Public health reports
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Public health reports · Nov 1992
National survey of state epidemiologists to determine the status of Lyme disease surveillance.
In 1990, the Council of State and Territorial Epidemiologists and the Centers for Disease Control made Lyme disease (LD) nationally notifiable and developed a national case definition. State epidemiologists were surveyed about their State LD surveillance system. Responses were received from all States and the District of Columbia. ⋯ Twenty-five State health departments offer diagnostic testing for LD, and 38 States have conducted surveys for infected ticks. This study has shown that there has been greater standardization of LD reporting with the adoption of a new national case definition for LD. However, many States confirm cases using data that are not a part of the criteria used for the national case definition.
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Although the American public health system has made major contributions to life expectancy for residents of this country over the past century, the system now faces more complex health problems that require comprehensive approaches and increased capacity, particularly in local and State public health agencies. To strengthen the public health system, concerted action is needed to meet these five critical needs: First, the knowledge base of public health workers needs to be supplemented through on-the-job training and continuing education programs. To this end, self-study courses will be expanded, and a network of regional training centers will be established throughout the country. ⋯ To improve the use of existing Federal support and enhance the availability of new community resources, grant programs will be modified, and innovative approaches to local resource enhancement will be developed and shared. Activities in these five key areas are designed to improve the infrastructure of the public health system and its capacity to carry out effectively the core functions of public health assessment, policy development, and assurance of the availability of the benefits of public health. If the nation is to achieve the health objectives for the year 2000, the public health system-the individuals and institutions that, when working effectively together, promote and protect the health of the people-must be strengthened.
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Public health reports · Nov 1992
Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988.
Numerous studies have shown that the receipt of adequate prenatal care is associated with improvements in pregnancy outcome, particularly a reduction in the risk of low birth weight. Since medical costs for these low birth weight infants are several times higher than for normal birth weight infants, one would expect that medical costs for newborns would be lower for babies whose mothers have had adequate prenatal care than for those with inadequate prenatal care. Explored in this paper is whether the reduction in Medicaid costs for newborn and post-partum maternal care is greater than the increase in prenatal costs for a Medicaid population. ⋯ Prenatal care costs were $233 higher for pregnancies with adequate prenatal care than for those in which prenatal care was inadequate. Newborn and post-partum costs starting within 60 days after the birth were $347 lower for the adequate prenatal care pregnancies, resulting in a savings of $1.49 for each extra $1 spent on prenatal care. Among the other factors studied in determining this benefit to cost ratio were global billing, Supplemental Food Program for Women, Infants, and Children (WIC), and participation in Medicaid under the expanded eligibility provisions that were effective in Missouri in 1988.
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Public health reports · Jul 1992
Comparative StudyUsing the Behavioral Risk Factor Surveillance System to monitor year 2000 objectives among American Indians.
The Behavioral Risk Factor Surveillance System, a data set based on telephone surveys that have been conducted by States in collaboration with the Centers for Disease Control, has been used to estimate the prevalence of behavioral risk factors for adults in the United States so health objectives can be set and progress towards accomplishing them measured. Data for adult American Indians in this regard have not been available generally. The use of these data to estimate behavioral risk prevalence for American Indians by geographic region was examined and the results compared with those for white Americans. ⋯ When they are used in conjunction with community-specific surveys, the Behavioral Risk Factor Surveillance System data may be useful for monitoring the progress of American Indians towards the Year 2000 national health objectives. The value of the surveillance system for monitoring trends in behavioral risk factors among Indians would be enhanced if States attempted to over sample regions (such as Indian reservations) with a high proportion of Indian residents. It appears that aggressive health promotion and disease prevention efforts will be needed if these objectives are to be achieved.
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Public health reports · May 1992
Estimating the probability of spontaneous abortion in the presence of induced abortion and vice versa.
An integrated approach to estimate the total number of pregnancies that begin in a population during one calendar year and the probability of spontaneous abortion is described. This includes an indirect estimate of the number of pregnancies that result in spontaneous abortions. The method simultaneously takes into account the proportion of induced abortions that are censored by spontaneous abortions and vice versa in order to estimate the true annual number of spontaneous and induced abortions for a population. ⋯ For the United States in 1980 the probability of a spontaneous abortion is 19 percent, given the presence of induced abortion. Once the effects of spontaneous abortion are discounted, women in 1980 intended to allow 73 percent of their pregnancies to proceed to a live birth. One medical benefit to a population practicing induced abortion is that induced abortions avert some spontaneous abortions, leading to a lower mean gestational duration at the time of spontaneous abortion.