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S M Horwitz

Publications and source records attributed to S M Horwitz.

17 recordsLinked to original sources
PubMed1992

Three-dimensional computed tomography studies of the tendons of the foot and ankle.

Three dimensional (3D) reconstruction techniques were applied to serial computed tomography scans of a cadaveric foot. Subsequent manipulations of the image data on a 3D imaging workstation facilitated differentiation of tendon from surrounding tissue. Through the use of free-rotation and density thresholding, detailed 3D images of the major tendons were produced and displayed. The value of the technique for education and its potential for diagnosis is discussed.

Ankle↗
PubMed1992

Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices.

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problems in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P less than or equal to .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

Misinformation about medications in rural Ghana.

Misuse of medications is a serious problem in developing countries where drug sales are not regulated. This study assessed drug knowledge and use in a rural Ghanaian town. We surveyed health care workers and a community population sample regarding knowledge and use of available drugs. Although drugs were used by a large percentage of the population, only a small percentage correctly described their recommended use. Doctors and medical assistants were knowledgeable in the correct use of drugs, while chemists were poorly informed. However, the majority of the non-health care worker (NHCW) population bought drugs from chemists without a prescription. We conclude that in this rural setting, chemists contributed to drug misuse by providing misinformation about drugs and selling drugs according to popular demand. Educational programs for chemists and the population regarding drug use and regulation of drug sales by chemists will be critical to drug reform in Ghana.

Adult↗
PubMed1991

School-age mothers: predictors of long-term educational and economic outcomes.

The long-term effects of school-age pregnancy were investigated in a 20-year follow-up of a cohort of women who were pregnant adolescents in the late 1960s. Of the 149 living young black primiparas in the original cohort, 121 (81%) were located and interviewed. At follow-up the study population ranged in age from 32 to 38 years, 68% were unmarried, 71% had finished high school, 82% were completely self-supporting, and 27% reported living in public housing. Long-term success, defined as currently employed or supported by a spouse and a high school education (62%) or its equivalent, was associated with six features: having completed more school prior to becoming pregnant (odds ratio [OR] = 18; 95% confidence interval [CI] 2.3, 139.5); participating more actively in a program intervention offered to these pregnant teenagers 20 years ago (OR = 11.11; 95% CI 1.54, 79.87); being in school with no subsequent pregnancy at 26 months postpartum (OR = 10.1; 95% CI 1.64, 62.07); feeling in control of one's life (OR = 5.4; 95% CI 1.36, 21.54) and little social isolation (OR = 8.24; 95% CI 1.56, 43.50) at 26 months postpartum; and lifetime fertility control defined as one or two children after the index child (OR = 14.19; 95% CI 3.28, 61.29). It is concluded that most former teenage mothers complete a reasonable amount of education and are economically self-sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Treatment adherence and risk of death after a myocardial infarction.

The relation of treatment adherence to mortality after a myocardial infarction was investigated among 2175 participants in the Beta Blocker Heart Attack Trial, which had data for measures of treatment adherence, clinical severity, and the psychological and social features that may influence post-infarction mortality. Overall, patients who did not adhere well to treatment regimen (ie, who took less than or equal to 75% of prescribed medication) were 2.6 times more likely than good adherers to die within a year of follow-up (95% confidence interval, 1.2, 5.6). Poor adherers had an increased risk of death whether they were on propranolol (OR = 3.1) or placebo (OR = 2.5). Furthermore, this increased risk of death for poor adherers was not accounted for by measures of the severity of myocardial infarction, sociodemographic features (eg, race, marital status, education), smoking, or psychological characteristics (high life-stress or social isolation).

Adult↗
PubMed1990

Health maintenance organizations vs indemnity insurance for children with chronic illness. Trading gaps in coverage.

There has been increasing discussion about the potential of health maintenance organizations to provide improved access to and coordination of care for children with complex conditions. This study compares benefits for a sample of health maintenance organizations and traditional indemnity insurers in Connecticut. We conclude that in Connecticut neither health maintenance organizations nor traditional indemnity insurers currently offer comprehensive systems of care to these children. Health maintenance organizations offer preventive care and are easier systems to access. However, for children with chronic conditions, health maintenance organizations have some problematic restrictions, including a lag between start of employment and activation of health care benefits. Both health maintenance organizations and traditional indemnity insurers tend to have restrictions for specific services needed by children with chronic illnesses, such as medical equipment and mental health services. Case managers in both systems tend to control expenditures rather than to coordinate care. Representatives of both systems predict additional restrictions in the future. Our data suggest the need for more extensive evaluation of the generalizability of these findings.

Child↗
PubMed1988

Determinants of pediatric injuries.

Injuries are an important health issue for children. Previous research, however, has presented confusing and conflicting results on the determinants of childhood injuries, particularly psychosocial predictors, largely due to methodologic problems. The purpose of this analysis, based on a prospective follow-up study of 532 children, was to identify factors related to injuries encountered in a prepaid group practice during a 12-month period. Using logistic regression, we found four factors independently associated with the risk of at least one treated injury: high activity level, high rate of pediatric utilization for non-injury-related visits during the follow-up period, occurrence of a treated injury during the year preceding the follow-up period, and negative attitude toward medical care providers by the child's mother. In addition, four factors were found to be independent predictors of injuries judged severe enough to always warrant medical care: occurrence of a treated injury in the preceding year, high rate of pediatric utilization for non-injury-related visits during the follow-up period, working more than 15 hours a week outside the home by the child's mother, and more life events reported by the mother for the year preceding the follow-up period. Since family stressors are related specifically to the risk of more severe injuries, which are unlikely to escape medical attention, we conclude that these factors probably are related to the occurrence of common injuries of early childhood and not exclusively to utilization behavior. We therefore suggest that children from families with these characteristics be targeted for injury prevention strategies.

Attitude↗
PubMed1988

Factors affecting pediatric preventive care utilization in a prepaid group practice.

Previous research on the utilization of pediatric preventive care has shown that certain sociodemographic factors, such as age, birth order, family size and race, as well as health attitudes and beliefs are related to the use of well-child services. To examine the simultaneous effects of sociodemographic, psychosocial and behavioral factors, we conducted a 16-month prospective investigation of 532 children belonging to a university-affiliated prepaired group practice. The children were under 5 years of age upon enrollment and came predominantly from white, middle-class families with well-educated parents. Our bivariable results showed that 13 factors were related to preventive care utilization (p less than 0.05) and, in effect, confirmed findings from previous investigations. However, using model-fitting procedures, we found that only two variables, child's age and birth order, significantly predicted the rate of preventive care visits; a high utilization rate was observed for younger children and for first-born children. Since the observed age-specific rates of preventive care utilization were nearly identical to the schedule recommended by the pediatricians in this practice, we believe that most of the variability in well-child care in our population was due to provider-induced demand. Furthermore, none of the other demographic or psychosocial factors that significantly predicted acute care utilization in this population had any effect on preventive care once age and birth order were accounted for.

Birth Order↗
PubMed1988

A simple index to estimate the likelihood of bacterial infection in patients developing fever after abdominal surgery.

To identify predictors of bacterial infection in patients developing postoperative fever, we prospectively studied 434 adults who underwent abdominal surgery. Of the 434 study patients, 163 (38%) developed postoperative fever (38.1 degrees C [100.6 degrees F] or greater) and 26 (16%) of the febrile patients were found to have bacterial infection. Logistic-regression analysis showed that postoperative infection was associated with a WBC count of less than 5000 or greater than 10,000/mm3, a BUN of 15 mg/dl or greater, and fever onset after the second postoperative day. A predictive index, constructed from these three features, created a useful gradient for estimating the likelihood of postoperative infection. In patients with zero, one, two or three of the index features, the proportions having infection were 2 per cent (1/50), 14 per cent (12/88), 45 per cent (10/22), and 100 per cent (3/3), respectively (P less than 0.0001). This simple index, which uses readily available clinical data, may help reduce the cost of postoperative care by identifying patients with a low probability of infection in whom cultures, imaging studies, and empirical antibiotics do not appear necessary. Thorough diagnostic evaluation in patients with two or more index features may also reduce delay in the detection and treatment of postoperative infection. The predictive value of this index should be validated in a new patient set, however, before widespread application of the index is warranted.

Abdomen↗
PubMed1987

A simple index to identify occult bacterial infection in adults with acute unexplained fever.

Patients with acute fever (less than three weeks' duration) and no localizing symptoms or physical findings to suggest a source (unexplained fever) may have self-limited illness or occult bacterial infection requiring prompt treatment. To develop a management strategy for patients with unexplained fever, we studied 880 adults who were evaluated for acute fever in an emergency room. At presentation, 135 (15%) patients had unexplained fever. Occult bacterial infection was found in 48 (35%) of these 135 patients, and 21 (44%) of 48 infected patients had bacteremia. Four bacteremic patients were incorrectly discharged from the emergency room without antimicrobial therapy. Neither a "toxic" appearance of the patient nor an initial temperature of greater than or equal to 39.4 degrees C (103 degrees F) were predictive of occult bacterial infection. An index of predictive features was developed that included: age 50 years or older; diabetes mellitus; a white blood cell count greater than or equal to 15,000/mm3 (15 X 10(9)/L); a neutrophil band cell count greater than or equal to 1500/mm3 (1.5 X 10(9)/L); and a Wintrobe erythrocyte sedimentation rate greater than or equal to 30 mm/h. In patients with 0, 1, 2, or 3 or more index features present, the proportions having occult bacterial infection were 5% (1/21), 33% (15/45), 39% (15/38), and 55% (17/31), respectively. All four bacteremic patients incorrectly discharged had two or more of the index features. Adults presenting with acute unexplained fever often have life-threatening bacterial infection. A simple clinical index can be used to estimate the likelihood of occult infection and may reduce the frequency of diagnostic error.

Acute Disease↗
PubMed1985

The use of pediatric medical care: a critical review.

The problems of who uses medical services and why, are important ones for investigators interested in studying chronic diseases, particularly if they wish to avoid systematic error when assembling a study population. These issues are important when studying pediatric diseases due to the uneven use of medical services by children and the tendency of lower socioeconomic groups to use hospital facilities rather than private practitioners. In order to address these problems, we must understand why families seek medical care for young children. Utilization research shows that a number of descriptive factors such as child's age, birth order, parental education, financial resources and perceived symptoms are related to service use. Additionally, psychosocial variables, such as distress, also predict utilization. Neither the descriptive nor psychosocial variables explain much of the variance in utilization. While some of this lack of explanatory power can be attributed to problems in measurement or study design, there are also conceptual and methodological issues that are not addressed in pediatric utilization research. This paper discusses four of these issues. It is our conclusion that two of these problems, the need for a new utilization taxonomy and the ambiguity of cause and effect, can be remedied. While more difficult to address, the inadequate conceptualization of social stress, psychological distress, and social support can be improved. However, measuring health status independently of utilization represents a major methodologic problem for which we currently have no ideal solution.

Birth Order↗
PubMed1985

The impact of social stressors and social networks on pediatric medical care use.

Substantial differences in the use of pediatric medical resources reinforce the need for identifying and understanding factors that influence the use of medical services for children. This research assesses the simultaneous impact of sociodemographic characteristics, health attitudes and beliefs, psychologic distress, social stressors, and social networks on the use of pediatric acute care services during a 12-month period. Using a prospective longitudinal study design, data were obtained on 513 children and their families enrolled in a prepaid group practice. Linear modeling results showed that health attitudes and social networks were important predictors of acute care utilization in addition to child's age, birth order, baseline health status, and ethnic group. The authors were able to show significant effects for network size, dispersion, and tendency to use one's network members. Individuals with large nondispersed networks are more likely to use pediatric health services, apparently due to the transmission of the networks' pro-medical care health beliefs. Also the tendency to call on network members modifies an individual's propensity to seek care for minor pediatric medical problems and can make a difference by as much as 1.6 visits per year per child for acute care episodes.

Adolescent↗
PubMedDate not supplied

Intergenerational transmission of school-age parenthood.

A long-term follow-up of a group of black New Haven women who were young mothers in the late 1960s revealed that the majority of their offspring had not become parents by age 19. The offspring who experienced early parenthood were most likely to be female and to report significant depressive symptoms. Of those children--both male and female--who did become young parents, many were the offspring of women who had moved out of their mothers' homes within 26 months of the child's birth, and of women who reported suffering from lifetime depression. The data indicate that emotional deprivation, particularly at an early age, may predispose adolescents to seek emotional closeness through sexual activity and early parenthood.

Adolescent↗
PubMedDate not supplied

A prospective study of medical care utilization and morbidity in preschool children belonging to a prepaid group practice: background and methods.

The purpose of this paper is to describe the background and methods of a prospective study of medical care utilization and morbidity in a fixed cohort of over 500 preschool children whose families belonged to a prepaid group practice affiliated with Yale University. Following baseline interviews with their mothers, study children were followed for 12 months between 1981 and 1982. Information concerning the subjects' contacts with the health care facility serving members of the group practice was collected from accompanying adults, attending clinicians, and medical records. Using these data, we were able to identify episodes of care, linking all clinical visits and phone calls for single occurrences of an illness or injury. The major aim of the study is to identify psychosocial determinants of pediatric utilization (for both acute and preventive care) and of childhood morbidity. The possible predictors of principal interest are factors associated with the family environment, such as social stress and strain, family structure, and different aspects of the mother's social network. The dual emphasis on both illness and behavior outcomes is based on the important interrelationship between epidemiologic and health services research, especially when examining psychosocial effects.

Attitude to Health↗