No easy solution to subgroup differences.

Replies to comments by A. G. Bedeian (see record 2002-12457-016), G. Bocknek (see record 2002-12457-017), G. E. Zuriff (see record 2002-12457-018), and J. E. Helms (see record 2002-12457-019) on the article by P. R. Sackett, N. Schmitt, J. E. Ellingson, and M. B. Kabin (see record 2001-00625-002) which posed the dilemma of how to use tests to select for performance without excluding minority group members. The authors argue that it is difficult to envision a university that would ignore cognitive ability when making admissions decisions, as Zuriff advocated. In response to Bocknek, the authors question the validity of individual assessments to index traits such as motivation, perseverance, and problem solving. In response to Bedeian, the authors argue that society and the legal system (as it exists now) force the consideration of ascribed characteristics, and few, if any, good measures of racial identity (or intellectual diversity) exist. Finally, the authors argue that Helm's position that individuals' racial identity must be destroyed in the interest of raising their status in high-stakes testing situation is misguided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Encopresis in a Hispanic boy: Distinguishing pathology from cultural differences.

Several models have been constructed to account for encopresis in children. These include social learning, family systems, and analytic models. One increasingly important practical question is whether existing models can be validly applied to culturally different children. The treatment of Juan, a child of very poor, rural Hispanic immigrant parents, presented an opportunity to examine the fit between theory and clinical practice in the case of a culturally unassimilated youngster. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnant women's perceptions of prenatal care

PROBLEM: To describe pregnant women's perceptions in two specific areas: expectations about prenatal care and satisfaction with prenatal care. METHOD: A focus group technique using a semi-structured interview format. Three focus groups (N = 22) were conducted in the third trimester of pregnancy. Data were transcribed from the taped sessions and studied using content analysis. FINDINGS: Three major dimensions of satisfaction were identified: satisfaction with health care provider(s); satisfaction with support staff; and satisfaction with the prenatal care, including the desire for continuity of provider, clear explanations, and accessible quality care. CONCLUSIONS & IMPLICATIONS FOR NURSING: The provider relationship was identified as having the greatest influence on the women's satisfaction with prenatal care. Satisfaction with prenatal care can be enhanced through positive provider-patient interactions.     

Ethnic and gender subgroup differences in assessment center ratings: A meta-analysis.

Assessment centers are widely believed to have relatively small standardized subgroup differences (d). However, no meta-analytic review to date has examined ds for assessment centers. The authors conducted a meta-analysis of available data and found an overall Black-White d of 0.52, an overall Hispanic-White d of 0.28, and an overall male-female d of -0.19. Consistent with our expectations, results suggest that Black-White ds in assessment center data may be larger than was previously thought. Hispanic-White comparisons were smaller than were Black-White comparisons. Females, on average, scored higher than did males in assessment centers. As such, assessment centers may be associated with more adverse impact against Blacks than is portrayed in the literature, but the predictor may have less adverse impact and be more "diversity friendly" for Hispanics and females. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care characteristics associated with women's satisfaction with prenatal care

OBJECTIVES: The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients. METHODS: African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction. RESULTS: For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women. CONCLUSIONS: Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.     

Varying forms of husband sexual aggression: Predictors and subgroup differences.

The relationships between two forms of husband sexual aggression (coercion and threatened/forced sex) and husband physical and psychological aggression were examined among a community sample of 164 couples. A stronger relationship between physical and sexual aggression was obtained than in previous research. Husbands' physical and psychological aggression predicted husbands' sexual coercion, but only physical aggression predicted threatened/forced sex. The more severely physically violent subtypes of the A. Holtzworth-Munroe et al. (2000) typology engaged in the most sexual coercion, and the most violent subtype (generally violent/antisocial) engaged in the most threatened/forced sex. In examining C. M. Monson and J. Langhinrichsen-Rohling's (1998) typology, the existence of a sexually violent-only subtype was documented, physically nonviolent husbands were found to engage in sexual coercion, and sexually and physically violent husbands engaged in the highest level of sexual aggression. The utility of using multiple measures, and both spouses' reports, to assess sexual aggression is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teenagers' perceptions of barriers to prenatal care

A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the importance of prenatal care, practical obstacles to access to health care (such as lack of transportation, day care, etc), financial problems related to care, problems finding time to obtain health care, knowledge of available prenatal care resources, and perceptions of ease or difficulty in the use of existing clinics. Multiple regression analysis using the Kessner index as the criterion variable showed that major factors related to the adequacy of prenatal care received by these teenagers were perceptions of cost barriers, the gestational age at which the teenager discovered she was pregnant, school enrollment status (those in school received poorer care than those who had dropped out), and the degree of social support experienced by the teenager. These findings suggest that specific changes in the health care system are needed to make prenatal care more accessible for pregnant teenagers. These changes would include enhancing community awareness that Medicaid pays for prenatal care, establishing links between prenatal clinics and school health systems, and scheduling prenatal clinics at times more convenient for teenagers.     

Racial subgroup differences in predictive validity perceptions on personality and cognitive ability tests.

The relationships between examinees' racial subgroup membership and their perceptions of the predictive validity of a widely used personality test (NEO Five Factor Inventory; P. T. Costa & R. R. McCrae, 1992) and a widely used cognitive ability test (Wonderlic Personnel Test; E. F. Wonderlic, 1984) were examined. Results from 241 undergraduates showed that Black examinees perceived the cognitive ability test as less valid than White examinees, whereas no significant Black–White difference in predictive validity perceptions was observed on the personality test. Results also indicated a significant but small positive association between performance on the cognitive ability test and predictive validity perceptions of the cognitive ability test. Contrary to predictions, there was little evidence that test performance mediated the relationship between race and predictive validity perceptions on the cognitive ability test. Conversely, predictive validity perceptions did not appear to account for any substantial portion of the racial subgroup differences in test performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices

CONTEXT: Two measures traditionally used to examine adequacy of prenatal care indicate that prenatal care utilization remained unchanged through the 1980s and only began to rise slightly in the 1990s. In recent years, new measures have been developed that include a category for women who receive more than the recommended amount of care (intensive utilization). OBJECTIVE: To compare the older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995, for the overall population and for selected subpopulations. Second, to examine factors associated with receiving intensive utilization. DESIGN: Cross-sectional and trend analysis of national birth records. SETTING: The United States. SUBJECTS: All live births between 1981 and 1995 (N=54 million). MAIN OUTCOME MEASURES: Trends in prenatal care utilization, according to 4 indices (the older indices: the Institute of Medicine Index and the trimester that care began, and the newer indices: the R-GINDEX and the Adequacy of Prenatal Care Utilization Index). Multiple logistic regression was used to assess the risk of intensive prenatal care use in 1981 and 1995. RESULTS: The newer indices showed a steadily increasing trend toward more prenatal care use throughout the study period (R-GINDEX, intensive or adequate use, 32.7% in 1981 to 47.1 % in 1995; the Adequacy of Prenatal Care Utilization Index, intensive use, 18.4% in 1981 to 28.8% in 1995), especially for intensive utilization. Women having a multiple birth were much more likely to have had intensive utilization in 1995 compared with 1981 (R-GINDEX, 22.8% vs 8.5%). Teenagers were more likely to begin care later than adults, but similar proportions of teens and adults had intensive utilization. Intensive use among low-risk women also increased steadily each year. Factors associated with a greater likelihood of receiving intensive use in 1981 and 1995 were having a multiple birth, primiparity, being married, and maternal age of 35 years or older. CONCLUSIONS: The proportion of women who began care early and received at least the recommended number of visits increased between 1981 and 1995. This change was undetected by more traditional prenatal care indices. These increases have cost and practice implications and suggest a paradox since previous studies have shown that rates of preterm delivery and low birth weight did not improve during this time.     

Birth outcomes and the effectiveness of prenatal care

OBJECTIVE: To investigate pregnant women's self-selection effects on the estimation of birthweight production function. A particular emphasis is placed on assessing the effectiveness of prenatal care as a major medical input in the birthweight production function. DATA SOURCES: Primary data compiled from birth and abortion certificates for the Commonwealth of Virginia in 1984. Several area-specific socioeconomic variables were also employed from the Area Resource File 1984; Supplemental Food Program for Women, Infants, and Children (WIC) Local Agency Directory; and the family planning clinics data by the Alan Guttmacher Institute (AGI). STUDY DESIGN: Two types of self-selection effects are defined: selection effect due to sample censoring from the resolution of pregnancies as live births or induced abortions; and selection effect due to the use of prenatal care as an endogenous variable. Race- and location-specific birthweight production functions are estimated using models with and without correction for self-selection effects. PRINCIPAL FINDINGS: The self-selection effect in the resolution of pregnancies is race-specific, being significant for African American women. The effectiveness of prenatal care in birthweight production is underestimated substantially by the selection bias from the use of prenatal care, and overestimated by the selection bias from pregnancy resolutions. On average, the overall estimated effectiveness of prenatal care is over five times higher after controlling for the selection effects. CONCLUSIONS: Self-selection effects could be a very serious problem in measuring the effectiveness of birthweight determinants in general. The overall effectiveness of prenatal care, in particular, tends to be significantly biased downward without controlling for selection effects. The significance and scale of the bias depends crucially on specific data and cohorts of the population investigated.     

Conceptions of prenatal care among Somali women in San Diego

Studies have shown that culturally sensitive prenatal care improves access to and utilization of that care. Focus groups were used to explore the beliefs and attitudes toward prenatal care among Somali women in San Diego, particularly in regard to their perinatal experiences following immigration. The women were very well informed about healthy prenatal practices, including nutrition and exercise, and very compliant in following such practices, having found ways and means to accommodate these practices into their new American lifestyle. The women were generally pleased with the care that they have received in San Diego and tolerant of most diagnostic and therapeutic interventions. The women preferred to be seen by a female doctor/health care practitioner who is informed about the female circumcision practiced in Somalia and who is conservative in the decision to perform cesarean section deliveries.     

Emergency department screening for syphilis in pregnant women without prenatal care

STUDY OBJECTIVE: To determine if there is a high seroprevalence of syphilis in pregnant women without prenatal care presenting to an urban emergency department. DESIGN: Prospective, nonblinded sampling of pregnant women without prenatal care with a comparison group of pregnant women with prenatal care from the obstetrics clinic. Patients in the ED setting were asked about such associated risk factors as previous syphilis and drug use. SETTING: Urban ED. TYPE OF PARTICIPANTS: Pregnant women without prenatal care. INTERVENTION: Patients were screened for syphilis using the automated reagin test. Reactive automated reagin tests were confirmed by the fluorescent treponemal antibody absorption. In addition, 44 patients with nonreactive automated reagin tests had confirmatory tests done. New cases were verified by the state health department. MEASUREMENTS AND MAIN RESULTS: Seventy-two patients were included in the study. The average age was 25 years. Eight patients (11.1%) were diagnosed with previously undetected syphilis. Four patients (5.6%) had previously treated syphilis. The laboratory cost of screening was $248 per new case of syphilis detected. The study group was compared with 118 patients matched for age and race who presented to the obstetrics clinic for routine prenatal care. Two new cases of syphilis were discovered in the clinic population (1.7%). CONCLUSION: A high rate of syphilis infection was detected in this inner-city ED population presenting without prenatal care. This was higher than that found in the patients presenting for obstetrics care in the clinic. Patients can be screened effectively in the ED.     

Family planning: an essential component of prenatal care

This nation's traditional approach to improving maternal and infant health has been prenatal care. But evidence is mounting that additional progress in reducing maternal and infant morbidity and mortality will depend, at least in part, on the care that a woman receives before she conceives. The studies reviewed in this paper indicate that increasing the interval between deliveries and preventing or delaying pregnancies among women at high risk could lower the rate of low birthweight (LBW). Since reducing the rate of unintended pregnancies would also reduce the number of pregnancies in women at high risk of LBW because of race, age, late or no prenatal care, and unhealthy behaviors, the prevention of unintended pregnancies would also reduce LBW. Unfortunately, prenatal care, as experienced by many women, devotes little attention to these family planning issues. Many women do not realize the importance of family planning to their own health and that of their children. Prenatal care providers should include instruction about the importance of pregnancy planning and encourage women to continue receiving health care between pregnancies. If the health of women and infants is to be improved, society must be willing to provide health services to women of reproductive age even when they are not pregnant.     

How economic demand influences access to medical care for rural Hispanic children

OBJECTIVES: In a study of access to medical care, the authors analyzed the relationship between factors influencing demand, local unmet needs, and the availability of physicians in a rural California community. METHODS: The California Department of Health Services screened 1,697 (90%) of children aged 1 to 12 years in McFarland, CA. The relation of demand to unmet needs was examined using multiple logistic regression. Factors influencing demand for medical care were: ability to pay (income, health insurance) desire to purchase care (ethnicity, education, perceived need), and incidental costs (transportation, child care, etc). Questions from the Hispanic Health and Nutrition Survey were reconstrued to fit the demand model. Local need and demand for physicians was compared with state levels to assess whether sufficient physicians were available. RESULTS: Eighty-six percent of the children were of Mexican ancestry. Factors influencing demand were linked with specific unmet needs. Although unmet needs were high, demand was low; 46% of all families were below the poverty level. Although four primary care physicians were needed, only one could be supported in the private sector because of low demand. CONCLUSIONS: Advantages to the demand model are: (1) it shows why medical services are underused and lacking in low-income areas although need is high, (2) it permits an economic rationale for extra services for poor diverse populations, (3) it estimates the amount of resources lacking to assure adequate levels of care, (4) it shows why facilitated access is needed for certain groups.     

Gender differences in satisfaction with primary care physicians in a managed care health plan

This study examines whether the formation of satisfaction with primary care physicians in a managed health care plan differs for men and women. Findings indicate that there are significant differences in the formation of satisfaction. For both men and women, the probability that an individual is satisfied is influenced by the type of plan enrolled in, number of problems experienced and beliefs about the quality of and access to benefits. Income and additional insurance coverage affects the probability of satisfaction for women only. Simulation analysis shows how satisfaction changes as individual characteristics and experience with managed care change.     

Social problems encountered during prenatal care in a Paris maternity ward]

Post-renal-transplantation bone disease is a well known entity. Immunosuppressive agents and persistence of hyperparathyroidism have primarily been implicated in its etiology. Renal transplantation patients are unique in that the bone changes occur on a background of pre-existing renal osteodystrophy. This review focuses on post-renal-transplantation bone disease. Unfortunately, the existing data in the review period, besides being scanty, provide conflicting information. This is due to the diversity of immunosuppressive regimens employed, the patient populations studied, diagnostic tools and criteria used by different centers, and the lack of formal trials.     

Recipient and provider perspectives of barriers to rural prenatal care

Barriers to prenatal care have been linked to inappropriate service usage and poor health outcomes of mothers and infants. This study describes barriers to prenatal care, as identified by low-income recipients and providers of prenatal care in a small rural county in the Midwest. A prospective survey design and focus group were used. An unexpected finding occurred. Almost half of the recipients identified no barriers to prenatal care; however, these women still received less than adequate prenatal care. Providers identified the attitudinal barrier of women as not valuing prenatal care, but the women did not. Some women were found to need information about availability and eligibility for Medicaid and other services. Issues surrounding prenatal care for rural women are complex and subtle. Community health nursing can inform and influence community leaders and members about prenatal care services for rural low-income women.