Survival of nurse-managed centers: the importance of cost analysis.

Despite the explosive growth in nurse-managed centers (NMC) in the past 20 years, most have been unable to achieve financial self-sufficiency, and many have closed. Combining costing techniques with outcome measures provides essential information needed by NMC for making operating decisions and for marketing NMC performance. These outcome data can be persuasive to policy makers and institutional decision makers and are crucial for NMC to improve their competitiveness in the health care market place.

Women's efforts to prevent pregnancy: consistency of oral contraceptive use.

CONTEXT: An understanding of determinants of inconsistent pill-taking could be useful to service providers who are trying to help women prevent unwanted pregnancy. This article explores the predictors of inconsistent use in a nationally representative sample of U.S. women aged 15-44. METHODS: Data on 1,485 pill users participating in the 1995 National Survey of Family Growth are used to describe users' characteristics, and logistic regression analyses are conducted to identify factors that predict inconsistent use (defined as missing two or more pills in a three-month period) among both users of the pill only and dual method users. RESULTS: While 85% of pill users rely solely on the pill, 15% also use another method. Overall, 16% of users are inconsistent in their pill-taking (16% of those using the pill alone and 20% of dual method users). Among users of the pill only, Hispanic and non-Hispanic black women have a significantly increased likelihood of inconsistent use (odds ratios, 2.5 and 2.1, respectively), as do those who recently began use (2.7) and those who have had an unintended pregnancy (1.6). For dual method users, the odds are significantly elevated among women whose income is less than 250% of the federal poverty level (4.3) and among new users (4.5). CONCLUSION: Service providers may need to better address consistency of pill-taking among women who have characteristics associated with inconsistent use.

Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives.

OBJECTIVE: To determine whether pregnancy outcomes differ by provider group when alternative explanations are taken into account. METHODS: Pregnancy outcomes were compared for 710 women cared for by private obstetricians and 471 cared for by certified nurse-midwives. At intake, all women qualified for nurse-midwifery care. They were retained in their original group for analysis, even if they were later referred to physicians. Infant and maternal mortality, 30 clinical indicators, satisfaction with care, and monetary charges were studied. The study site's history and philosophy of honoring consumer choice of provider precluded random assignment, but multivariate analyses minimized the effects of multiple confounding factors. The statistical power was adequate for the study design. RESULTS: Significant differences (P < .05) between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: infant abrasions (7 versus 4%), infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care, average hospital charges ($5427 versus $4296), and average professional fee charges ($3425 versus $3237). When maternal risk, selection bias, and the medical intensiveness of care were controlled, the provider group did not continue to have an independent effect on infant abrasions, hemorrhage, and professional fee charges; when women's preferences were added, the difference in hospital charges disappeared. However, the provider group continued to have significant independent effects on the other four outcomes. Interaction effects were not significant. CONCLUSION: Although most outcomes were equally good, important differences between obstetrician and nurse-midwife care remained after multivariate analysis.

Public health nurses and family planning.

Unintended pregnancy is a health problem that is particularly important in the practice of public health nurses (PHNs). Data from 844 PHNs showed that they were likely to practice in settings that incorporate family planning services and were knowledgeable about specific family planning methods. They favored family planning services and an expanded supportive government role in both family planning and abortion. Since PHNs are an important resource for the community activism required to build the consensus needed to expand these services, a multiple-regression analysis was performed to determine predictors of activism. Political participation was the major predictor for activism on both family planning and abortion.

A practical guide to political effectiveness. The case of federal funding for nursing research.

The future viability of nursing research depends on federal funding decisions, which in turn depend upon national and local action by researchers and other advocates of nursing research. Since successful action is facilitated by familiarity with national policy-making, the legislative process is reviewed and a plan for action at the state and local level is offered. Basic actions are suggested to organize, arouse public support, build coalitions, and gain access to legislators. All these must follow a developed work plan. Ideas for specific implementing steps are provided, but each local area requires specially designed activities appropriate for their own needs and resources. The goal is to build a grass roots system to support national lobbying to stabilize and increase federal funding for nursing research.

Birth planning propaganda, incentives and peer pressure.

PIP: Family planning policies are promoted at every level of Chinese society through the 3 concepts: lateness in marriage and childbirth, spacing of children, and reduction in family size (late, long, and few). The minimum legal age for girls to marry is 18, for boys, 20, but marriage is discouraged until ages 23 and 25. The Chinese put free family planning services within the reach of every eligible couple. An equally great effort is put into the acceptance and use of the services. Propaganda is pervasive, and peer pressure at the community level is intense. Individual and group sessions effect sanctions against noncompliance. Generous paid leaves are the incentives for sterilization and abortion. Community involvement in birth control has evolved to the point where annual birth quotas are established and allotted among couples. To some visitors these methods are highly coercive, a serious invasion of privacy. The 1-child family is being publicized and promoted with a generous incentive program which pays 5 yuan a month as child-care subsidy until the child is 14 years old. Living space will be given the 1-child family on a preferential basis. When 1-child couples retire they will be entitled to a monthly pension for as long as they live. The pension amounts to 80% or higher of their monthly wage at the time of retirement. Childless couples will receive 100% of their wages.^ieng

Revolutionary social changes.

PIP: This is a composite article made up of statements by Americans who have visited China in the last 2 years. Observers note great social changes and great economic progress in the country. Fertility behavior has also changed as part of the larger socioeconomic development taking place. Although China is still a poor country, most Chinese families are experiencing improvements in health, education, and general living standards. These changes combined with the new equity in Chinese society provide the hope to families that their children will survive to adulthood and prosper as result of new educational and employment opportunities. There has been recent emphasis on equality between the sexes in China which has accomplished as much as any other single social change in reducing fertility levels. Girl children are as important to families as boys. Women are needed in the work force. Therefore, family limitation is encouraged and day care facilities are provided for working women. All the observers mentioned the improved status of women in the country.^ieng