Effects of a home visiting program on prenatal care and birthweight: a case comparison study.

Recent reports have stressed the importance of social support services to the health and well being of pregnant women and their newborns. The impact of paraprofessional support services on the amount of prenatal care received and birthweight was studied in a sample of 111 low-income women. Paraprofessionals were women who had been on public assistance and successfully attained health and human services for themselves and their infants. They were similar to the patients they served in educational background and ethnicity. A six-week training program prepared them to counsel and assist pregnant women with health and social services, housing, food, transportation and other basic necessities. Women attending a publically-funded prenatal clinic were randomly assigned to a paraprofessional. A comparison group matched for ethnicity, parity and trimester entering prenatal care was also selected. Women followed by a paraprofessional had significantly more prenatal appointments (8.0 vs 6.5 visits) and infants with average higher birthweight (3125 grams) over the matched comparison group (3273 grams). While intensity of contact with a paraprofessional contributed significantly to the amount of prenatal care received by patients of paraprofessionals, the mechanism for improvement in birthweight is unknown.

Development of a paraprofessional home visiting program for low-income mothers and infants.

This article reports the development of a paraprofessional home visiting program based upon empirically documented client needs, maintenance of the qualities of mutuality and cooperation found in the indigenous paraprofessionals, and methods of ongoing program revision. Three studies are described that suggested four areas of program emphasis: (1) continuity of services from pregnancy through infancy, (2) needs assessment procedures sensitive to a broad range of health and social problems, (3) an ongoing personal relationship with an indigenous paraprofessional, and (4) reduction of barriers to prenatal care inherent in the health care system itself. We provide examples of program application and revision through training of paraprofessionals, case management procedures, and interventions within the perinatal health care system.

Effects of social supports on attitudes, health behaviors and obtaining prenatal care.

The influence of social support on attitudes, health behaviors and attaining prenatal care was assessed in 300 postpartum patients. Demographic, medical, sociocultural, attitudinal and behavioral factors were assessed by interview and review of the medical chart. Three discrete social support factors (intimacy, comfort, security) were identified by factor analysis. The presence of social support was correlated with positive prenatal attitudes, not using drugs, and adequate health resources. Stepwise multiple-regression analysis demonstrated that one social support factor (intimacy), two health behaviors (not drinking and not smoking while pregnant), and parity accounted for 22% of the variance in amount of prenatal care.

Issues in adolescent gynecologic care.

Adolescence is a period of transition from childhood to adulthood. During this period, the potential for high-risk behaviors that may negatively impact on gynecologic health care are great. To enhance the potential for optimal care of this group of individuals, the physician must understand that (1) adolescents must be active participants in the decision making concerning their gynecologic health, (2) adolescents need to be able to communicate their concerns about gynecologic health in a confidential forum, and (3) there are areas of early gynecologic development and maturation for which anticipatory guidance is required.

Enhancing the adolescent reproductive process: efforts to implement a program for black adolescent fathers.

The importance of adolescent fathers participating more fully in pregnancy and childrearing has been emphasized increasingly in the literature. This article describes the development and evaluation of childbearing clinical services designed for adolescent fathers. This multidisciplinary effort used an action research model that integrates empirical research into ongoing programs, continuously monitoring progress. It is comprised of five elements: population description, determination of clients' health needs, assessment and development of resources, evaluation of program services, and monitoring of outcomes. Although the study was not designed exclusively for black adolescents, 95% of the individuals who participated were black. The cultural composition of the study population suggests and impact on the findings. Suggestions are made for future program efforts with adolescent parents.

Effective utilization and evaluation of indigenous health care workers.

The use of indigenous health care workers (IHCWs), who were key elements in community health care programs in the United States in the 1960s, has gone in and out of fashion in subsequent years. The author and his colleagues recently established a service program at Wayne State University's Institute of Maternal and Child Health that employs IHCWs. Characterizations of IHCWs in previous health care programs were reviewed in the process of developing criteria and guidelines for the recruitment, selection, training, employing, and evaluating these workers in the Institute's program. The unique applicability of indigenousness to the delivery of health care services is addressed in terms of the rationale for the use of IHCWs as well as criteria for their success, benefits and problems encountered in the use of these workers, and deficiencies in evaluations of IHCWs. A model of program evaluation, action research, is proposed that assesses the processes and outcomes of providing health services by indigenous paraprofessionals.

Correlates of parenting on a neonatal intensive care unit: maternal characteristics and family resources.

The association of maternal characteristics, family resources, and receipt of prenatal care with parenting behaviors observed in a neonatal intensive care unit (NICU; n = 383) was assessed. The parenting behavior of mothers not receiving prenatal care (n = 128) was compared to that of mothers of the preceding and subsequent admissions (n = 256) by retrospective chart review. Parenting variables included frequency of visits to the NICU and evaluative ratings of parents' involvement with their infant. Parenting of the no-prenatal-care group was significantly less favorable than the control on all comparisons. Factor analysis supported a priori grouping of parenting variables. A stepwise multiple regression of maternal and family characteristics to the factor-derived variable, parenting, showed significant contributions for prenatal drug use and father involvement. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.

Correlates of neonatal morbidity: maternal characteristics and family resources.

The association of mental characteristics, family resources, and receipt of prenatal care with infant birth weight, gestational age, and Apgar scores was assessed in a retrospective review of an extant computerized data base of admissions to a neonatal intensive care unit (NICU; n = 3,818). Prediction variables included mother's age, marital status, health insurance, parity, prenatal health problems, and prenatal drug use. Less favorable infant birth status was associated with prenatal health problems, being single, not having private insurance, obtaining a prior elective abortion, prenatal drug use, and not receiving prenatal care. Stepwise multiple regressions of predictor variables to birth weight and lack of prenatal care were performed. Low birth weight was associated with being single, receiving no prenatal care, and being Black. Lack of prenatal care was associated with mother's age, high parity, prenatal health problems, and prenatal illicit drug use. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.

Clinical applications of self-esteem and locus of control to adolescent health.

Self-esteem and locus of control are two associated constructs representing, respectively, a generalized self-evaluation and an assessment of personal control. Measures representing these constructs generally rely on self-report. These measures have been applied to adolescent health as predictors and outcomes. Most studies rely on chi 3, t-test, and ANOVA analysis and report mixed results in attaining significant group comparisons on issues including contraceptive use, adolescent pregnancy, and substance abuse. Few studies employ multiple regression or discriminant function analysis assessing the relative influence or predictive accuracy and sensitivity of these measures. Studies using these analyses report limited or nonsignificant contributions of these measures to clinical issues (e.g., adolescent fatherhood, adolescent pregnancy, substance abuse, medical management) relative to variables such as patient age, social class, parental attitudes, and peer relationships. Our discussion of these results addresses the validity of self-reports of self-esteem and locus of control versus observation procedures assessing these constructs by verbal and nonverbal presentation of self, analytic procedures appropriate to clinical prediction of behavior by person and situation characteristics, and procedures to advance the clinical adoption of behavioral measures.

Effects of stress and characteristic adaptability on semen quality in healthy men.

Semen from 28 healthy volunteers was assessed for basic semen measure and percent of abnormal morphologic forms every 2 weeks for 6 months. Concurrent self-reports were obtained on abstinence, frequency of ejaculation, health behavior and status, experienced stress, social support, and life events. A single assessment of characteristic adaptability (ego resiliency) also was obtained. Significant between-subject positive correlations were reported among selected semen measures, abstinence, and ego-resiliency. Stress was correlated negatively with semen measures of volume and percent normal morphologic forms.

Effects of social supports on attitudes and health behaviors of pregnant adolescents.

The influence of social support on maternal attitudes and behaviors was assessed in 57 third-trimester adolescent women attending an urban prenatal clinic. Sociodemographic characteristics, social support, self-esteem, and feelings about pregnancy were measured by questionnaire. The support and influence of the adolescent father was emphasized. Social support was measured as a multidimensional construct derived by a priori and empirical procedures. The outcomes measured were the amount of prenatal care, attendance at scheduled postpartum appointments, and pleasure with the pregnancy. Stepwise multiple-regression analyses were used to assess the contributions of the predictor to criterion variables. Pleasure with pregnancy was positively associated with the receipt of assistance from the adolescent's mother, favorable opinions of friends, and satisfaction with living arrangements. Attendance at postpartum visits was associated with high self-esteem. Notably absent as significant contributors were sociodemographic characteristics, receipt of emotional and tangible support from the adolescent father, and expectation of aid from social-assistance programs.

PIP: The influence of social support on maternal attitudes and behaviors was assessed in 57 3rd-trimester adolescent women attending an urban prenatal clinic. Sociodemographic characteristics, social support, self-esteem, and feelings about pregnancy were measured by questionnaire. The support and influence of the adolescent father was emphasized. Social support was measured as a multidimensional construct derived by a priori and empirical procedures. The outcomes measured were the amount of prenatal care, attendance at scheduled postpartum appointments, and pleasure with the pregnancy. Stepwise multiple-regression analyses were used to assess the contributions of the predictor to criterion variables. Pleasure with pregnancy was positively associated with the receipt of assistance from the adolescent's mother, favorable opinions of friends, and satisfaction with living arrangements. Attendance at postpartum visits was associated with high self-esteem. Notably absent as significant contributors were sociodemographic characteristics, receipt of emotional and tangible support from the adolescent father, and expectation of aid from social-assistance programs.

Effect of stress on semen quality in semen donors.

Fifty-three donors with good semen quality were studied monthly for sperm count and motility over 9 to 22 months. Medical students (n = 31) in freshman and sophomore years subjected to the stress of twice-yearly examinations were compared with nonstudents (n = 22) not exposed to common stressful periods. Sperm count and quality (count X motility) for the student group were significantly elevated during examination months versus nonexamination months. Controls demonstrated no differences over these months. Differences between individuals, donor selection factors, and the effects of variable degrees of stress on sperm transport may have contributed to this finding.

Stability of basic semen measures and abnormal morphology within individuals.

Semen from 15 healthy volunteers was assessed for basic semen measures every 2 weeks over a 6-month period to determine the relative stability of these factors. The parameters were: sperm count, semen volume, sperm motility, and normal morphology, along with the type of abnormal morphologic forms. Basic semen measures were generally more stable than the morphologic forms. Using three samples, seven semen factors (sperm count, normal morphology, semen volume, sperm motility, microcephaly, tapering and round tail) were found to be stable and contributed to the identification of the fifteen individuals with a classification accuracy of 75.0%. While individuals do have characteristic patterns of spermatogenesis, the biologic basis for these findings is as yet undetermined.

Pregnant adolescents' health-information needs. Implications for health education and health seeking.

The prenatal health information needs of 142 predominantly black, urban, and low-income adolescents (mean age = 16.9 years) were assessed by questionnaire early in the third trimester of pregnancy. Factor analysis identified three clusters of health topics labeled new morbidity, depressed somatization, and pregnancy. Relationships of these factors to self-esteem and health seeking were assessed in a subset (n = 57). A high score on depressed somatization was associated with low self-esteem and missed postpartum visits. Implications for planning prenatal education and effecting appropriate health-seeking behaviors are discussed.

Health needs of high school students in Detroit.

This project identified the health care needs and information concerns of high school students who were potential patients for a new adolescent health clinic in Detroit. Questionnaires assessed current health problems, information needs, and factors affecting use of health services by 613 predominantly black, urban, high school students at a regional high school (n = 187, X age = 16.8) and a neighborhood high school (n = 426, X age = 15). Reported health problems included eating the proper foods, school problems, acne, depression, and headaches. Expressed health information needs included skin problems, drugs, gender, and birth control. Differences among school, age, and gender were noted. Subjects preferred continuity of provider care and receiving health information by private, direct, patient-physician contact. The findings were used in staff training and in program planning for the adolescent health clinic for high-risk youth.

Variation of semen measures within normal men.

Variation in semen measures was assessed bimonthly in 15 healthy men over a 6-month period. Average within-subject coefficients of variation for sperm count, morphologic features, motility, and semen volume demonstrate considerable variation. Each day of abstinence increased the volume by an increment of 0.62 ml, the count by 17.6 X 10(6)/ml, and motility by 1.2%. Sperm count and semen volume correlated positively within subjects. Intraclass and serial correlations of semen measures provided an empirical clinical guide to the number and spacing of specimens. Three specimens spaced no more than 2 weeks apart established a reliable semen profile. Findings can be applied to basic research and clinical practice.

Primary care of adolescents. Issues in program development and implementation.

Recent reviews of adolescent primary care urge the development of a dynamic program evaluation strategy. An action research evaluation model that combines service, training, and research to foster the development and implementation of primary care services is presented. The strategy includes description of patient populations, determination of patient health care needs, specification of service objectives, assessment of health care resources, and evaluation of service procedures and outcomes. Elements of the action research strategy are applied to evaluate two current issues in adolescent primary care: family-oriented versus adolescent-limited services and "new morbidity".

Methodologies of affective classification.

Three methodologies to classify the affective domain are reviewed: phenetic, cladistic, and ontological. The merits and seeming deficiencies of these approaches are analyzed, and illustrative applications of these methodologies are presented. A systems analysis of the affective domain is proposed as most adequately performing the classification functions of grouping elements to emphasize their autonomy and homonomy, indicate their nature and degree of relatedness, and structurally represent abstract conceptualizations of this domain.

Affective behavior of abused and control children: comparisons of parent-child interactions and the influence of home environment variables.

Affective behaviors of 14 pairs of infant and preschool abused and control children matched on age, race, sex, and socioeconomic level were assessed in parent-child interaction. Subgroups of abused and control samples were formed by introduction of selected home environment variables chosen to represent properties of the parent-child dyad. Matched-pairs analysis showed few matched t-test comparisons to be significant. However, significant interactions were observed when two-way analyses of variance were performed with abused-control and status of home environment as factors. For positive affective behaviors, the abused group favored on home environment variables was higher than the favored control group. For negative affective behaviors, the abused group less-favored on home environment variables was higher than the less-favored control group. As a response to abuse, an increased sensitivity to the physical and social stimulation of the home environment is proposed.