Biomedical subjects

L H Margolis

Publications and source records attributed to L H Margolis.

40 records · Page 3Linked to original sources

PubMedDate not supplied

Midwives, physicians, and the timing of maternal postpartum discharge.

Hospitalization for childbirth has traditionally provided the opportunity to assure that infants and mothers have adjusted to the birth and that ongoing care has been arranged, but economic and social pressures have resulted in a dramatic decrease in the duration of hospitalization. Using a sample of mothers who delivered well infants from the 1988 nationally representative National Maternal and Infant Health Survey, this study examines how midwives and physicians used an extra day of hospitalization in response to demographic, economic, behavioral, health status, and health care risk factors. Although midwives were much more likely to discharge mothers early (OR = 2.29) there were marked differences between risk factors and discharge timing for midwives and physicians. For the patients of midwives, the only factor associated with early discharge timing was attendance at childbirth classes. For the patients of physicians, less than a high school education, inadequate prenatal care, receipt of Medicaid or lack of insurance, and no childbirth classes were associated with early discharge. In spite of the intense pressures to discharge patients early, midwives appear to have been more attentive to potential risk factors in making discharge decisions in 1988. Because brief hospitalization is now prevalent, attention to maternal and newborn adjustment after birth, as apparently practiced by midwives, is crucial.

Adaptation, Physiological↗

PubMedDate not supplied

Risk status and pregnancy outcome among medicaid recipients.

Although Medicaid has increased access to medical care for low-income pregnant women, the Medicaid population remains at high risk for poor pregnancy outcomes. In 1983 the Michigan Department of Public Health conducted 1 week of in-hospital, postpartum interviews addressing risk factors for poor pregnancy outcome among 1,945 women. These births represented over 90% of the births during the study period and constituted a sample of approximately 1.5% of the yearly births in Michigan. Of these women, 24.6% reported receiving Medicaid during pregnancy. The demographic characteristics of the Medicaid women placed them at greater risk for poor pregnancy outcomes than either insured or uninsured women. In terms of medical services, Medicaid recipients began prenatal care later and had fewer visits. In terms of behavioral risks, more Medicaid recipients reported tobacco and alcohol use than did the other mothers. Finally, the infants of Medicaid recipients were 200 g lighter than the other infants. We suggest that the Medicaid program--the major source of prenatal health care for these women--is not adequate to address their risks for poor pregnancy outcomes.

Adolescent↗

PubMedDate not supplied

Validity of the Maternal and Child Health Services Block Grant as an indicator of state infant mortality reduction initiatives.

Since state Maternal and Child Health Services Block Grant applications represent the most comprehensive source of information about community and state needs assessment, policy development, and program assurance for the population of mothers and children, these documents have the potential to play a central role in state accountability to Congress and the Maternal and Child Health Bureau. To measure the validity of block grant applications as a reporting mechanism, we assessed the sensitivity of the applications from seven states to strategies for reducing infant mortality. We used the independent coding of infant mortality strategies from the Healthy Futures/Healthy Generations Program intensive evaluation as the standard. Overall, the sensitivity of the block grant applications was only 45%. Since the open-ended design of the block grant applications does not appear to reflect the extent of state activity in infant mortality reduction, a uniform application should be adopted that will facilitate clear and systematic reporting of state activities.

Child↗

PubMedDate not supplied

Characterizing state strategies to assure primary care for mothers and children.

To assure primary care for all mothers and children, state health officials concerned with maternal and child health must be able to identify and characterize strategies to meet that goal. Since each state's Maternal and Child Health (MCH) Services Block Grant application reflects plans for reaching primary care goals and objectives, we reviewed the 1992 MCH Services Block Grant applications from the eight states in the Southeast (Department of Health and Human Services Region 4) to identify state strategies to improve primary care. We identified two major sets of strategies. The first set was directed toward increasing the number of providers and facilities and accounted for 14% of state strategies. The second set was directed toward improving the quality of care and constituted 86% of state strategies. Of these strategies to improve the quality of care, efforts to enhance the content of care, expand outreach, improve coordination, and improve intake and referral accounted for 46%, 32%, 15%, and 7%, respectively. The review of strategies delineated in state MCH Services Block Grant applications may provide an efficient mechanism to monitor the development of primary care at the state level.

Child Health Services↗