An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States.

BACKGROUND: The 1997 American Thoracic Society (ATS) statement "A Framework for Health Care Policy in the United States" outlined core principles for the Society's activities in the public health arena. In the succeeding 10 years, profound changes have taken place in the United States health care environment. In addition, the 2005 publication of the Society's Vision highlighted some differences between the original Statement and our current priorities. Therefore, the Health Policy Committee embarked on a re-analysis and re-statement of the Society's attitudes and strategies with respect to health and public policy. This Statement reflects the findings of the Committee. PURPOSE: To outline the key aspects of an internal ATS strategy for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States. METHODS: Committee discussion and consensus-building occurred both before and after individual members performed literature searches and drafted sections of the document. Comments were solicited on the draft document from ATS committee and assembly chairs and the Executive Committee, resulting in substantive revisions of the final document. RESULTS: Specific strategies are suggested for the ATS in the arenas of research, training and education, patient care, and advocacy so as to enhance the delivery of health care in the fields of respiratory medicine, sleep medicine, and critical care. CONCLUSIONS: The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States.

New Jersey Medical School's unique relationship to its community.

The Newark, New Jersey, riot of 1967, sparked in part by tensions created by the conflicting emphasis of President Lyndon Johnson's Model Cities Program, community action programs, and the New Jersey state medical school's move to Newark's Central Ward, has profoundly affected the medical school and its delivery of medical care in Newark. This paper delineates how these Johnson-era programs contributed to the riot and details the continuing legacy of these events on the medical school and the delivery of health care in Newark. The paper concludes that New Jersey Medical School is expected by its community to have a higher standard of local involvement than comparable institutions. Furthermore, it suggests that New Jersey Medical School's relationship and commitment to its community serve as a model for community interactions for medical schools throughout the United States.

Expenditures associated with preventive healthcare.

BACKGROUND: The Office of Disease Prevention and Health Promotion emphasizes the use of preventive healthcare interventions to "increase quality and years of healthy life". The objective of this study is to evaluate over a 1-year period the total individual healthcare expenditures based upon the likelihood of the person utilizing preventive healthcare measures. METHODS: We analyzed data from the 1998 Medical Expenditure Panel Survey (MEPS) to compare healthcare expenditures of respondents who have and have not followed generally accepted preventive healthcare measures including influenza vaccination, blood pressure checkup, prostate examination, cholesterol determination, and mammography. RESULTS: In general, respondents who lacked evidence of pursuing accepted preventive healthcare practices had lower overall healthcare expenditures in 1998 compared to those who pursued such practices. Specifically, they had lower expenditures for office-based visits and for prescriptions. CONCLUSIONS: People who pursue accepted preventive healthcare measures spent more for their total healthcare over a given year.

Influenza vaccination among minority populations in the United States.

BACKGROUND: A large portion of the elderly population of the United States fails to receive an annual influenza vaccination. Minorities may receive disproportionately fewer vaccinations. The objectives of this study were to (a) estimate the levels of influenza vaccination among noninstitutionalized, U.S. citizens, 65 years and older, (b) examine the immunization levels among minority racial and ethnic groups relative to various majority groupings, and (c) explore potential factors that may contribute to disparities in vaccination levels. METHODS: We analyzed data from the 1996 Medical Expenditure Panel Survey to compare influenza vaccination levels of different racial and ethnic groups among 2,309 persons aged 65 years and older. RESULTS: Whites had 68.0% (+/- SE 1.5%) current influenza vaccination, Hispanics 61.7% (+/- SE 4.1%), and blacks 47.3% (+/- SE 4.3%). Blacks differed significantly compared to whites. Adjustment for potential confounders such as increased health risk, age distribution, perceived health status, family size, poverty level, and the number of ambulatory visits to a health care provider failed to change this difference substantially. CONCLUSIONS: In 1996, among elderly noninstitutionalized, U.S. citizens, blacks relative to whites were less likely to have current influenza vaccinations. This relationship remained significant even after adjustments for potential confounding variables.