This paper investigates the relationship between macroeconomic conditions, alcohol use, and drinking problems using individual-level data from the 1987-1999 years of the Behavioral Risk Factor Surveillance System. We confirm the procyclical variation in overall drinking identified in previous research using aggregate sales data and show that this largely results from changes in consumption among existing drinkers, rather than movements into or out of drinking. Moreover, the decrease in alcohol use occurring during bad economic times is concentrated among heavy consumers, with light drinking actually increasing in these periods. We find no evidence that the decline in overall drinking masks a rise in alcohol use for persons becoming unemployed during contractions, suggesting that any stress-induced increases in consumption are more than offset by reductions resulting from changes in economic factors

Bac k g r o u n d: The evidence that heat waves can result in both increased deaths and illness is substantial, and concern over this issue is rising because of climate change. Adverse health impacts from heat waves can be avoided, and epidemiologic studies have identified specific population and community characteristics that mark vulnerability to heat waves. Objectives: We situated vulnerability to heat in geographic space and identified potential areas for intervention and further research. Me t h o d s: We mapped and analyzed 10 vulnerability factors for heat-related morbidity/mortality in the United States: six demographic characteristics and two household air conditioning variables from the U.S. Census Bureau, vegetation cover from satellite images, and diabetes prevalence from a national survey. We performed a factor analysis of these 10 variables and assigned values of increasing vulnerability for the four resulting factors to each of 39,794 census tracts. We added the four factor scores to obtain a cumulative heat vulnerability index value. Results: Four factors explained> 75 % of the total variance in the original 10 vulnerability variables: a) social/environmental vulnerability (combined education/poverty/race/green space), b) social isolation, c) air conditioning prevalence, and d) proportion elderly/diabetes. We found substantial spatial variability

A primary focus of health care education at the beginning of the 21 st century is diabetes including reduction of diabetic complications. Diabetic complications, including foot ulcers and amputations, threaten the quality and quantity of life in a large segment of the population. In order to reduce the incidence of foot ulcers and amputations, health care consumers and professionals must be knowledgeable about risks, assessment, prevention, and treatment. A module on the Internet “Preventing Diabetic Foot Complications, ” will provide pertinent information to a large target audience of Ball State University students, health care consumers, and health care professionals. The module also will provide an opportunity for health care professionals to earn continuing education credit while enhancing ability to provide care to patients with diabetes.

ABSTRACT: This report provides state policymakers with a menu of policy interventions that have been implemented to address disparities in minority health and health care. The authors divide these state and local programs into those targeting infrastructure, management, and capacity, and those targeting specific health conditions. Based on their review, the authors identified eight key needs that state and national policymakers will need to consider: consistent racial/ethnic data collection; effective evaluation of disparities-reduction programs; minimum standards for culturally and linguistically competent health services; greater minority representation within the health care workforce; expanded health screening and access to services (e.g., through expanded insurance coverage); establishment or enhancement of state offices of minority health; involvement of all health system stakeholders in minority health improvement efforts; and creation of a national coordinating body to promote continuing state-based activities to eliminate racial and ethnic health disparities. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

Twenty years ago, Congress made a major commitment to securing older Americans’ access to acute medical care with the creation of Medicare. Subsequent legislation extended the Medicare program to disabled people and to victims of end-stage renal disease. Medicare has been an unquestioned success in reducing financial barriers to health care for its beneficiaries, but the program’s costs have risen rapidly. Medicare’s payment methods have discouraged doctors, hospital managers, and patients from making cost-effective decisions regarding the use of medical technology. Retrospective cost-based hospital reimbursement was particularly troublesome and, most would agree, inflationary. Congress ended cost-based reimbursement for inpatient hospital care for Medicare beneficiaries with the creation of Medicare’s prospective payment system (PPS) in 1983. The new hospital payment system has reversed the financial incentives away from the provision of more care for hospitalized patients to the provision of less care, Now, the Nation needs to know what this radical change in financial incentives is doing to the quantity and quality of health care received by Medicare beneficiaries, and to the effectiveness

Controlled vocabularies have been used as the means for unifying disparate terminologies found within an application field. This unification leads to better administration of information and enhanced communication among various parties. Semantic networks have been shown to be excellent vehicles for modeling controlled vocabularies. However, they often lack the necessary access flexibility and robustness required by external agents such as intelligent information-locators and decision-support systems. In this paper, we describe the process of mapping an existing medical vocabulary based on a semantic network model into an Object-Oriented Database (OODB) system. We first consider two straightforward approaches to carrying out this task and describe their deficiencies. We then present a new approach which yields a very compact OODB schema for the representation of the vocabulary's entire hierarchy and inter-connectivity. We refer to the resulting OODB as the Object-Oriented Healthcare Vocabulary Repository (OOHVR), which is currently up and running in the context of ONTOS, a commercially available OODB system. 1

Controlled vocabularies have been used as the means for unifying disparate terminologies found within an application field. This unification leads to better administration of information and enhanced communication among various parties. Semantic networks have been shown to be excellent vehicles for modeling controlled vocabularies. However, they often lack the necessary access flexibility and robustness required by external agents such as intelligent information-locators and decision-support systems. In this paper, we describe the process of mapping an existing medical vocabulary based on a semantic network model into an Object-Oriented Database (OODB) system. We first consider two straightforward approaches to carrying out this task and describe their deficiencies. We then present a new approach which yields a very compact OODB schema for the representation of the vocabulary's entire hierarchy and inter-connectivity. We refer to the resulting OODB as the Object-Oriented Healthcare Vocabulary Repository (OOHVR), which is currently up and running in the context of ONTOS, a commercially available OODB system. 1

Controlled vocabularies have been used as the means for unifying disparate terminologies found within an application field. This unification leads to better administration of information and enhanced communication among various parties. Semantic networks have been shown to be excellent vehicles for modeling controlled vocabularies. However, they often lack the necessary access flexibility and robustness required by external agents such as intelligent information-locators and decision-support systems. In this paper, we describe the process of mapping an existing medical vocabulary based on a semantic network model into an Object-Oriented Database (OODB) system. We first consider two straightforward approaches to carrying out this task and describe their deficiencies. We then present a new approach which yields a very compact OODB schema for the representation of the vocabulary's entire hierarchy and inter-connectivity. We refer to the resulting OODB as the Object-Oriented Healthcare Vocabulary Repository (OOHVR), which is currently up and running in the context of ONTOS, a commercially available OODB system.

Chapter 13 Basic Biomedical Research Policy “[In a time of budgetary constraint] with NIH being a discretionary program, that does

Pennsylvania, and the University of Chicago for helpful comments, and to the National Institute on Aging and the National Science Foundation for financial support. The views expressed herein are those of the author and not necessarily those of the National Bureau of Economic Research.