Annual review of public health
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Annu Rev Public Health · Jan 1999
ReviewThe key to the door: Medicaid's role in improving health care for women and children.
Medicaid is the nation's major public financing program for providing health insurance coverage and long-term care services to the poor. This article assesses Medicaid's contributions over the last three decades to improving the coverage, access to care, and health of low-income children and women. ⋯ Medicaid has shown over the last three decades that it is an important lever to help open the door to better health care, and ultimately to improved health for America's poor women and children, by substantially expanding coverage of the low-income population and helping to reduce differentials in access to care between the poor and the privately insured. Gaps in coverage and limitations in access persist, but overall the program has resulted in better coverage, access, and health care for millions of poor children and their parents.
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This paper begins with a review of the problem of teen pregnancy in the United States. Domestic trends are compared with those of other developed countries. Antecedents of the problem are discussed. ⋯ An analysis of the different ways in which the problem can be framed and the implications for solutions of the problem follow. Examples of promising teen pregnancy and STD/HIV/AIDS prevention programs are provided. The paper ends with a recommendation for an eclectic approach to framing the problem and possible solutions.
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Annu Rev Public Health · Jan 1996
ReviewPublic health and regulatory considerations of the Safe Drinking Water Act.
This paper provides an overview of the public health and economic issues associated with drinking water quality regulations in the United States. A historic perspective is provided by the use of filtration and chlorine disinfection, and of public health laws from the early 20th century up to passage of the Safe Drinking Water Act (SDWA), in 1974. ⋯ Risk-cost and benefit-cost analyses are offered for carcinogens, systemics, and pathogens. The paper describes the evolution of public health issues from the initial focus on waterborne infectious diseases to concerns over chemical contaminants, and the recent reemergence of microbials as the high-priority public health concern.
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Annu Rev Public Health · Jan 1995
ReviewBayesian statistical methods in public health and medicine.
This article reviews the Bayesian statistical approach to the design and analysis of research studies in the health sciences. The central idea of the Bayesian method is the use of study data to update the state of knowledge about a quantity of interest. ⋯ The Bayesian method also provides a flexible framework for the monitoring of sequential clinical trials. We present several examples of Bayesian methods in practice including a study of disease progression in AIDS, a comparison of two therapies in a clinical trial, and a case-control study investigating the link between dietary factors and breast cancer.
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In conclusion, this review reveals much about the constituents and fate of wood smoke but not enough about the health effects. Animal toxicological studies show that wood smoke exposure can disrupt cellular membranes, depress macrophage activity, destroy ciliated and secretory respiratory epithelial cells, and cause aberrations in biochemical enzyme levels. With respect to the human epidemiological data, the literature summarized in Table 4 shows a coherence of the data from young children, with 7/8 studies especially in children with asthma, reporting increased respiratory symptoms, lower respiratory infection, and decreased pulmonary function as a result of exposure to wood smoke. ⋯ There is strength of association, consistency (7/8 studies showing positive associations), temporality, plausibility, coherence, and analogy (using ETS exposure; 70, 94). A biological gradient has not been shown, although one is suggested in the study of pulmonary function in wildfire fighters. We conclude that the preponderance of the data suggest a causal relationship between elevated wood smoke levels and adverse respiratory health outcomes in young children.