Changes in the association of low birth weight with socioeconomic status in Hawaii: 1970-1990.

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

[Occupational rehabilitation of psychiatrically handicapped patients in Leningrad, USSR: a visit to the Bechterew Psychoneurologic Institute]. / Berufliche Rehabilitation psychisch Behinderter in Leningrad, UdSSR.: Ein Besuch am psychoneurologischen Institut Bechterew.

With reference to a recent reader on rehabilitation for the chronically mentally ill in the German Democratic Republic and the USSR the authors travelled to Leningrad, USSR, to learn about the efforts to integrate rather than add up multidisciplinary approaches to work rehabilitation. The authors found a sheltered workshop for about 400 patients where much of the principles of work rehabilitation obviously work: flexible and manyfold work, well adapted to the varying standards of the patients both unskilled workers and patients with academic background. The workshop being one branch of the nationally significant Bechterev Institute for Psychiatry and Neurology also transfers patients to the general workforce where rehabilitation patients are paid a 125% salary. Both the optimistic atmosphere and the economically self supporting shop give good reason to learn more about rehabilitation for the chronically ill in the USSR and the efforts to progress.

Compliance by Samoans in Hawaii with service norms in pediatric primary care.

American Samoans are one in a number of Pacific Basin groups for which the U.S. Government provides health care assistance and one in a large number of recent immigrant groups to the United States. Although these groups often have health care beliefs inconsistent with Western primary care, their compliance with basic provider expectations (such as appointment keeping and appropriate emergency room use) remains largely unstudied. In the case of Samoans in Hawaii, concern is often expressed that a group much in need of health care (pediatric hospitalization and acute illness visit rates are high) often seems "out-of-sync" with Western health care. Four measures of noncompliance were studied in the Hawaii pediatric primary care residency training program. Enrolled Samoan patients were compared with an aggregation of more established ethnic groups. Four matched case-control studies controlled for socioeconomic status and the presence or absence of medical insurance and a home telephone. Samoans were more likely than the comparison group to miss health maintenance appointments, to drop in without an appointment, and to use the emergency room for nonurgent problems when a same-day-notice clinic visit would have usually sufficed.

[Cooperation barriers in psychiatric and psychosocial after care: organizational and sociologic aspects]. / Kooperationshindernisse bei psychiatrischer und psychosozialer Nachsorge: Organisatorische und soziologische Aspekte.

Community based out-care systems for the long term patient has been a concern ever since deinstitutionalization and rehabilitation became a task in the 60's. Much of our efforts failed. Here we try to make the point of organizational factors and their impact on motivation and cooperative incentives both for the staff in the wards, and in the community based clinics. Exchange theory is offered as a base to outline better planning.

[After care services for psychiatric patients: organizational problems and perspectives exemplified by the service area of Honolulu, Hawaii, USA--initial status, empirical results]. / Nachsorgende Dienste für psychiatrische Patienten: Organisatorische Probleme und Perspektiven am Beispiel des Versorgungsgebietes Honolulu, USA--Ausgangssituation, empirische Ergebnisse.

During the past decades much effort has been taken to encourage community - based treatment and service for mental patients, and to reduce the share of the large custodial institutions within mental health care systems. Both in the United States and in W-Germany (FRG) there has been a growing awareness that major inadequacies occur especially with providing community--based out-care for the seriously mentally ill. Much of these inadequacies refer to those released from the mental hospital with such needs as help to structure their everyday lives, adequate housing, nutrition, support for the families and neighborhoods involved, financial support, and further treatment. Part 1 delines the growing awareness of these problems with reference to the expectations of "reformists" both for the U.S. and the F.R.G. The paper then describes empirical data about the care given to patients released from the psychiatric hospital within a 90 days' period in the State of Hawaii, U.S.A. It also gives a structural description of agencies involved in the aftercare services, and relates this both to the empirical findings and reformists' views on aftercare needs.

Racial and socioeconomic status differences in survival of colorectal cancer patients in Hawaii.

The study reported here examines the survival experience up to 84 months of patients from the five major racial groups in Hawaii diagnosed with colorectal cancer during the years between 1960 and 1974 based on data in the Hawaii Tumor Registry. Previous research in Hawaii showed that racial differences in survival existed even after adjusting for sex, age at diagnosis, stage of the disease at diagnosis, and normal life expectancy. In this paper, socioeconomic status differences between racial groups are hypothesized as a possible explanation for these survival differences. The results show that socioeconomic status did account for some survival differences between racial groups beyond what could be explained by the other variables. After adjusting for all the covariates, the only statistically significant racial differences which remained were higher survival rates for the Japanese patients compared with the rates for the Hawaiian and Filipino patients. Socioeconomic status was not found, however, to have a statistically significant effect on survival independent of race or the other variables examined. Reasons for the modest effects of socioeconomic status in this study are discussed.