Malpractice coverage for health professionals with physical, mental, or substance-abuse impairments. How do insurance companies make their decisions?

How do insurance companies decide whether or not to provide malpractice insurance to health professionals? What information do they gather on applicants and renewing policyholders? Who has the responsibility to determine if health professionals are suffering from physical, mental, or substance-abuse impairments that make them unfit to care for patients? The authors conducted a survey to find the answers to these questions.

Early childhood survivorship in Vietnam.

The effects on early childhood mortality of birth order, age of the mother at the time of the child's birth, mother's education, as well as infant mortality risk in the province, urban/rural residence, the presence of schools and other facilities and health care services, were examined using data from the 1988 Vietnam Demographic and Health Survey and the 1990 Study of Accessibility of Contraceptives in Vietnam. A total of 4137 urban and rural children born between 1983 and 1988 to the 4172 women interviewed in the Demographic and Health Survey were included in the hazard model analysis of maternal and child characteristics. However, since the Accessibility of Contraceptives Study included only rural respondents, the hazard model analysis of community development characteristics and health services effects on early childhood mortality was based on a subsample of 3314 rural children. Rural children in birth orders five and higher had the greatest risk of early childhood death, birth order one an intermediate risk and orders 2-4 the lowest risk of early childhood death. Rural children residing in communes with fewer than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither age nor education of the mother nor gender of the child, had a significant impact on early childhood survivorship independent of other variables. Risk of infant mortality in the child's province was of borderline significance.

PIP: The authors examined the effects of the following factors upon early childhood mortality: birth order, mother's age at the time of the child's birth, mother's education, infant mortality risk in the province, urban/rural residence, and the presence of schools and other facilities and health care services. Data were used in a hazard model analysis of maternal and child characteristics for 4137 urban and rural children born between 1983 and 1988 whose 4172 mothers were interviewed in the 1988 Vietnam Demographic and Health Survey. Data were also used for a subsample of 3314 rural children from the 1990 Study of Accessibility of Contraceptives in Vietnam. Analysis found that rural children of birth orders five and higher had the greatest risk of early childhood death. Birth order one held an intermediate risk, while orders 2-4 held the lowest risk. Rural children residing in communes with less than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither mother's age nor education, nor gender of the child, had a significant impact upon early childhood survivorship independent of other variables. The risk of infant mortality in the child's province was of marginal significance.

Menstruation, menarche, and sexuality in the public school curriculum: school nurses' perceptions.

Nurses employed by schools and health departments have varying responsibilities for curricula related to menstruation, menarche, and sexuality. Nevertheless, the school nurse is usually a source of information on these subjects whether employed full-time in school health or also participating in other nursing roles in the community. This survey examines the involvement of school nurses in curricula related to human reproduction including contraception. Data about their involvement in these classroom topics provides a basis for evaluating their roles and making recommendations for subsequent continuing education programs for school health nurses.

Vietnamese infant and childhood mortality in relation to the Vietnam War.

OBJECTIVES: There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. METHODS: The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. RESULTS: For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. CONCLUSIONS: The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces.

Factors influencing infant mortality in Vietnam.

Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.

PIP: The purposes of this study of infant mortality in Viet Nam were to determine the contribution of select variables to infant mortality and to compare these determinants with determinants of neonatal and postneonatal mortality. Data were obtained from the 1988 Vietnam Demographic and Health Survey (DHS) and the Vietnam Accessibility of Contraceptives Study in 1990. The DHS Sample included 4172 women aged 15-49 years and reports on 4884 children born between 1983 and 1988 and a subsample of 3382 children born in rural areas between 1983 and 1988. Explanatory variables were mother's age at time of birth, mother's education, birth order, sex, previous birth interval, the infant mortality risk status of the province, residence, and regional location. The accessibility survey provided data on availability of health care services, characteristics of the village, and geography of the area. Logistic regression showed that none of the explanatory variables significantly affected the infant mortality rate (IMR) for first births. For second and higher order births, provincial infant mortality risk was the only significant explanatory variable for IMR, and for postneonatal mortality for first births total, and for second and higher order births in the rural population. Risk was higher in areas with a higher than 40/1000 IMR. For second and higher order births, none of the explanatory variables was a significant predictor of neonatal, postneonatal, or infant mortality for all areas. Birth orders of 2-4 had a significantly lower risk of infant mortality than birth order of 5 or greater. In the rural subsample, high and low risk provinces were equally likely to live among the mountains and highlands; high risk provinces were more likely to be in coastal and delta areas. Children from intermediate sized villages were more likely to live in high risk provinces from those living in villages of under 2000 population or larger villages with 10,000 population. Lower infant mortality rates were associated with living in areas with public transport, a secondary school, a telephone, and electricity. Low risk infant mortality provinces also had higher proportions of children living 10 km from a polyclinic which was open over 24 hour/weeks and having a nurse or midwife available. More children with a village midwife lived in high risk provinces. The presence of public transport was associated with a significantly lower IMR.

Individual and community characteristics influencing breastfeeding duration in Vietnam.

This analysis of selected community and maternal characteristics influencing duration of breastfeeding in Vietnam utilized data from the 1988 Demographic and Health Survey and 1990 Accessibility of Contraceptives Survey available for the 4434 children born to 2769 women having their last birth between 1983-88. Explanatory variables included as covariates in the hazards model were mother's education, age of the mother at the time of the child's birth, birth order, and gender of the child, urban versus rural residence, infant mortality risk in the child's province, locality (mountains and highlands compared to delta and coastal), and region of the country (north, south). Indicators of development in the child's village included availability of electricity and public transportation. Breastfeeding duration was longer among the more highly educated women and among those women living in provinces with higher infant mortality. However, there were no significant differences in the duration of breastfeeding with variations among certain development characteristics of the village. Although there were regional differences in the duration of breastfeeding for the rural population, there were no regional differences for the overall population. There were no significant variations in the duration of breastfeeding by age of the mother, birth order or gender of the child. Although there were significant variations in duration of breastfeeding by some maternal and community characteristics, between 80-90 per cent of all women breastfeed for at least the first year of the child's life.

Factors related to the utilization of prenatal care in Vietnam.

Data from the 1988 Vietnam Demographic and Health Survey and 1990 Vietnam Accessibility of Contraceptives Survey were used in this analysis of the influence of selected individual and community characteristics on the utilization of prenatal care in Vietnam. Specific analysis of the impact of availability of health services and other development characteristics of the community on utilization of prenatal care was done in a rural subsample. The woman's educational level and total number of living children were the most significant predictors of prenatal care utilization. Age independent of parity did not significantly affect the use of prenatal care. Rural women and women living in provinces with the highest infant mortality rates were significantly less likely to use prenatal services than their counterparts in the urban areas and provinces with low infant mortality rates. Non-physician health care providers were the main sources of prenatal care for women in both rural and urban areas.

PIP: Researchers analyzed data from the 1988 Vietnam Demographic and Health Survey and the 1990 Vietnam Accessibility of Contraceptives Survey to determine the influence of individual and community characteristics on use of prenatal care. Most pregnant women received prenatal care services from midwives or assistant physicians (34.8-51.2%). Less than 5% received prenatal care from a physician. Level of education and utilization of prenatal care were positively associated (p = .0001). Higher parity women were less likely to use prenatal care (47.1% vs. 68.8%), perhaps reflecting that they were more confident about pregnancy and felt less need for prenatal care. Maternal age did not affect utilization of prenatal care, regardless of parity. Urban women were more likely to use prenatal care than rural women and those living in the provinces where infant mortality was higher than 40/1000 live births. The lack of transport in rural areas was likely responsible for this difference in prenatal care utilization. Absence of prenatal care services in provinces with high infant mortality rates probably explained the difference in prenatal care use. Among rural women, the factor having the most influence on prenatal care utilization was education. These findings emphasized the need for promotion of prenatal care services among women with limited education and expansion of the accessibility and availability of prenatal services. They also indicted the importance of improving women's education which in turn improves utilization of prenatal care services.

Contraceptive use in Vietnam: the effect of individual and community characteristics.

Data from the 1988 Vietnamese Demographic and Health Survey and the 1990 Vietnam Study of Accessibility of Contraceptives were used in this analysis to determine how selective individual and community characteristics influenced the use of modern methods of contraception in Vietnam. Although there were no significant differences in the use of contraceptives between women with a primary education and those with a higher educational attainment, the illiterate women with no formal education were significantly less likely to use modern methods of contraception. Women living in provinces with high infant mortality rates were significantly less likely to use modern methods of contraception than women in low-infant-mortality provinces. Independent of other individual and community characteristics, there were no significant differences in the use of contraception between urban and rural women.

A profile of young adolescents attending a teen family planning clinic.

The purpose of this study was to assess the client records of adolescents attending a teen family planning clinic to determine the reported episodes of sexually transmitted diseases, sexual abuse, alcohol and drug use, and other dysfunctional situations in the family. In addition, information about the initiation of sexual activity and sexual partners was assessed in the record review. Data were obtained from a county health department located in a metropolitan area of a southeastern state. A review of the records of 183 adolescents 15 years of age or younger provided information on ethnicity, grade in school, and assessment data from the clinic interviews and exams. Twenty-five clients said they were not sexually active when they came to the family planning clinic for the first time, and were brought to the clinic by a parent (usually the mother). Those clients who came without parents said they were sexually active. Forty-one percent had their first sexual experience between 12 and 13 years of age, 18% between the ages of 14 and 15, and the remainder before the age of 12. While over 7% specifically stated that they had been sexually abused or raped, an additional 19% described situations in the home or exhibited symptoms associated with a history of sexual abuse. Eleven percent had a history of two to three different sexually transmitted diseases, and 26% had three or more diseases. Seventy-two percent indicated that there was conflict in the home; several had left home because of abuse. Fourteen percent admitted using drugs, mostly cocaine or marijuana, and 17% reported that they used alcohol at least occasionally.

PIP: Client records of 1833 adolescents attending a county health department teen family planning clinic in a metropolitan area of the southeastern US were reviewed to gain insight into reported episodes of sexually transmitted diseases (STDs), sexual abuse, alcohol and drug use, initiation of sexual activity, sexual partners, and family life characteristics. Clients were aged 15 or younger,k with 82.8% aged 14 or 15 years; 80% were black. 25 stated that they were not sexually active at the time of their 1st visit to the clinic, while the remaining clients were sexually active. 41% began sexual relations between ages 12 and 13, 18% between ages 14 and 15, and the remainder prior to age 12. 7% claimed to have been sexually abused or raped, 19% described home situations or showed symptoms associated with history of sexual abuse, 80% had not been pregnant, 17% had 1 child, and 3% had 2 children. 11% had histories of 2-3 different STDs, 26% had 3 or more, and 7% stated that they had had sex with more than 2 partners. The majority of STD cases reported involved chlamydia and gonorrhea, followed by herpes. 14% admitted using drugs, primarily cocaine or marijuana, and 17% reported consuming alcohol at least occasionally. 72% cited conflict in the home, with several clients leaving the home due to abuse.

Smoking habits and smoking cessation among North Carolina nurses.

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.

A follow-up of vasectomy clients in rural Bangladesh.

A one-year follow-up of 585 vasectomy clients sterilized at vasectomy camps in Shibpur and Shalna in rural Bangladesh showed that almost half of the clients were dissatisfied with their vasectomies. The majority of dissatisfied clients stated that their primary reasons for dissatisfaction were: (a) their ability to work had decreased and (b) they had not received all of the incentives they had been promised. However, 58% of the matched nonvasectomized controls also felt that their ability to work had decreased in the last year. Only 2%--7% of the dissatisfied clients cited decreased sexual performance as their primary reason for dissatisfaction. Satisfied vasectomy clients most frequently cited: (a) the permanence of this method of birth control and (b) the incentives they received as their reasons for satisfaction.