PubMed Health⌕ Search

Biomedical subjects

M C McCormick

Publications and source records attributed to M C McCormick.

At least 19 recordsLinked to original sources
PubMed1992

Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index.

Severity-of-illness scales have proven valuable in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 +/- 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

Hospitalization↗
PubMed1991

Health care use among young children in day care. Results in a randomized trial of early intervention.

Exposure of young children to group day-care settings increases the risk of illness and may result in higher use of medical care. These observations raise concerns that the use of such settings for early intervention programs for low-birth-weight infants may increase the already high burden of medical care costs incurred by these children and their families. To address the question of medical care use associated with center-based care, we examined the hospital-based and ambulatory care reported for participants of the Infant Health and Development Program. This project is a multisite randomized trial of an early intervention program for preterm low-birth-weight infants with an intervention including 2 years of center-based care. The Intervention group did not differ in hospital-based care and averaged only two more physicians' visits over the 3-year observation period than the comparison group. We conclude that early intervention programs involving high-quality group care are not accompanied by substantial increases in health care use.

Ambulatory Care↗
PubMed1991

Cohort reconstruction: which infants can be restudied at school age?

Longer-term follow-up of infants with specific health concerns, such as low birthweight, is critical to assessing the effect of medical interventions. This report examines the approach of reconstructing previously studied cohorts in terms of the factors discriminating between respondents and non-respondents. Follow-up was attempted during 1987-1988 for 1875 children born during a 6-month period in 1978 in three geographically defined regions in the United States, for whom 1-year assessments of health and developmental status were obtained at 1 year of age as part of a previous study. For a 25% sample, participation involved a clinic visit for developmental assessments; for the remainder an interview by telephone or home visit. Follow-up was obtained for 72.5% of the cohort. Refusal rates were low (7%); most non-response was due to an inability to locate the families. Predictors of non-response reflected primarily low socio-economic status; completion rates were not influenced by mode of assessment. The role of a tracing agency is discussed. We conclude that cohort reconstruction is feasible with response rates comparable to some prospective studies with ongoing cohort maintenance.

Child Development↗
PubMed1991

Costs incurred by parents of very low birth weight infants after the initial neonatal hospitalization.

To assess the economic impact of the posthospitalization care of very low birth weight (VLBW) infants, the costs incurred in the first year of life by 32 VLBW infants were compared with those incurred by 34 term, comparison infants. Diaries and quarterly interviews revealed that VLBW infants averaged $10,139 in direct medical charges compared with $1179 for the term infants; the differential in charges was greatest in the first two quarters and virtually disappeared by the fourth quarter. In addition, expenditures associated with transportation and child care presented an added substantial burden, although only the former were significantly higher for the VLBW infants. Clinicians may need to inquire specifically about the burden on family resources because, despite the economic burden and evidence of less social support, the parents of VLBW infants were less likely to perceive their child's care as having an impact on the family than were the parents of term children.

Adult↗
PubMed1990

Factors associated with smoking in low-income pregnant women: relationship to birth weight, stressful life events, social support, health behaviors and mental distress.

Since low-income women are at increased risk of having low birth weight infants, factors associated with birth weight among such groups have special relevance. Cigarette-smoking has emerged as an important predictor of low birth weight due to intrauterine growth retardation and pre-term delivery. After confirming the relation of smoking with birth weight, we examined the association of smoking with sociodemographic factors, attitudes towards pregnancy, health behaviors, stressful life events, social support, and symptoms of mental distress in a cohort of 458 Central Harlem women. We found that social support, stress and mental health were associated with smoking behavior but not directly with birth weight. These findings suggest that programs designed to modify health behaviors such as smoking during pregnancy must also take into account such characteristics of the women and their environments which may make behavioral change difficult. Moreover, programs aimed at fostering better health behaviors to improve pregnancy outcome may have to extend beyond the current pregnancy, as indicated by an association between prior adverse pregnancy outcome and smoking in the current pregnancy.

Adult↗
PubMed1990

Very low birth weight children: behavior problems and school difficulty in a national sample.

We addressed three questions concerning the behavioral and academic status of low and very low birth weight infants through a secondary analysis of the 1981 National Health Interview Survey--Child Health Supplement: (1) in children born with very low birth weight, what is the risk of behavior problems and school difficulty compared with that in heavier low birth weight and normal birth weight children? (2) What are the correlates of school difficulty? (3) Are behavior problems associated with school difficulty when variables are controlled for these correlates? The analysis revealed that 34% of very low birth weight children could be characterized as having school difficulty, compared with 20% and 14% of the other groups, respectively, and that they were more likely to have higher scores on the hyperactive subscale of the Behavior Problems Index. Although a broad array of sociodemographic factors correlated with school difficulty, very low birth weight and hyperactivity scores contributed independently to the risk of academic problems. We conclude that very low birth weight infants are at risk of having school problems that are in part associated with hyperactive behavior.

Adolescent↗
PubMed1990

Health and developmental outcomes of a surfactant controlled trial: follow-up at 2 years.

Several randomized clinical trials have shown that surfactant therapy improves the pulmonary status of infants with respiratory distress syndrome and has the potential to reduce morbidity and mortality in these infants. Relatively little is known, however, about the long-term consequences of surfactant treatment. In this report, the results of health and developmental assessment are described at 1 and 2 years of age of 32 survivors of an initial group of 41 infants enrolled in a randomized clinical trial of bovine surfactant therapy. The frequencies of abnormal findings were comparable in the two groups although there was a trend toward a greater frequency of allergic manifestations in the control group (6 of 16 (38%) vs 1 of 15 (7%), P = .08). Similarly, no differences were seen in the mental and motor scores of the Bayley Scales of Infant Development at either 1 or 2 years of age. This study and other recently published reports of follow-up studies of infants treated with surfactant provide encouraging evidence that major long-term side effects do not result from surfactant therapy.

Animals↗
PubMed1989

Outreach as case finding: its effect on enrollment in prenatal care.

One mechanism proposed for encouraging use of prenatal services in low-income communities involves the employment of community residents to encourage and support individuals in the use of available medical care. This study examines the effect of such workers on the start of prenatal care among a cohort of women receiving prenatal services at clinics affiliated with Harlem Hospital. Of the 599 women enrolling for prenatal care during the intake period for the study, only 52 had had an outreach contact before the start of prenatal care despite extensive field activity. No difference in the week of gestation at the start of prenatal care was noted between those with and without outreach contacts. Controlling for factors associated both with trimester of initiation of prenatal care in this population and with outreach contact did not account for this lack of difference. This type of outreach, known as case-finding, proved to be very labor intensive. Other less costly techniques for encouraging use of services in mobile, urban populations should be sought.

Adolescent↗
PubMed1989

Outreach as case finding. The process of locating low-income pregnant women.

This article documents the process of an outreach program for locating disadvantaged women who, as a group, do not receive prenatal care early and have adverse pregnancy outcomes. Three full-time community residents searched for pregnant women for a year, being paid a commission for each woman that they found who enrolled for antenatal care. Outreach workers spent more than half of their time in the field, contacted 20 to 25 people per day, and used a variety of strategies to locate women. Fifty-two women entered the Harlem Hospital Medical Center health care system through the outreach process, with 104 pregnant women not already receiving antenatal care being identified by the outreach workers. Their effort, conversion rate, and yield were comparable to private sector salespeople. The cost per enrollee was high (although not higher than the cost of additional low-birthweight births). Alternatives for locating pregnant women are suggested.

Community Health Workers↗
PubMed1989

Factors associated with maternal rating of infant health in central Harlem.

Maternal perceptions of infant health are strongly associated with the use of health services and may influence the child's future health and development. The extent to which such perceptions reflect infant health problems or a response to environmental stress in the mother's life is unclear. Because this issue may be especially important in disadvantaged groups for which both high levels of infant morbidity and environmental stress are common, we have explored the correlates of maternal perceptions of infant health among 367 mothers of 12-month-olds in central Harlem. Lower ratings of infant health were associated with such indicators of morbidity as problems in the neonatal period, hospitalization, and one or more episodes of illness. They were also associated with lower family income and the mother's rating of her own health in the bivariate analyses, but not in multivariate analyses. Neither maternal mental health, social support, nor environmental stress appeared to influence maternal rating of child health. These findings indicate that a mother's ratings of her infant's health relate specifically to the child's morbidity, independent of her own health and environmental stress. Moreover, within disadvantaged communities, infants of the poorest mothers may experience greater levels of morbidity.

Child Welfare↗
PubMed1988

Preliminary observations on maternal rating of health of children: data from three subspecialty clinics.

Although routinely used in health surveys, the factors affecting maternal perceptions of health in children, especially those with health problems, have received little examination. This question has been addressed using a telephone interview of families of 483 children followed in one of three clinics at Children's Hospital of Philadelphia: the Neonatal Follow-up Program, the Pediatric Rheumatology Center and the Spina Bifida Program. Limitations in activities of daily living due to the health of the child, medical care use and variables indicative of socio-economic disadvantage were associated with a maternal rating of child health as fair/poor in all groups. The relationship was strongest in the rheumatologic group and less strong in the other two, suggesting that mothers may distinguish between a chronic active disease in a previously healthy child and the disability following a neonatal event in conceptualizing health. The results add to our information about maternal perceptions in assessing child health and suggest ways in which such ratings may prove useful in assessing health and health services for children with health problems.

Activities of Daily Living↗
PubMed1988

Correlates of reported smoke detector usage in an inner-city population: participants in a smoke detector give-away program.

As part of a smoke detector give-away program, 388 adults were surveyed to characterize smoke detector ownership in a low-income population and to identify those who would acquire a free smoke detector following their child's visit to the hospital. Factors associated with smoke detector ownership included higher education, home ownership (vs public housing), knowledge of the city smoke detector law, and the practice of other injury prevention measures. Regardless of ownership, the great majority of parents (82 per cent) acquired a free smoke detector, but those previously without a smoke detector were more likely to do so. These characteristics of smoke detector usage and acquisition should be considered in targeting future intervention strategies.

Adolescent↗
PubMed1987

The planning of pregnancy among low-income women in central Harlem.

A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, we have compared the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal mental health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The two groups did not differ in any other risk factor or in outcome in terms of birth weight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly based interventions that are not confined to the periconceptional period.

Educational Status↗
PubMed1987

Chronic disease: effect on health cognition and health locus of control.

An assessment of health cognition and health locus of control (HLOC) was obtained in 85 healthy and 81 chronically ill children, using instruments adapted from Piaget's work and standard HLOC measures. A relationship between HLOC and compliance was sought in a subset of children with spina bifida taught self-catheterization. Evidence of the developmental nature of health cognition and HLOC was documented. Contrary to the effect of experience in formal learning, experience with chronic disease did not alter developmental progression in these health-related areas. Our results suggest that in communicating with children about illness, the pediatrician's approach should not be altered by an appearance of superficial sophistication that some children may acquire as part of their experience with chronic disease.

Adolescent↗