Should a reformed system be prepared for public health emergencies, and what does that mean anyway?

Any reformed health care system must be able to react to and mitigate the consequences of a public health emergency. This article identifies four essential components of public health emergency preparedness, and presents measures that can be taken immediately to improve our capacity to respond to emergencies.

Reducing racial, ethnic, and socioeconomic disparities in health care: opportunities in national health reform.

Policy often focuses on reducing health care disparities through interventions at the patient and provider level. While unquestionably important, system-wide reforms to reduce uninsurance, improve geographic availability of services, increase workforce diversity, and promote clinical best practices are essential for progress in reducing disparities.

Private gain and public pain: financing American health care.

Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the "usual suspects" most frequently cited as drivers of health care costs and explain why these may not be as important as they seem.

Women and health insurance: implications for financing preconception health.

This article examines health insurance coverage among women of reproductive age and considers how national health insurance reform may affect access to high-quality, timely, and affordable preconception and interconception care. A focus on preconception and interconception care increasingly is understood as essential, not only to the health of women, but to that of infants as well, and thus, as a key part of a comprehensive infant health strategy. After a brief overview that examines the relationship between preconception and interconception health care and health insurance reform, the article examines the current state of health insurance coverage among women of childbearing age and the underlying causes of uninsurance and underinsurance in this population group.

Animals as early detectors of bioevents: veterinary tools and a framework for animal-human integrated zoonotic disease surveillance.

The threat of bioterrorism and emerging infectious diseases has prompted various public health agencies to recommend enhanced surveillance activities to supplement existing surveillance plans. The majority of emerging infectious diseases and bioterrorist agents are zoonotic. Animals are more sensitive to certain biological agents, and their use as clinical sentinels, as a means of early detection, is warranted.

Early age at first childbirth associated with advanced tumor grade in breast cancer.

Background: Many studies have investigated risk factors for developing breast cancer, but few have explored whether these risk factors are associated with the aggressiveness of the tumor. This case-case study examined the relationship between risk factors for breast cancer and the histological grade of the tumor at diagnosis, an important indicator of breast cancer aggressiveness.

Methods: We interviewed 215 breast cancer patients and obtained information on their demographics, reproductive history and hormone use.

Undergraduate public health education: past, present, and future.

The IOM's 2003 report Who Will Keep the Public Healthy? recommended that "...

Maternal zinc supplementation and growth in Peruvian infants.

Background: Little is known about how maternal zinc intake influences growth in utero and in postnatal life in humans.

Objective: We aimed to assess the effect of maternal zinc supplementation during pregnancy on infant growth through age 1 y.

Design: A double-blind, randomized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in Lima, Peru.

Connecting for health literacy: health information partners.

This article describes a community-based health information partnership to address health literacy and health information inequalities in marginalized communities. Public health, medical, literacy, and library practitioners promote health literacy through outreach, training, and professional development activities in community settings. They create learning environments for people to develop the necessary knowledge and skills to better understand health information and health policy so they can make decisions concerning personal and community health.

Thimerosal exposure in infants and neurodevelopmental disorders: an assessment of computerized medical records in the Vaccine Safety Datalink.

The study evaluated possible associations between neurodevelopmental disorders (NDs) and exposure to mercury (Hg) from Thimerosal-containing vaccines (TCVs) by examining the automated Vaccine Safety Datalink (VSD). A total of 278,624 subjects were identified in birth cohorts from 1990-1996 that had received their first oral polio vaccination by 3 months of age in the VSD. The birth cohort prevalence rate of medically diagnosed International Classification of Disease, 9th revision (ICD-9) specific NDs and control outcomes were calculated.

The epidemiology of inflammatory breast cancer.

The epidemiology of inflammatory breast cancer (IBC) has been of great interest to a number of investigators, but epidemiological research has been hampered by the lack of an agreed upon case definition and the relatively small number of patients available to any single investigator or institution. Several features of IBC have become apparent through population-based studies, which, although varying somewhat in case definition, generally agree on some key features of the disease. These include the incidence of the disease, apparently less than 3% of breast cancer cases in the United States, the younger age of onset compared to non-inflammatory breast cancer, the much higher incidence in Black women compared to White, the generally poor outcome of this disease compared to non-inflammatory breast cancer, and the continued increase in reported incidence, particularly as compared with non-inflammatory breast cancer in general and locally advanced breast cancer (LABC) in particular.

Getting young adults to quit smoking: a formative evaluation of the X-Pack Program.

The lack of promising smoking cessation interventions targeting young adults is a recognized public health problem. This study was designed to determine the feasibility of a young-adult-oriented program, the X-Pack Program, when administered to college student smokers, and to estimate its effect on smoking cessation. Participants (N = 83) were randomized after enrollment to receive either a moderately intensive, E-mail-based, young-adult intervention (the X-Pack group) or a less-intensive program aimed at a general adult audience (the Clearing the Air group).

The effectiveness of mass communication to change public behavior.

This article provides an overview of the ways in which mass communication has been used -- or can be used -- to promote beneficial changes in behavior among members of populations. We use an ecological perspective to examine the ways in which mass media interventions can be used to influence public behavior both directly and indirectly. Mass media interventions that seek to influence people directly -- by directly targeting the people burdened by the public health problem of concern and/or the people who influence them -- have a long basis in public health history, and recent reviews have clarified our expectations about what can be expected from such approaches.

Enhancing work flow to reduce crowding.

Introduction: Approximately one third of hospitals in the United States report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the emergency department (ED). In a recent national survey, 40% of hospital leaders viewed ED crowding as a symptom of workforce shortages. Many health systems are implementing a variety of strategies to improve flow and reduce crowding.

Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003.

Study Objective: In 2005, the Centers for Disease Control and Prevention reported increasing emergency department (ED) visit rates per 100 people. The greatest increase in visit rate was among individuals 65 years and older. Given that older ED visitors have longer lengths of stay in the ED, are more likely to be admitted, and compose a growing proportion of the American population, this finding could have a significant negative effect on ED crowding.

Massachusetts et al. v Environmental Protection Agency: implications for public health policy and practice.

This installment of reviews the U.S. Supreme Court's April 2, 2007, decision in and considers its implications for public health policy and practice.

A study of Gulf War veterans with a possible deployment-related syndrome.

A previous symptom-based survey of veterans of the 1990-1991 Persian Gulf War suggested a neurological syndrome (blurred vision, loss of balance/dizziness, tremors/shaking, and speech difficulty). The authors conducted the present study to determine whether specific findings could indicate an organic basis for this possible syndrome. They completed an extensive clinical and laboratory evaluation on Gulf War veterans with all 4 symptoms, using 3 comparison groups.

Assumed equity: early observations from the first hospital disparities collaborative.

Disparities in healthcare represent a failure in the equity domain of quality. Although disparities have been well documented, little has been written about how hospitals might use improved data collection and quality improvement techniques to eliminate disparities. This article describes early findings from the planning phase of the first hospital-based disparities collaborative.

Indoor and outdoor air pollution: tobacco smoke, moulds and diseases in infants and children.

Although outdoor air pollution first brought the issue of air pollution health effects to public attention, it is now indoor air pollution that likely has the greatest impact on children's health. The World Health Organization estimates that the global burden of disease from indoor air pollution is far greater than the burden from outdoor air pollution. This review focuses on two indoor pollutants, one that has been well studied, and another that deserves additional study.