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R Halpern

Publications and source records attributed to R Halpern.

45 records · Page 3Linked to original sources
PubMedDate not supplied

[Prenatal care in Pelotas, Rio Grande do Sul, Brazil, 1993].

All 5304 births in the hospitals of Pelotas, Rio Grande do Sul, Brazil in 1993 were studied. Neonates were examined and their mothers were interviewed regarding sociodemographic conditions, family income, reproductive health, and medical care during pregnancy. Ninety-five per cent of women received prenatal care. The mean number of physician visits during pregnancy was 7 and the majority of the women (84.7%) began visits before the fifth month of pregnancy. Women who did not receive prenatal care were from the lowest socioeconomic stratum and were mostly adolescents or over 40 years of age. Incidence of low birth weight in this group was 2.5 times that of the group with more than five visits (p>0.001). Perinatal mortality rate was 50.6/1000 in the group without prenatal care and 15.8/1000 in the group with more than five visits. With regard to utilization of health care, the study shows that twenty-five per cent of women with high gestational risk received inadequate prenatal care. The rate was less than 10% in the group of women with low gestational risk. These results suggest the need for improvement in the quality of prenatal care with special attention for mothers with high gestational risk.

Adolescent↗
PubMedDate not supplied

[The Children's Pastoral in Criciúma, Southern Brazil: coverage and socio-demographic characteristics of participating families].

This study describes the main social, economic, biological, and demographic characteristics of children and families who participate or have participated in the Children's Pastoral as compared to the overall urban population of Criciúma (Southern Brazil). A population-based cross-sectional study with a probabilistic sample of 2208 children under three years of age was conducted; 16.7% of the mothers confirmed having participated in the Pastoral at any given time, of whom 4.8% were currently participating, while the rest had dropped out. Black children and those over 12 months old or with two or more older siblings participated more frequently in the Pastoral. The main family factors associated with participation were mother's age (over 25), mother not working outside the home, low per capita income, low parental schooling, living in the neighborhood for more than 4 years, and death of sibling before age five. Reasons most often given by mothers for dropping out were migration, lack of time, and interruption of the Pastoral's activities in the neighborhood. The conclusion was that the Pastoral should prioritize the poorest of the poor and adopt measures to reduce drop-out rates.

Adolescent↗
PubMedDate not supplied

[Public and private day-care centers in Pelotas, RS: compliance with the regulations]

OBJECTIVES: Seventy-seven day-care centers were evaluated in Pelotas, RS, Brazil, in 1996, in order to assess compliance with current service regulations. METHODS: Information about physical structure, facilities, equipment, hygiene practices, and day-care staff was collected through a structured questionnaire. RESULTS: The median number of children in public day-care centers was 89 children per center, while in the private centers the median was 29 children per center (p<0.001). A nursery was available in 88% of public day-care centers, and in 36% of the private centers (p<0.001). Concerning the physical structure, the majority of the public centers had exclusive toilet facilities for the children (91%), while this was the case in only 66% of the private centers (p<0.001). Fire extinguishers were found in public centers in a proportion three times higher than in the private centers. Proper bottle washing and refrigeration was done in 95% of the day-care centers studied, while sterilization of the bottles was reported in only 47% of the centers. Despite the fact of 85% of the centers kept records with health information on the children, 93% of the centers did not have the required health license provided by the municipal authority. CONCLUSIONS: There is a good deal of work to do in both private and public day-care centers in order for them to comply with the current service regulations.

Journal Article↗
PubMedDate not supplied

[Populational study of investigation of perinatal and infant deaths: methodology, validity of diagnosis and under-registration].

OBJECTIVE: The main objectives of the present study were to evaluate the percentage of under-registration of infant mortality in 1993 and compare it with the ones found 1982; to analyze the agreement between the official death certificates and the ones made by the referees. METHODS: The infant mortality of all children born in Pelotas, in 1993, was monitored through daily visits to hospitals, as it was done in 1982; monthly, cemeteries and public registration offices were visited to detect any deaths outside the hospitals. Besides the official death certificates, two independent referees established the underlying cause of death based on information from pediatricians, case-notes, autopsies and through a home visit to the parents of the children. RESULTS: The percentage of under-registration fell substantially from 24%, in 1982, to 5.4%, in 1993. The agreement between the official death certificates and the ones made by the referees showed satisfactory Kappas, unless for ill defined diseases such as sudden infant death, where the agreement was null. CONCLUSIONS: The authors conclude that there was a significant fell of the under-registration for infant death in Pelotas, and the ill defined causes such as sudden infant death have been hidden by the diagnosis of pneumonia.

English Abstract↗
PubMedDate not supplied

[Risk factors for low birth weight in a rural community in southern Brazil].

This paper reports a study assessing risk factors for low birth weight (LBW), preterm and intrauterine growth retardation (IUGR) in a sample of 936 mothers who delivered babies in the Canguçu Hospital, a rural area of southern Brazil. Traditional risk factors for delivering LBW, preterm and IUGR were examined. The relative importance of the risk factors was studied through risk calculation and logistic regression analysis. Some risk factors for LBW such as low maternal education and number of prenatal consultations were not associated with the risk of delivering babies in any of the three risk groups. Hospitalization during pregnancy and maternal age less than 20 years were confirmed as risk factors for LBW. In the preterm group, low maternal weight and hospitalization during pregnancy showed significant association after control for confounders. The results suggest that there are specific targets for intervention in each of the three groups, and some traditional risk factors must be redefined according to the characteristics of each population.

English Abstract↗
PubMedDate not supplied

[Risk factors for suspicion of developmental delays at 12 months of age]

OBJECTIVE: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. METHODOLOGY: A sample of 20% (1,363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, childreńs care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. RESULTS: At 12 months of age, 34% (463) of the total of 1,363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR= 1.5), very low birth weight (OR= 4.0), gestational age less than 37 weeks (OR= 1.6), more than three siblings (OR= 1.9), and duration of breastfeeding less than three months (OR=1.6), or no breastfeeding (OR= 1.9). Children who presented weight/age at six months of age less or equal to -2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. CONCLUSIONS: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development.

Journal Article↗
PubMedDate not supplied

Identifying, assessing and managing high-risk patients under Medicare risk contracts.

Physicians participating in Medicare managed care plans are increasingly sharing in the financial risks of providing care to enrollees. Although capitation payments are calculated to reflect the average costs for an entire patient panel, there is typically great variation among patients, from healthy individuals to patients requiring high volume and high-cost care. To be successful, physicians must identify high-risk seniors, develop care plans to maintain health and functioning, and monitor health status and ongoing care and treatment. Techniques for performing a comprehensive geriatric assessment include written questionnaires and interviews during office appointments. The goal is to evaluate each patient's health status, medical risk factors, psychosocial profile, cognitive capacities, and functional capabilities and limitations. After frail and at-risk seniors are identified, the physician must collaborate with the case manager, geriatric nurse practitioner, other caregivers, and the patient and family members to initiate and maintain effective care management.

Aged↗