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Biomedical subjects

M Kotelchuck

Publications and source records attributed to M Kotelchuck.

10 recordsLinked to original sources
PubMed1988

Infant mortality increase despite high access to tertiary care: an evolving relationship among infant mortality, health care, and socioeconomic change.

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

Birth Rate↗
PubMed1985

Racial and socioeconomic disparities in childhood mortality in Boston.

We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.

Accidents, Traffic↗
PubMed1984

The effect of WIC supplemental feeding on birth weight: a case-control analysis.

Extant data from prenatal patients in Massachusetts were analyzed to evaluate the effects of WIC supplemental feeding on birth outcomes. A total of 418 pairs of WIC and non-WIC women were directly matched for racial/ethnic group, age, parity, marital status, and income. Participation in WIC supplemental feeding appears to have a positive effect on pregnancy outcome. Participation in WIC is associated with a 107 g increase in mean birth weight (p = 0.012) and a 4.0% decrease in the incidence of low birth weight (p = 0.059). Teenage, Black, and Hispanic women show similar, if not stronger, benefits.

Adolescent↗
PubMed1984

WIC participation and pregnancy outcomes: Massachusetts Statewide Evaluation Project.

The effects of WIC prenatal participation were examined using data from the Massachusetts Birth and Death Registry. The birth outcomes of 4,126 pregnant women who participated in the WIC program and gave birth in 1978 were compared to those of 4,126 women individually matched on maternal age, race, parity, education, and marital status who did not participate in WIC. WIC prenatal participants are at greater demographic risk for poor pregnancy outcomes compare to all women in the same community. WIC participation is associated with improved pregnancy outcomes, including, a decrease in low birthweight (LBW) incidence (6.9 per cent vs 8.7 per cent) and neonatal mortality (12 vs 35 deaths), an increase in gestational age (40.0 vs 39.7 weeks), and a reduction in inadequate prenatal care (3.8 per cent vs 7.0 per cent). Stratification by demographic subpopulations indicates that subpopulations at higher risk (teenage, unmarried, and Hispanic origin women) have more enhanced pregnancy outcomes associated with WIC participation. Stratification by duration of participation indicates that increased participation is associated with enhanced pregnancy outcomes. While these findings suggest that birth outcome differences are a function of WIC participation, other factors which might distinguish between the two groups could also serve as the basis for alternative explanations.

Adolescent↗
PubMed1984

Personal health maintenance for children.

The foundations for lifelong responsibility for personal health maintenance are laid down in childhood. Personal health maintenance for children is important for a healthy childhood, for a healthy adulthood and for the development of positive values about health, personal health responsibility and the use of health services. Present knowledge in this area is weak but growing. Five areas of development are highlighted: (1) the cognitive understanding of health and disease, (2) a psychological sense of control over health, (3) parental and media influences on health behaviors, (4) school health education and (5) training by health professionals about self-management of childhood illness and health services usage patterns. Implications for current practice are developed.

Adolescent↗
PubMed1978

Child abuse and dentistry: orofacial trauma and its recognition by dentists.

Orofacial trauma was found in 49% of 260 documented cases of child abuse seen during of five-year period at the Children's Hospital Medical Center, Boston. An additional 16% of the cases involved head trauma; the total percentage of head and facial trauma was 65%. Head or facial trauma was the principal reason for admission to the hospital in 45% of the cases. A survey of 537 dentists in Massachusetts showed that the majority were unaware of their legal and social responsibilities to report suspected cases of child abuse. Eleven percent of all dentists surveyed saw orofacial trauma cases that were of a suspicious nature, by only 22 confirmed cases of child abuse were noted by the dentists. Of these, only four were reported to social agencies. In general, oral surgeons and pedodontists saw a higher percentage of these cases and were more aware of their responsibilities than were general practitioners.

Child↗
PubMed1975

Infant reaction to parental separations when left with familiar and unfamiliar adults.

The results of two experiments examining infants at 6, 9, 12, 15, 18, and 21 months of age and varying levels of father interaction are summarized to show that separation protest is more a function of a strange person remaining in an unfamiliar laboratory situation with the infant than the temporary loss of a specific parent. The use of protest as an index of infant-parent attachment seems undesirable.

Age Factors↗