deaths in the county, with particular attention to each woman's pregnancy history. A community review team reviews composite cases that illustrate some particular problem that might lead to infant mortality, such as teenage pregnancy or short intervals between pregnancies. This team provides insights into cultural patterns and a community perspective on the problems. Recommendations from the two teams are acted on by the health department, with the assistance of other agencies as needed. IMPACT OF THE IMR PROCESS: The IMR process has been used to increase community agency participation in health department activities, improve health department procedures, increase health department staff acceptance of a new and controversial program (Healthy Start), and offer services to women who need them. CONCLUSIONS: IMR has become a mechanism for CQI in the health department, embodying many of the principles of CQI, including the use of teams, focus on a team mission, and examination of processes, not individuals. The program offers a model of how to reduce rates of fetal and infant mortality.

Adult↗
PubMed2000

The intendedness of pregnancy: a concept in transition.

BACKGROUND: Although interest in the intendedness or the planning status of a pregnancy goes back many centuries, it is only since 1941 that questions about these issues have been asked systematically in large-scale surveys. More recently, questions about intendedness have become standard features of the National Survey of Family Growth and of the Pregnancy Risk Assessment Monitoring System (PRAMS). Interest in and concern about the large numbers of unintended pregnancies reported in those surveys resulted in an Institute of Medicine report on the subject and the inclusion of a national health objective for increasing the proportion of pregnancies that are intended in Healthy People 2000 and Healthy People 2010. NEEDS: The terms, "intended," "unintended," "mistimed," "wanted," "unwanted," and "planned" are often used without significant attention being paid to their meaning or how they are derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors. In addition, research has revealed that women are often happy despite experiencing an unintended pregnancy and that contraceptive failures do not always result in a report of an unintended pregnancy. OBJECTIVES: Researchers have begun to ask questions about the meaning of the intendedness concept and its relationship to what women express as their feelings about pregnancies and births. This article, and this entire issue, is an attempt to make the reader aware of the current issues in this area and to suggest additional research that is needed to enable policy makers and program planners to design programs that will better assist couples in meeting their fertility goals.

Data Collection↗
PubMed2000

Smoking reduction activities in a federal program to reduce infant mortality among high risk women.

OBJECTIVES: To determine the smoking cessation/reduction services offered to pregnant women by federally funded Healthy Start projects designed to reduce infant mortality. DESIGN: Information was obtained by questionnaires sent to all Healthy Start projects in 1999. Responses were received from 76 sites. SETTING: The federal government selected the Healthy Start sites on the basis of infant mortality rates that were much in excess of the national average. PATIENTS: The projects served largely minority clients. Most of the women were poor and eligible for Medicaid. MAIN OUTCOME MEASURES: The services that projects offered to pregnant smokers, the priority given the smoking related activities, and whether more should be done. RESULTS: Only 23% of the sites thought that they were doing enough to help pregnant smokers stop or reduce smoking. The sites felt the national office should develop a manual of best practices, provide client materials, and organise workshops. While three quarters of the sites expected home visitors to counsel pregnant smokers, less than half provided training in this area during orientation, but most visitors received on-the-job training. Only 64% of sites gave smoking cessation/reduction activities high priority in comparison to other objectives of home visiting. CONCLUSIONS: Although Healthy Start sites were aware of the importance of smoking cessation/reduction activities for their clients, they offered a limited range of services. These projects, and others with similar objectives serving similar populations, need a better understanding of the time and money such interventions require and greater belief in their effectiveness, along with more funds, staff training and materials, and office systems that promote counselling.

Counseling↗
PubMed1999

Douching: a problem for adolescent girls and young women.

OBJECTIVE: To compile available published data on the prevalence of douching practices in adolescent girls and young women and the effects of douching on gynecologic health, including studies of gynecologic changes due to douching in adolescent girls and young women, surveys that demonstrated the prevalence of douching in the populations, and policy statements or lack thereof from professional and medical organizations with regard to the practice of douching. DATA SOURCES: We did Internet searches, including a MEDLINE search, a literature review, and used the telephone, mail, and e-mail to contact professional organizations. RESULTS: Douching has been found to be strongly associated with increased risk for pelvic inflammatory disease, bacterial vaginosis, and ectopic pregnancy, the former of which is especially prevalent in adolescent girls and young women. Douching is practiced by 15.5% of adolescent girls and young women in the United States, with significantly higher prevalences in certain groups in the population. We have not found any official position of professional and medical organizations on the practice of douching. CONCLUSIONS: Because vaginal douching has been shown to be associated with bacterial vaginosis, pelvic inflammatory disease, and ectopic pregnancy, and because no benefits are conferred on those who practice it, douching should be discouraged among adolescent girls and young women. There is a great need for further studies, particularly prospective ones, to determine if there is evidence of a direct causative influence of douching on pelvic inflammatory disease, ectopic pregnancy, and/or bacterial vaginosis, and to determine why adolescent girls and young women douche.

Female↗
PubMed1999

How legislation and health systems can promote adolescent health.

This chapter focuses on some of the laws and regulations that could make it easier for adolescents to adopt health-promoting and disease-preventing behaviors, or that have minimized the dangers that might be caused by their behaviors. It also reviews some of the aspects of health care systems that may present barriers to health-promoting behaviors and suggests how they might be changed.

Adolescent↗
PubMed1998

Medical status of adolescents at time of admission to a juvenile detention center.

PURPOSE: To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. METHODS: Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. RESULTS: Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. CONCLUSIONS: A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Adolescent↗
PubMed1998

The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population.

OBJECTIVES: The objective of this study was to determine whether the length of the interval between pregnancies was associated with either preterm birth or intrauterine growth retardation in a low-income, largely Black population. METHODS: The study population consisted of 4400 women who had received prenatal care in county clinics and had two consecutive singleton births between 1980 and 1990. RESULTS: Interpregnancy intervals were positively associated with age and negatively associated with the trimester in which care was initiated in the second pregnancy. Whites had shorter intervals than non-Whites. The percentage of preterm births increased as the length of the interpregnancy interval decreased, but only for women who had not had a previous preterm birth. The association between interval and preterm birth was maintained when other factors associated with preterm birth were controlled. There was no significant relationship between intrauterine growth retardation and interpregnancy interval. CONCLUSIONS: Women, particularly those who are poor and young, should be advised of the potential harm to their infants of short interpregnancy intervals.

Adolescent↗
PubMed1997

Procreative experiences and orientations toward paternity held by incarcerated adolescent males.

PURPOSE: To describe the procreative experiences and the attitudes related to paternity held by a sample of incarcerated adolescent males. METHODS: All adolescent males who were admitted to a long-term correctional facility between July 1994 and October 1994 were asked to participate in a confidential, face-to-face interview. RESULTS: One hundred twenty-five incarcerated adolescents agreed to participate in the study. Over one-quarter (25.6%) of the respondents reported having ever gotten a girl pregnant; 40.6% of fathers reported having caused more than one pregnancy. A majority of respondents believed that fathering a child would be desirable, that they would be capable of being a father to a child, and that they could be responsible for the baby and mother. Fathers were more likely than nonfathers and black respondents were more likely than white respondents to report that they, their parents, and their friends would be pleased were they to get girls pregnant. Black respondents were more likely than white respondents to believe that they could be a good father to a child. CONCLUSIONS: The general perceptions that fathering a child as a teenager is desirable and that they could be good fathers to their children will make the prevention of pregnancy and parenting difficult in this population. Incarcerated adolescents should be educated about parenting prevention using interventions that take into consideration their attitudes and perceptions of teenage parenting.

Adolescent↗
PubMed1997

After graduation, what? An analysis of the job placements of graduates of public health maternal and child health training programs. Project of the Association of Teachers of Maternal and Child Health.

OBJECTIVES: In 1995, the Association of Teachers of Maternal and Child Health (ATMCH) decided that information about the employment status of program graduates was essential to attempts to improve MCH curricula. METHOD: ATMCH requested information from 13 MCH programs in schools of public health funded by the federal Maternal and Child Health Bureau and 12 provided information about their master's degree graduates in the 1990-1994 period, including the year of graduation, degree, Bureau traineeship support, position held, and employing agency. RESULTS: The total number of graduates was 742. Four programs averaged less than 8 graduates per year (small); six, 10-16 (midsize); and two more than 22 (large). More than 90% of graduates received a M.P.H. In the 10 programs that provided data on Bureau support, 46% received traineeship support from the Bureau. Midsize programs had the largest percentage of graduates receiving traineeship support. Overall, 45% of graduates were in administrative positions, 32% were involved in patient care, 20% were in policy-analytic positions, and 3% in other positions. Forty-seven percent of program graduates entered into or continued in community-based agencies, 18% in government agencies, 17% in academic or research agencies, and 18% in other agencies. Program size was significantly associated with both position and the agency in which the graduate was employed. Bureau traineeship support was associated with employing agency. CONCLUSIONS: The study suggests the need for changes in MCH curricula, enhanced education opportunities in specialty skill areas, and an ongoing survey of graduates of MCH programs.

Adult↗
PubMed1997

Promoting the well-being of children: the need to broaden our vision--the 1996 Martha May Eliot Award Lecture.

As those in the field of maternal and child health attempt to redefine their role to meet the challenges of the 1990s and beyond, they should review the history of their field. They should examine the legacy of the Children's Bureau which investigated and reported upon all matters pertaining to the welfare of children. They should note the medicalization of MCH and the drift away from broader child welfare issues. In Dr. Eliot's words, they should remember "the inseparability of the health and social aspects of the growth and development of a child." MCHers can advance the well-being of children by defining child health broadly and by promoting it in many ways.

Adult↗
PubMed1996

Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women.

OBJECTIVE: Our purpose was to determine whether various demographic, behavioral, housing, psychosocial, or medical characteristics explain the difference in pregnancy outcome between black and white women. STUDY DESIGN: A sample of 1491 multiparous women with singleton pregnancies, 69% of whom were black and 31% of whom were white and who enrolled for care between Oct. 1, 1985, and March 30, 1988, participated in the study. The frequencies of various demographic, medical environmental, and psychosocial risk factors among black and white women were determined. The outcome measures were birth weight, gestational age, fetal growth restriction, preterm delivery and low birth weight. RESULTS: White infants were heavier and born later than black infants. The white women in this sample smoked more cigarettes, moved more frequently, and had worse psychosocial scores. The black women had lower incomes, were less likely to be married, and had more hypertension, anemia, and diabetes. Besides race, only maternal height, weight, blood pressure, diabetes, and smoking had a consistent impact on outcome and did not explain the difference in outcome between the two groups. CONCLUSION: In this low-income population, many of the risk factors for low birth weight were more common among white women than black women. Nevertheless, black women had more infants born preterm, with growth restriction, and with low birth weight than did white women. The various maternal characteristics studied did not explain these differences.

Black People↗
PubMed1994

Perinatal health care policy: how it will affect the family in the 21st century.

Demographic trends, pressures to reduce medical care costs and to improve access, biomedical research, and women's preferences for health care will result in many important changes in perinatal health care during the next 2 decades. These changes have the potential for influencing family structure and functioning. For example, the rates of teen-age pregnancy, unwanted or mistimed pregnancy, and infertility, with all their attendant adverse consequences, might be reduced.

Choice Behavior↗