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P A St Clair

Publications and source records attributed to P A St Clair.

8 recordsLinked to original sources
PubMed1999

National probability samples in studies of low-prevalence diseases. Part II: Designing and implementing the HIV cost and services utilization study sample.

OBJECTIVE: The design and implementation of a nationally representative probability sample of persons with a low-prevalence disease, HIV/AIDS. DATA SOURCES/STUDY SETTING: One of the most significant roadblocks to the generalizability of primary data collected about persons with a low-prevalence disease is the lack of a complete methodology for efficiently generating and enrolling probability samples. The methodology developed by the HCSUS consortium uses a flexible, provider-based approach to multistage sampling that minimizes the quantity of data necessary for implementation. STUDY DESIGN: To produce a valid national probability sample, we combined a provider-based multistage design with the M.D.-colleague recruitment model often used in non-probability site-specific studies. DATA COLLECTION: Across the contiguous United States, reported AIDS cases for metropolitan areas and rural counties. In selected areas, caseloads for known providers for HIV patients and a random sample of other providers. For selected providers, anonymous patient visit records. PRINCIPAL FINDINGS: It was possible to obtain all data necessary to implement a multistage design for sampling individual HIV-infected persons under medical care with known probabilities. Taking account of both patient and provider nonresponse, we succeeded in obtaining in-person or proxy interviews from subjects representing over 70 percent of the eligible target population. CONCLUSIONS: It is possible to design and implement a national probability sample of persons with a low-prevalence disease, even if it is stigmatized.

Data Collection↗
PubMed1990

Unlicensed midwifery practice in Washington state.

We examined the role of unlicensed midwives in Washington State by questioning mothers of infants born out-of-hospital with an unlicensed person in attendance. Only a small proportion of the state's births (0.11 percent) were attended by unlicensed midwives. Unlicensed midwives attended 7 percent of home births, licensed midwives and certified nurse-midwives attended 69 percent. Mothers chose unlicensed midwives because they had religious beliefs in common, or because they were the only providers available who would attend a home birth.

Adolescent↗
PubMed1989

Are in-vitro fertilisation and embryo transfer of benefit to all?

The efficacy, safety, costs, and benefits of in-vitro fertilisation and embryo transfer (IVF/ET) have been reviewed. IVF/ET benefits only a small proportion of infertile women, it is expensive, and has serious health risks. Therefore policies for the management of infertility in which most financial and manpower resources are applied to prevention of infertility must be developed. Health authorities should also require accreditation of IVF/ET programmes, certification of providers, and ongoing monitoring of clinics. Full and accurate information on IVF/ET must also be disseminated, so that individuals seeking treatment for infertility can make the best informed choice about their care and health authorities can decide the place of IVF/ET in their infertility services.

Costs and Cost Analysis↗
PubMed1989

Social network structure and prenatal care utilization.

The associations between social network structural characteristics, sociodemographic factors, and prenatal care utilization were examined in a sample of 185 low-income, inner-city, maternity patients. It was predicted that the networks of women who underutilized care would be larger and of higher density than those of women who utilized care appropriately. They were also expected to be less disperse, with members living near one another; less diverse, with members drawn mainly from immediate family and extended kin; and composed primarily of strong relational ties between members. Findings indicated that women were more likely to underutilize care if they were embedded in strong-tie, nondisperse networks where most members were immediate family or relatives. Of the sociodemographic variables, only parity was associated with prenatal care utilization. The findings support the underlying assumption that social networks have a significant influence on individuals' utilization of prenatal services. This suggests that providers of services to pregnant women may need to revise their current strategies for bringing women into care and their methods of delivering educational services to women already in care.

Adult↗
PubMed1989

Social network advice during pregnancy: myths, misinformation, and sound counsel.

One hundred eighty-five low-income, inner-city women were interviewed after they gave birth. They were allowed to report on up to 30 members of their social networks, including household members, relatives, and friends. Questions were asked regarding the types and nature of health advice given to them by these individuals, the relationship of each advisor, and his or her age and sex. Respondents received between 0 and 211 (median 20) pieces of advice related to pregnancy health from 0 to 19 (median 5) members of their social networks. Both folk beliefs and information aligned with accepted medical views of health promotion were communicated to individual women. Most advice rendered was sound, but often the rationale for the recommended health action was poorly understood. Some respondents received advice that, if followed, could be harmful to health. This suggests that for some low-income, inner-city women, social networks serve as important resources for health information. However, the advice they convey may cause unnecessary worry or come into conflict with recommendations of health care providers. Therefore, new educational strategies are required to address the informational needs not just of individual women, but of their social networks as well.

Adult↗
PubMedDate not supplied

Childrearing knowledge, beliefs, and practices of Cambodian refugees.

Forty Cambodian women in Seattle, Washington were interviewed to learn about their childrearing knowledge, beliefs, practices, and information resources. It was found that women who once relied on family and elders for advice now turned to pediatric providers and other clinic staff. Most women reported accurately the ages at which developmental milestones occur, with the exception of vision and hearing milestones. Their treatment of common childhood illnesses included both Western and Cambodian remedies. Beliefs about children's nature, discipline, learning, and reincarnation were explored. Implications for providers trying to support the parenting efforts of Cambodian women in the United States are discussed.

Adult↗
PubMedDate not supplied

Situational and financial barriers to prenatal care in a sample of low-income, inner-city women.

The relationship between the use of prenatal care and factors that may impede access to care was examined in a sample of low-income, inner-city women. Situational and financial barriers to care were not important correlates of utilization. In unadjusted analyses, only insurance status and employment status were associated with utilization. Of the sociodemographic characteristics studied, only parity was strongly associated with the use of prenatal care. When the apparent associations between utilization and insurance status and utilization and employment were analyzed controlling for parity, the estimated strength and statistical significance of these relationships diminished considerably. Multiparous women who were more likely than primiparous women to be underutilizers were also more likely to be on medical assistance and to be unemployed. These findings suggest that situational and financial barriers are not important correlates of utilization for low-income, adult women living in urban areas where there are accessible clinic facilities and public transportation. Efforts to identify and surmount other kinds of barriers may prove to be a more effective approach to prenatal outreach for women in these circumstances.

Adult↗