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Biomedical subjects

P Braveman

Publications and source records attributed to P Braveman.

28 records · Page 2Linked to original sources
PubMed1989

Adverse outcomes and lack of health insurance among newborns in an eight-county area of California, 1982 to 1986.

In this study of hospital discharge data on births to residents of an eight-county region of California, we found an increasing lack of health insurance that was associated with an elevated and increasing risk of adverse outcomes in newborns. Between 1982 and 1986, the percentage of newborns without health insurance increased overall by 45 percent (from 5.5 to 8.0 percent; P less than 0.001); the increases were larger among Asians (by 54 percent [from 7.8 to 12.0 percent]; P less than 0.001) and Latinos (by 140 percent [from 8.2 to 19.7 percent]; P less than 0.001). By 1986, the odds ratio for an adverse hospital outcome (defined as a prolonged hospital stay, transfer of the newborn to another institution, or death) was 1.31 (95 percent confidence interval, 1.17 to 1.46) in uninsured as compared with privately insured newborns, with control for race or ethnic group. There was a significant increase in risk over time (P less than 0.03); the comparable odds ratios in 1982 and 1984 were 1.11 (95 percent confidence interval, 0.93 to 1.33) and 1.19 (1.05 to 1.35), respectively. In 1986 the risks were especially elevated for uninsured as compared with privately insured blacks and Latinos (odds ratios, 2.24 [95 percent confidence interval, 1.60 to 3.13] and 1.56 [1.26 to 1.94], respectively); the increases in risk over time were the most marked in these groups. We believe that the elevated and increasing risks for uninsured newborns are explained at least in part by inadequate and diminishing access to care and that this burden is borne disproportionately by blacks and Latinos.

California↗
PubMed1989

Lower-extremity amputation in people with diabetes. Epidemiology and prevention.

The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research.

Aged↗
PubMed1988

Evaluating outcomes of pregnancy in diabetic women. Epidemiologic considerations and recommended indicators.

Many programs have been applied in various settings to reduce adverse outcomes of pregnancy in women with diabetes. Efforts to standardize criteria and methods for evaluating these programs are relatively recent. Without such standardization, evaluation of the impact of many programs and comparisons among programs have not been possible. We review the suitability of available data sources for monitoring adverse outcomes of pregnancy in women with diabetes in light of epidemiological considerations relevant to selection of indicators of program impact. This article is intended to be a resource to help evaluate in a standardized fashion the impact of programs at a regional, state, or local level. We conclude that primary data (information collected by programs themselves) collected in a standardized manner are necessary for evaluation of programs for diabetes in pregnancy. Secondary data sources alone are of limited value for monitoring outcomes because of underreporting of maternal diabetes, especially in the absence of identified complications. Ultimately, the ability to rigorously assess the impact of efforts to improve outcomes of diabetes in pregnancy may depend on the creation of comprehensive statewide systems to identify women of childbearing age who have diabetes.

Congenital Abnormalities↗
PubMed1987

Nicaragua: a health system developing under conditions of war.

Since its inception in 1979, the Nicaraguan National Health System has dramatically improved health care in Nicaragua through the provision of universal coverage, emphasis on preventive community-based primary care, and community participation in health activities. Of major importance in the development of the health system has been the decentralization of the administration, planning, and implementation of health programs. The war in Nicaragua has had a major impact on the development of the health system. Nicaraguan health personnel and facilities have been the objects of attack by the contras and scarce resources have been diverted from the development of social programs to military activities. A large refugee population has been created which further strains existing resources. Community-based preventive health programs have been adversely affected, particularly in rural areas where military activity is the most intense. Because of the war, efforts to optimize regionalization of the health system have been retarded. Economic pressures both within Nicaragua resulting from the war and within the entire Latin American area have further hampered efforts for development. Continued major improvements in health care in Nicaragua will depend on a settlement of the present military conflict which is draining resources in all sectors of development, including health.

Economics↗
PubMedDate not supplied

Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health.

OBJECTIVE: Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention. METHODS: Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c) racial/ethnic disparities in the health indicators "adjusting" for different SES measures. RESULTS: Education-income correlations were moderate and varied by race/ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator. CONCLUSIONS: Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome- and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.

Adolescent↗
PubMedDate not supplied

Maternal marital status as a risk factor for infant mortality.

The increased risk of infant mortality associated with single motherhood is neither consistent among social and demographic subgroups nor inevitable, according to data from national linked birth and infant death files for 1983-1985. Maternal age is the only variable found to have a significant interaction with marital status among black mothers, and the risk associated with unmarried status increases with age. Among white mothers, age, educational level and receipt of prenatal care all show significant interactions with marital status; the increased risks of infant mortality attributed to unmarried motherhood are concentrated among subgroups usually thought to be at lower risk. For example, the risks of infant mortality among unmarried white women relative to married white women are highest among 25-29-year-olds. However, being unmarried did not affect the risk of infant mortality among babies born to college-educated white women.

Adolescent↗
PubMedDate not supplied

Health service use among low-risk newborns after early discharge with and without nurse home visiting.

BACKGROUND: To examine the potential benefits of routine nurse home visiting after early discharge, we compared health service use among low-risk newborns with and without a nurse home visit and telephone follow-up after short hospital stays. METHODS: Records of newborns discharged routinely before (n = 83) and after (n = 91) implementation of a universal postpartum home visiting program were reviewed retrospectively. Acute care visits, rehospitalizations, and well-baby visits for newborns up to 74 days of age were compared between the groups. RESULTS: Acute care visits, rehospitalizations, and missed well-baby visits consistently appeared less likely among newborns receiving home visiting services, in both unadjusted and adjusted analyses. Adjusting for insurance, parity, and breast-feeding, a twofold reduction in acute care visits by 14 days was significant. Although not statistically significant, adjusted analyses of acute care and missed well-baby visits revealed apparently similar patterns at all time intervals. There were too few rehospitalizations for multivariate analysis. CONCLUSIONS: Despite the limitations of this small retrospective study, the consistency of the findings suggests potentially important benefits of home visiting services after early discharge of low-risk newborns, with substantial implications for clinical and reimbursement policy. Effects could be greater with more vulnerable populations and shorter stays than those in this study.

Confidence Intervals↗