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OBJECTIVES: We sought to determine how risk factors for disease vary among Asian subgroups. METHODS: Using data from a case-control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors. RESULTS: Chinese and Japanese patients had a lower body mass index (kg/m(2)) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m(2). Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes. CONCLUSIONS: These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.
This notice provides for the updating of hospital-specific per diem rates for high volume providers and regional per diem rates for low volume providers; the updated cap per diem for high volume providers; the beneficiary per diem cost-share amount for low volume providers for FY 1998 under the TRICARE Mental Health Per Diem Payment System; and the updated per diem rates for both full-day and half-day TRICARE Partial Hospitalization Programs for fiscal year 1998.
This notice provides necessary information for each State which chooses to adjust the capital expenditure and annual operating cost expenditure minimums that are used to determine whether proposals are subject to review under a State's certificate of need program. The notice also provides guidance to assist a State Health Planning and Development Agency (State Agency) in determining the exact minimum dollar figure it will use and in seeking further information.
This notice sets forth the name, address, service area, and date of qualification of an entity determined by the secretary to be a qualified health maintenance organization (HMO). In addition, the service areas of two previously qualified HMOs have been changed.
This final rule amends the existing regulations governing the National Vaccine Injury Compensation Program (VICP) by adding vaccines against rotavirus to the Table of Injuries, which lists the vaccines covered under the VICP. This action is taken under section 2114(e) of the Public Health Service Act (the Act). The VICP provides a system of no-fault compensation for certain individuals who have been injured by specific childhood vaccines. The two prerequisites for adding vaccines against rotavirus to the VICP have been satisfied. An excise tax of 75 cents per dose was enacted on October 21, 1998, and took effect for sales of the vaccines after October 21, 1998. The Centers for Disease Control and Prevention (CDC) has recommended to the Secretary of HHS that this vaccine be routinely administered to children. Thus, vaccines against rotavirus are now included in the VICP.
The HHS is publishing in the Federal Register, final regulations governing eligibility for services from the Indian Health Service. The eligibility regulations currently codified at 42 CFR part 36 are under a congressional moratorium. Republishing the regulations that are currently in effect while the codified regulations are under moratorium is being done for the convenience of the public and in conformance with the requirement of the Administrative Procedure Act, 5 U.S.C. 552(a)(1), that the Code of Federal Regulations (CFR) must contain currently effective regulations.
This ethnographic exploratory study sought to define the meaning of Sanhujori from the perspective of the women who experienced it. Participant observation and interviews indicated that the women perceived the postpartum to be a new state of being, in which they underwent profound physiological, psychological, and sociological changes. Sanhujori was regarded as a phenomenon including belief system and practice system of care that would assure the successful recovery of the woman, her long-term well-being, and the health of her child. Sanhujori as a Belief System includes know-how, period, rationale, condition and consequences built upon six principles. They included: invigorating the body by augmentation of heat and avoidance of cold; resting without working; eating well; protecting the body from harmful strains; keeping cleanness; and handling with the whole heart. Sanhujori as a Practice System is a dynamic process performing according to Belief System. A failure to "Doing a Sanhujori well" was believed to put the mother at risk for a variety of ills (Sanhubyung). Influencing factors on the process included personal and environmental factors. This finding raises a basic question about the relation of professional care during the postpartum to the women's received cultural beliefs about that care.
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In accordance with the Maternal and Child Health Service Act, public health centers and municipalities offer health education, health counseling, health examinations, and home visits for children and their mothers in their jurisdiction. On the basis of the new Maternal and Child Health Service Act, municipalities will have the responsibility to effectively promote health examination for three-year-old children beginning in 1997. To provide health examinations to infants and children, establishing a health personnel system, especially the public health nurse program, is extremely important. The purpose of this study is to determine fundamental facts concerning health manpower development among public health nurses in the municipalities, by reviewing research on health examinations for both infants and children. To determine personnel staffing requirements necessary for health examinations of infants and children in the municipalities of Japan, pertinent references were systematically reviewed. The main results are as follows; 1) The correlation coefficients between the total working hours of the public health nurse for MCH and the population per area and number of birth per year were significantly positive. 2) Total working hours for health examination of three-year-old children per 100 births per year, by the public health nurse were 143 hours, of which 79% were spent just for performing the examination itself. 3) Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with a population of less than 3,000, 43% of the total volume of work performed by public health nurses during the health examinations of three-year-old children required the assistance of prefectural public health nurses. 4) On the other hand, in those areas with populations more than 10,000, 88% of the total volume of work required to be performed by public health nurses during the health examinations for three-year-old children was covered by municipal public health nurses. 5) When the total number of working hours of the public health nurse for Maternal and Child Health was divided into the four parts of planning, implementation, evaluation and training, 86.7% of working hours were spent on implementation itself. 6) In those cities designated by the Government, the health personnel system was sufficient to carry out these health examinations. 7) It was found that in towns and villages with small populations, the health examinations for infants and children can be better carried out in combination with assistance by prefectural public health nurses. 8) The review of the findings suggests that it is important to clarify by further studies not only the relationship between the health manpower system and implementation of the health examination but also the relationship between this system and the effectiveness of the health examination in near future.
BACKGROUND: In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. AIMS OF THE STUDY: In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. METHODS: Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. RESULTS: While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. DISCUSSION: The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a change in the pattern of mental health service delivery from a reliance on costly inpatient care to more efficient outpatient services. CONCLUSIONS: Health reform in Colombia improved access to health services for the general medical services, but not for specialized mental health services. Although the primary goal of the health reform was to provide universal medical coverage, by not including mental health services in the standardized benefits package, inequities in the delivery of mental health services appear to have been perpetuated or even exacerbated. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: If health reform in Colombia and elsewhere is to provide universal coverage and adequate access to comprehensive health care, mental health services must be added to the standardized package of health benefits and efforts to develop accessible and effective mental health treatment at the primary care level should continue. IMPLICATIONS FOR FUTURE RESEARCH: Mental health services research in Colombia should focus future studies on the differential impact of health reform on access to mental health services across regions, and between urban and rural areas.
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