A controlled study of health education in accident prevention: the Rockland County Child Injury Project. 1966.

The Rockland County Child Injury Prevention Project was designed to test the effects of public health education for parents on the incidence of accidental injuries to children under 7 years of age in a controlled situation. The incidence of accidental injuries, defined as any actual or presumed trauma following an accident for which medical or dental attention was obtained, was determined in a study population before, during, and after exposure to the educational program and in a comparable control group during a corresponding period of time. The study group was exposed to an intensive education program involving neighborhood discussion groups conducted by lay and professional leaders, meetings with organized groups, and a monthly newsletter. The study population was organized into small neighborhood units of about 24 homes within the suburban housing developments. To measure the effect of the education program, accident rates were computed for each three month reporting period, projected on an annual basis. No consistent differences were discernible in the trends in the accident rates between the study and control groups during the three years of the project. On the contrary, the curve for the study group crossed that of the control group on no less than five occasions. There was a sharp decline in accidents during the second half of the education phase. Any conclusions regarding a positive effect of the education program proved untenable in the light of the sharp and disproportionate increase in the accident rate in the study group during the six month phase after education had stopped. After what appeared to be a contrary trend earlier, developments during this period demonstrated vividly the need to continue reporting for a sufficient time in a controlled situation to be sure that fortuitous changes over short periods do not lead to unwarrented conclusion. The flow of reports from hospitals was more consistent than from physicians. This suggested that, in selected control studies, adequate rates for comparative purposes might have been obtained entirely from hospital records.

Medically attended injuries among young children: observations in a suburban area. 1964.

A control study of the effect of public health education on the rate of accidental injuries among children under 7 years of age in a newly developing suburban area provided an opportunity to gain an insight into the nature and extent of the accident problem itself during a one year baseline period preceding the educational phase of the study. An accident was arbitrarily defined as any actual or presumed trauma following an incident for which direct medical or dental attention was obtained. Data were gathered through regular visits of data collectors to physicians, dentists, and hospitals in the area. An annual accident rate of 124 per 1000 children under 7 years of age was found. Two or more accident occurred to 10% of the children. The highest injury rate by age (179 per 1000 children) was found among 2 year old children, with the rate amount 2 year old boys 75% higher than any other age-sex group. The possible relationships of suburban living to the type and location of accidents by age and sex and to the variation in accidents by day of week are also presented.

The significance of genetic contributions and markers in disorders of spinal structure.

Clinical evidence suggests that a moiety of patients with low back syndrome refractory to conventional treatment may embody a pleiotropic expression of Marfan-like pathology of support tissue. Individuals in the suspect group display a triad of clinical findings including refractory low back syndrome, certain dural ectasias, and a susceptibility to protracted reactions after lumbar puncture. Certain stigmata found in these patients and their families are among those commonly seen in Marfan's disease. The concept, if valid, has important implications affecting therapeutic choices and may offer insights into unexplained failures. The finding of significant family involvement strengthens the possibility of a heritable substratum for this category of low back disease.

The posthospital needs and care of patients: implications for discharge planning.

Sixty-nine patients hospitalized for a serious illness and discharged to their own or relative's homes were followed up to learn about patient's posthospital needs; sources of help they received and how well they met these needs; and the extent to which hospital social work targets these needs in the discharge planning process. The patients, who were mostly elderly, had substantial needs for care. The family was the major care provider. Although service provision was limited, the social worker had a pivotal role in linking the patient to community services. This exploratory study points to gaps in the hospital screening and discharge planning process.

Profits under pressure. The economic performance of investor-owned and nonprofit health maintenance organizations.

This study assesses the economic performance of investor-owned and private nonprofit health maintenance organizations by comparing their costs and revenues, controlling for other characteristics of the plans and the areas in which they are located. Data are drawn from a sample of 173 HMOs operating in 1983, one quarter under proprietary auspices. For-profit plans have average costs 10% higher than their nonprofit counterparts, primarily due to higher expenses for ambulatory care. Average revenues are also higher in investor-owned HMOs, although this difference is one third the size of the estimated difference in costs. The paper concludes with a discussion of the implications of these findings for both the future performance of the HMO industry and public policy affecting prepaid health care.

Social work screening in New Jersey hospitals: progress, problems, and implications.

The essential components of a viable high-risk screening system are identified in this report of a study of social work screening in New Jersey's acute-care hospitals. Although almost every hospital was found to use some form of screening, the most commonly used screening criteria tended to focus narrowly on identifying patients likely to have prolonged hospitalizations. The implications of these and other findings are discussed.

Surviving DRG's: New Jersey's social work experience with prospective payments.

This is a report of a study which examined the impact of New Jersey's four-year experience with all-payer DRG's upon 82 hospital social work departments as these were reported by their directors. Although DRG's have made discharge planning, and thus social work, central to hospitals' financial health, departments have faced increased caseloads and some refocus of staff deployment, not always with compensatory increases in staff. Strategies to survive the cost-containment policies and other implications are noted.

Selected Jewish views of life and medical practice.

PIP: This article discusses some basic tenets of Judaism as they apply to 3 health care delivery issues: death, abortion, and triage. The most pervasive value in Judaism is the utter sanctity of life and an obligation to prevent disease. Orthodox Jewish thought requires the following criteria and standards of death: unresponsive coma, absence of spontaneous respiration and movement, absence of reflexes, absence of pupillary response to light, absence of oculocephalic response, substance screening, and radioisotope angiography to differentiate true brain death from other causes. General endorsement of euthanasia is rejected, but, in cases where these criteria have been met, further medical support systems can be discontinued. Jewish law generally prohibits abortion, except in cases where pregnancy poses a threat to the woman's life. However, those from the conservative denomination accept abortion in cases where there is a probability of severe physical deformities or profound retardation. Those from the reform movement recognize psychological factors as being as important as physical factors in the determination of the appropriateness of abortion; moreover, they stress that the decision regarding abortion should rest with the pregnant woman and her family. Triage, the allocation of health care on the basis of priority, is generally rejected in favor of serving people on a first-need basis.^ieng

Hospital social work roles and decision making.

A comparison of selected New Jersey hospitals in 1975 and 1981 suggests that despite intensive attention to cost control, hospital social work departments have continued to expand and assume an increasingly important role in the hospital. The departments have sustained or enhanced their position with respect to the professionalization of the department, staff size, involvement in patient care, and participation in hospital decision-making. Losses were observed in such areas as hours of coverage and services to discharged patients.

Hydromyelia: clinical presentation and comparison of modalities of treatment.

The clinical and radiographic features of 60 cases of hydromyelia area discussed. A combination of motor and sensory symptoms and signs is the usual presentation, but pure motor or sensory forms of the disease are not infrequent. Pain and scoliosis are usually associated with a high degree of blockage. A normal spinal fluid protein content in the presence of an enlarged spinal cord is of diagnostic value. Important radiographic clues include widening of the spinal cord without venous stagnation and collapse of the spinal cord visualized with the patient in the upright position. Metrizamide computed tomography is now used routinely, and the contrast agent may at times appear in the dilated central spinal canal. Decompression of the foramen magnum is the treatment of choice in the presence of an associated Arnold-Chiari malformation and is the treatment most likely to succeed. In selected cases, decompressive laminectomy and syringostomy may be indicated. Percutaneous spinal cord puncture is a safe diagnostic-therapeutic procedure which, surprisingly, may afford relief equal to that of more drastic measures. Therefore, percutaneous spinal cord puncture may be an option of therapeutic value in a disorder that is frustrating to treat.

Cerebellar metastasis from ovarian carcinoma.

The most common sources of metastatic disease of the brain are lung and breast carcinoma. Considerably less common are metastases from malignant melanoma, hypernephroma, and carcinomas of the alimentary tract. All other sources are rare. This report presents a unusual case of a single cerebellar metastatic lesion from ovarian carcinoma.

Social work roles in health care: an educational framework.

Changes in demography, technology, and values have created new health problems and increased the number of people whose needs for service are extensive and complex. The authors describe an educational design intended to prepare social work students for the complicated new roles evolving for workers in health care.