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Biomedical subjects

P A Buescher

Publications and source records attributed to P A Buescher.

At least 19 recordsLinked to original sources
PubMed2001

Physical abuse of women before, during, and after pregnancy.

CONTEXT: Clinicians who care for new mothers and infants need information concerning postpartum physical abuse of women as a foundation on which to develop appropriate clinical screening and intervention procedures. However, no previous population-based studies have been conducted of postpartum physical abuse. OBJECTIVES: To examine patterns of physical abuse before, during, and after pregnancy in a representative statewide sample of North Carolina women. DESIGN, SETTING, AND PARTICIPANTS: Survey of participants in the North Carolina Pregnancy Risk Assessment Monitoring System (NC PRAMS). Of the 3542 women invited to participate in NC PRAMS between July 1, 1997, and December 31, 1998, 75% (n = 2648) responded. MAIN OUTCOME MEASURES: Prevalence of physical abuse during the 12 months before pregnancy, during pregnancy, and after infant delivery; injuries and medical interventions resulting from postpartum abuse; and patterns of abuse over time in relation to sociodemographic characteristics and use of well-baby care. RESULTS: The prevalence of abuse before pregnancy was 6.9% (95% confidence interval [CI], 5.6%-8.2%) compared with 6.1% (95% CI, 4.8%-7.4%) during pregnancy and 3.2% (95% CI, 2.3%-4.1%) during a mean postpartum period of 3.6 months. Abuse during a previous period was strongly predictive of later abuse. Most women who were abused after pregnancy (77%) were injured, but only 23% received medical treatment for their injuries. Virtually all abused and nonabused women used well-baby care; private physicians were the most common source of care. The mean number of well-baby care visits did not differ significantly by maternal patterns of abuse. CONCLUSION: Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.

Adolescent↗
PubMed2001

Stressful life events and physical abuse among pregnant women in North Carolina.

OBJECTIVES: This study estimates the prevalence of stressful life events and physical abuse among North Carolina women prior to infant delivery, and examines potential associations between abuse and the other stressors. METHODS: Data were from the North Carolina Pregnancy Risk Assessment Monitoring System, a statewide representative survey of over 2,600 postpartum women. The survey assessed women's sociodemographic characteristics and their experiences of physical abuse and 13 other stressful life events before delivery. The prevalences of each life event and abuse were estimated. Logistic regression modeled the probability of women having high levels of stressful life events in relation to physical abuse and sociodemographics. RESULTS: Most women were married, white, high school graduates, aged 20 or older. The most common stressful life events were residential moves, increased arguing with husbands/partners, family member hospitalizations, financial hardship, and deaths of loved ones. Fourteen percent of women had high levels of stressful events (5 or more), and almost 9% were physically abused. Abuse was positively associated with increased arguing with husbands/partners, physical fighting, having someone close with an alcohol/drug problem, becoming separated/divorced, and financial hardship. Logistic regression analysis showed that a high level of stressful life events was significantly more likely among women abused both before and during pregnancy (OR = 11.94) and among women abused before but not during pregnancy (OR = 14.19). CONCLUSIONS: The high frequency of multiple stressful events and abuse in women's lives suggests that women's care providers should ask their patients about these issues, and offer appropriate referral/interventions to those in need.

Adolescent↗
PubMed1999

Multiple deliveries in North Carolina: effects on birth outcomes.

OBJECTIVES: The purpose of this study is to examine the trends in multiple deliveries in North Carolina and assess their effect on the rates of low birth weight, fetal mortality, and infant mortality. METHODS: Using North Carolina vital statistics files, trends in multiple births, categorized by race, maternal age, and birth weight, were examined for the period 1980-1997. A partitioning method was used to estimate the contribution of maternal age distribution and age-specific multiple birth rates to the overall increase in multiple births, and the contribution of the changing multiple birth rate to observed trends in low birth weight and fetal and infant mortality. RESULTS: Between 1980 and 1997, the state's multiple birth rate increased by 40%. Most of the increase was due to a rise in the age-specific multiple birth rates, rather than a shift in the maternal age distribution. The increase in the multiple birth rate accounted for a substantial proportion of the increase in low birth weight among Whites and Blacks. The rise in multiple births also hindered further declines in fetal and infant mortality during this time. CONCLUSIONS: Multiple births are an increasingly important contributor to perinatal outcomes, and warrant greater consideration in research aimed at evaluating trends in low birth weight and infant mortality.

Adult↗
PubMed1999

Using Medicaid data to estimate state- and county-level prevalence of asthma among low-income children.

OBJECTIVES: Asthma is one of the most common illnesses among children, yet there is little reliable information on the number of children at the state and county level who are living with asthma. This study examines the prevalence of asthma among low-income children in North Carolina using Medicaid paid claims and enrollment data. METHODS: Claims paid by Medicaid during state fiscal year 1997-1998 with a diagnosis of asthma or for a prescription drug used to treat asthma are examined to estimate prevalence among children ages 0-14 years. Percentages of enrolled children with asthma are presented by age, race, and rural/urban residence, and the costs of asthma treatment are calculated. RESULTS: More than 12% of North Carolina children ages 0-14 years on Medicaid had an indication of asthma. Prevalence rates were found to be highest among younger children, some minority groups, and residents of rural areas. More than $23 million was paid by Medicaid during the fiscal year for asthma-related services for children ages 0-14 years. CONCLUSIONS: State Medicaid databases are a useful means of studying the prevalence of asthma and other health conditions in low-income populations. Strengths and weaknesses of the proposed methodology are discussed. Existing administrative data systems can provide quick updates of prevalence rates at the state and county level, enhancing the ability to study trends in illness over time.

Adolescent↗
PubMed1999

Method of linking Medicaid records to birth certificates may affect infant outcome statistics.

OBJECTIVES: This study assessed how different methods of matching Medicaid records to birth certificates affect Medicaid infant outcome statistics. METHODS: Claims paid by Medicaid for hospitalization of the newborn and for the mother's delivery were matched separately to 1995 North Carolina live birth certificates. RESULTS: Infant mortality and low-birthweight rates were consistently lower when Medicaid was defined by a matching newborn hospitalization record than when results were based on a matching Medicaid delivery record. CONCLUSIONS: Studies of birth outcomes in the Medicaid population may have variable results depending on the method of matching that is used to identify Medicaid births.

Bias↗
PubMed1994

Etiology of low-birthweight birth: a population-based study.

BACKGROUND: Preterm and low-birthweight births remain the major correlates of infant mortality in the United States. The recognition that these births result from varying proximal etiologies is essential to the development of preventive strategies specific to each etiologic group. METHODS: Using vital statistics data tapes provided by the North Carolina Center for Health and Environmental Statistics, mothers in 20 counties who delivered infants with birthweights between 1 pound and 5 pounds, 8 ounces were identified. Maternal hospital records of 4,754 women were reviewed for data about prenatal and intrapartal events. Two perinatologists classified births into four proximal etiology groups: term-lowbirthweight, medically indicated preterm birth, preterm premature rupture of membranes, and idiopathic preterm birth. Information from birth certificate and hospital records was merged to provide an expanded data set. RESULTS: Race, age, education, and marital status are associated with different patterns of proximal etiology. Rates were higher for all etiologies in black women and in young women; however, the absolute number of LBW births was highest among white women. Idiopathic preterm birth was highest in black women and decreased as age increased; medical indications for preterm birth increased with increasing age. CONCLUSIONS: Classification of LBW births by etiologic group provides insights of value to both clinicians and researchers. Studies in which LBW and/or preterm birth are the outcome variables will be enhanced by identifying etiology. Multiple preventive strategies should address varying etiologic groups.

Adolescent↗
PubMed1993

Prenatal WIC participation can reduce low birth weight and newborn medical costs: a cost-benefit analysis of WIC participation in North Carolina.

A number of previous studies have found that prenatal participation in the Special Supplemental Food Program for Women, Infants, and Children (WIC) improves birth outcomes, but only a few studies have provided cost-benefit analyses. The present study linked Medicaid and WIC data files to birth certificates for live births in North Carolina in 1988. Women who received Medicaid benefits and prenatal WIC services had substantially lower rates of low and very low birth weight than did women who received Medicaid but not prenatal WIC. Among white women, the rate of low birth weight was 22% lower for WIC participants and the rate of very low birth weight was 44% lower; among black women, these rates were 31% and 57% lower, respectively, for the WIC participants. Multivariate logistic regression analysis confirmed that prenatal participation in a WIC program reduced the rate of low birth weight. It was estimated that for each $1.00 spent on WIC services, Medicaid savings in costs for newborn medical care were $2.91. A higher level of WIC participation was associated with better birth outcomes and lower costs. These results indicate that prenatal WIC participation can effectively reduce low birth weight and newborn medical care costs among infants born to women in poverty.

Black or African American↗
PubMed1993

The quality of the new birth certificate data: a validation study in North Carolina.

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.

Birth Certificates↗
PubMed1992

A comparison of risk assessment models for term and preterm low birthweight.

BACKGROUND: Most epidemiological research dealing with the assessment of risk for low birthweight has focused on all low birthweight births. Studies that have attempted to distinguish between term and preterm low birthweights have tended to examine preterm low birthweight, since the risk of perinatal mortality and morbidity is greatest for this group of infants. METHOD: This study uses data from 25,408 singleton births in a 20-county region in North Carolina to identify and compare risk factors for term and preterm low birthweights, and also examines the usefulness of separate multivariate risk assessment systems for term and preterm low birthweights that could be used in the clinical setting. RESULTS: Risk factors that overlap as significant predictors of both types of low birthweight include race, no previous live births, smoking, weight under 100 lb, and previous preterm or low birthweight birth. Age also is a significant predictor of both types of low birthweight, but in opposite directions. Younger age is associated with reduced risk of term low birthweight and increased risk of pattern low birthweight. CONCLUSION: Comparison of all risk factors indicates that different multivariate models are needed to understand the epidemiology of preterm and term low birthweights. In terms of clinical value, a general risk assessment model that combines all low birthweight births is as effective as the separate models.

Adolescent↗
PubMed1991

An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina.

BACKGROUND: Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. METHODS: Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. RESULTS: Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. CONCLUSIONS: These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.

Continuity of Patient Care↗
PubMed1989

The effect of a preterm birth prevention program in 17 rural and three urban counties in northwest North Carolina.

The results of a program of low birthweight prevention in 17 rural (20,727 births) and three urban counties (15,561 births) for calendar years 1985 and 1986 are described. Records for women in the program were matched with birth certificate data by computer. Rural and urban women in and out of the program were compared by race on the following risk factors: age less than 18 years, unmarried, education less than 12 years, Medicaid recipient, not WIC recipient, inadequate prenatal care, and previous fetal or live born death. Adjusting for these risk factors, logistic regression was used to estimate program effects on low birthweight (LBW), very low birthweight (VLBW), and preterm low birthweight (PLBW) among rural women. There was a statistically significant difference (p less than or equal to 0.01) favoring women in the program for very low birthweight and preterm low birthweight in white women, and low birthweight and preterm low birthweight in nonwhite women. The differences in rural areas exceed those in urban areas for all but one mean, very low birthweight births among white women.

Adolescent↗
PubMed1988

A comparison of women in and out of a prematurity prevention project in a North Carolina perinatal care region.

We assessed a prematurity prevention project in a North Carolina region with 21,000 annual births in terms of its impact on low birthweight. Project records were matched to birth certificates in order to compare characteristics of women in and out of the program who received prenatal care from private providers. A logistic regression analysis, in which the effects of race, marital status, age, and other risk factors for low birthweight were statistically controlled, showed that women not in the project were 1.32 times (95% Confidence Interval 1.14, 1.54) as likely as project participants to have a birth under 2500 grams. The relative risk for non-participants for a birth under 1500 grams was 1.87 (95% CI 1.25, 2.80). Strengths and limitations of the study are discussed. The results are consistent with previous work examining the etiologies of low birthweight in private versus public patients.

Adolescent↗
PubMed1987

Source of prenatal care and infant birth weight: the case of a North Carolina county.

The impact of a comprehensive prenatal care program on the birth weights of infants born to low-income women is assessed. Women receiving care through the prenatal program of a large county public health department were compared to pregnant Medicaid-eligible women in the same county, who received prenatal care primarily from private-practice physicians. The percentage of low birth weight was 8.3 for the health department women compared with 19.3 for the Medicaid women. After differences between the two groups in race, marital status, participation in the Special Supplemental Food Program for Women, Infants, and Children (WIC), quantity of prenatal care, and other risk factors were statistically controlled, the chance of a Medicaid woman having a low-weight birth was still more than twice as great (p = 0.007). A case-management approach and greater use of services ancillary to basic obstetric medical care appear to contribute to the better birth weight outcomes in the health department.

Birth Weight↗
PubMed1987

Regional program for prevention of premature birth in northwestern North Carolina.

We present our experience with introducing and implementing a prematurity prevention program in a 20-county region in northwest North Carolina. The program is based on the risk assessment and educational model. In the first 25 months of results available, 17,370 births occurred in women enrolled in the project. During 1985, 42.5% of all births in the region occurred in the project. During the time span examined, a downward trend was seen for rates of low birth weight births in public and private patients and for very low birth weight births in private patients. During 1985, private births in the project were significantly less likely to be low birth weight or very low birth weight than private births to women not in the project. These results suggest that regional implementation of prematurity prevention programs is feasible and that such programs are particularly appropriate for private patients.

Costs and Cost Analysis↗