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Biomedical subjects

L H Margolis

Publications and source records attributed to L H Margolis.

At least 19 recordsLinked to original sources
PubMed1994

An analysis of the costs and benefits of two strategies to decrease length of stay in children's psychiatric hospitals.

OBJECTIVE: We analyze the costs and benefits of two strategies-intensive home-based services and increased remuneration for providers of community-based placements--to decrease excessive length of stay in a children's psychiatric hospital. DATA SOURCES AND STUDY SETTING: Clinical, demographic, and financial data were collected retrospectively on all children discharged during 1987 through 1989 from the state children's psychiatric hospital that serves Wayne County, Michigan. Characteristics of the discharged children were similar to those reported in other studies of intensive home-based services. STUDY DESIGN: A sample of 22 children was used for a simulation analysis. Excessive length of stay was defined as the duration of hospitalization after readiness for discharge and associated planning were indicated in the record. For the simulated analysis of the intensive home-based program, costs included estimated charges for the program and charges for the children hospitalized due to failure of the intervention. For analysis of the increased remuneration strategy, costs included charges for the out-of-home placement and charges for hospitalization. For both strategies benefits were defined as averted hospitalization charges. DATA COLLECTION/EXTRACTION METHODS: Charts of the discharged children were reviewed and 21 clinical, demographic, and financial variables were extracted. PRINCIPAL FINDINGS: Analysis of costs and benefits of intensive home-based services produced a favorable cost-benefit ratio of .47. Analysis of the strategy to increase remuneration for providers of community-based placements resulted in a cost-benefit ratio of 1, indicating no financial savings. CONCLUSIONS: Intensive home-based services represent an efficient strategy to decrease excessive length of stay for children in psychiatric hospitals by averting hospitalization altogether. Although increased remuneration to providers of community-based placements in order to increase the supply of placements as a means to hasten discharge from the hospital has a neutral cost-benefit ratio, the opportunity to provide care in the "least restrictive" environment argues in its favor as well.

Child↗
PubMed1994

The relationship between needs assessments and state strategies for meeting healthy people 2000 objectives: lessons from the Maternal and Child Health Services Block Grant.

Recognizing the critical role of needs assessments in the development of public health policy, the Omnibus Budget Reconciliation Act of 1989 required states to include needs assessments in their Maternal and Child Health Services Block Grant applications and to demonstrate a link between needs and programs. We examined this link by analyzing the relationship between strategies to meet health objectives and needs assessments in the applications for fiscal year 1992 for the eight states in the southeast (DHHS Region 4). Overall, the proportion of strategies based on reported needs was 88%. Numerous other needs, however, were not related to any strategies. Furthermore, there were neither needs nor strategies described for many objectives. These data required extensive analysis of the applications. A uniform structured report would facilitate the explicit collection of this information and thus the usefulness of this important document for policy development and accountability.

Child↗
PubMed1992

Use and misuse of automobile child restraint devices.

OBJECTIVE: To determine demographic, social, and behavioral characteristics that are associated with correct child restraint device (CRD) use. DESIGN: Cross-sectional. SETTING: Fast-food restaurant parking lots in southeastern Michigan. PARTICIPANTS: Children younger than age 4 years and their drivers. SELECTION PROCEDURES: Consecutive sample. INTERVENTION: None. MEASUREMENTS/MAIN RESULTS: Seven hundred seventeen child passengers were observed for 11 dimensions of CRD use and 661 of their drivers were interviewed. Three hundred ninety-four (55%) of the children were in CRDs, but 248 (63%) of those children were incorrectly restrained. A 43-point misuse index was constructed based on scores assigned for different types of misuse. Seven variables (ie, age of child, race of parent, driver as a parent, days driving, number of occupants, perceived comfort of CRDs, and belief that the social norm supports CRD use) were highly predictive of CRD use. In contrast, only three factors (ie, age of child, education of the driver, and knowledge of the CRD law) were minimally predictive of correct use. CONCLUSIONS: Since correct use of CRDs represents such a complex behavior, the best strategy to address the widespread problem of CRD use may be through the design of less complicated CRDs.

Age Factors↗
PubMed1991

The ethics of accepting gifts from pharmaceutical companies.

How physicians respond to the promotional activities of the pharmaceutical industry is the subject of ongoing debate and controversy. This paper postulates that the acceptance of gifts in virtually any form violates fundamental duties of the physician of nonmaleficence, fidelity, justice, and self-improvement. The medical community must articulate this position clearly, and it should act accordingly.

Beneficence↗
PubMed1990

Effects of a mandatory safety belt law on hospital admissions.

Although the effectiveness of automobile safety belts in reducing risk of serious injury in traffic crashes is well documented, safety belt use in many U.S. jurisdictions remains low. Michigan's mandatory safety belt law for front-seat occupants, implemented in July 1985, is one of 34 similar laws in the United States intended to increase belt use and reduce crash-related injuries. Using time-series intervention analyses of data from 14 hospitals throughout the state, we found a 19% reduction in the rate of admitted patients for all automobile occupant injuries and a 20% reduction in the rate of admitted patients with extremity injuries following implementation of the safety belt law. The utility of hospital data for the evaluation of interventions like the safety belt law reinforce the importance of consistently recording E-codes for all injury patients.

Accidents, Traffic↗
PubMed1989

Barriers to implementation of a prenatal care program for low income women.

By the middle of the second year of the Michigan Prenatal/Postpartum Care (PPC) program to provide pregnancy-related services to low income women who were ineligible for Medicaid or other insurance, only 25 per cent of the participating health departments were enrolling greater than 90 per cent of contracted potential clients. Using a survey of program directors and relevant state documents, we identified several barriers to successful implementation: institutional (program complexity, high levels of administrative concerns along with low levels of communication between local health departments and providers); economic (inadequate resources for provider reimbursement, outreach, transportation, high-risk pregnancies, or administrative overhead); psychological (servicing populations with multiple and hard to care for problems, potential discomfort of low income women with traditional providers); and informational (insufficient information about the program infiltrating the target community).

Female↗
PubMed1988

The effects of a mandatory child restraint law on injuries requiring hospitalization.

Using data on all inpatients in 16 Michigan hospitals from 1980 through 1985, the clinical effects of a mandatory child restraint law were examined. Time-series analytic techniques revealed a 36% decline in hospitalization for all injuries, with a 25% decline for head injuries, and a 20% decline for extremity injuries for children younger than 4 years. In addition, length of stay declined for children hospitalized secondary to motor vehicle crashes. This study confirms the effectiveness of the child restraint law in Michigan, previously demonstrated by analyses of police records. Current hospital databases may be able to serve as one component for the implementation of comprehensive injury surveillance systems.

Accidents, Traffic↗
PubMed1988

Characteristics of child safety seat users.

Direct observation of child restraint use was combined with interviews and mail questionnaires to measure prevalence of various child restraint practices and factors related to use of child safety seats and seat belts for children under the age of four. Trained observers assessed multiple dimensions of child restraint practices for a sample of motorists entering fast-food parking lots in Michigan. On-site interviews and follow-up questionnaires measured sociodemographic, attitudinal, belief, and behavioral characteristics related to restraint use. Ninety-two percent of infants under age 1 and 55% of children age 1 to 3 were traveling in a child safety seat. Public support for the mandatory child restraint law was very high--9 out of 10 believed it should be strictly enforced. Child restraint use was lower than average among motorists who: (1) had low family incomes, (2) were not currently married, (3) were of nonwhite ethnic backgrounds, and (4) were over the age of 40. A shift in social norms appears to have occurred in recent years, such that restraint of young children traveling in cars is now socially expected behavior. Recommendations include: (1) continuing educational efforts to increase knowledge of mandatory child restraint use laws, and (2) increased enforcement of mandatory child restraint use laws.

Accidents, Traffic↗
PubMed1988

Is the early and periodic screening, diagnosis, and treatment program effective with developmentally disabled children?

The effectiveness of the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) in identifying health and developmental problems and facilitating diagnosis, treatment, and follow-up for a sample of Michigan children with moderate and severe developmental disabilities was studied. Three data sets, derived from parent reports and Medicaid records concerning 281 Medicaid-eligible, young developmentally disabled children from nine representative counties in the state were studied. Approximately 56% of these children had used EPSDT, and 44% had not. Findings from the first data base, a parent questionnaire, indicated no differences between the two groups in terms of age at diagnosis, access to routine or specialized health care, or reasons for inability to obtain needed care. The second database, the screening summaries from the EPSDT sites, contained reports on 108 children. Many of the required procedures were not performed on these children. The final data set, the Medicaid claims records, was used to assess whether appropriate medical follow-up occurred in response to the screening encounter. Only 62% of the screenings with a referral had a Medicaid visit within 1 year of screening and only half of the referrals that resulted in a follow-up visit had a diagnosis that confirmed the reason for referral. Recommendations for improving the health and developmental screening of disabled children are presented and the policy implications of these findings are discussed.

Child↗
PubMed1986

Children in alcohol-related motor vehicle crashes.

Review of North Carolina traffic crash data revealed that alcohol use, although associated with 7.9% of motor vehicle crashes involving children, accounted for 15.4% of the motor vehicle-related deaths and 10.4% of the injuries. The largest proportion of these deaths were child passengers in a vehicle in which the driver had been drinking, followed by child passengers in multiple-vehicle crashes in which the other driver had been drinking. The smallest proportion of deaths were child pedestrians. These findings suggest that, in addition to supporting more stringent alcohol control legislation, health care providers should be admonishing parents about the deadly hazards of drinking and driving to the children in their care.

Accident Prevention↗
PubMed1985

Childhood injuries in North Carolina: a statewide analysis of hospitalizations and deaths.

We report the nature and causes of childhood injuries leading to hospitalization or death in North Carolina. Based on an 89 per cent sample of 1980 hospital discharges of children between 0 and 19 years of age, the overall annual rate of trauma-related hospitalizations was 80 per 10,000. The rate varied from 119 per 10,000 for the 15-19 year age group to 56 per 10,000 for children between ages 5 and 9. Hospitalization rates are lower than those reported elsewhere, although death rates, based on a seven-year period, are higher in the data reported here. Potential reasons for these differences are suggested.

Adolescent↗
PubMed1983

Type A behavior: an ecological approach.

The recognized association between Type A behavior and coronary heart disease has prompted efforts to alter the behavior's deleterious components in both individuals who have experienced myocardial infarction and those who are at risk for that disease. Utilizing concepts from psychology, sociology, history, and other disciplines and material from scholarly and popular literature, this paper suggests that instead of singularly concentrating on components at the level of the individual, it is important to view Type A behavior from an ecological perspective, with attention directed at the interpersonal, institutional, and cultural environments of individuals. This perspective will enhance understanding of Type A behavior and possibly stimulate interventions at the primary as well as secondary and tertiary prevention levels.

Achievement↗
PubMed1983

Accidental policy: an analysis of the problem of unintended injuries of childhood.

The problem of childhood injury is examined from an ecological, public health perspective, and a range of preventive and ameliorative strategies is considered. Three policy evaluation criteria--efficiency, freedom of choice, and equity--are discussed. A framework is proposed, and examples given, to assist professionals concerned with mental health and with child health and development in critically analyzing policy options.

Accident Prevention↗