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Veterans and Agent Orange -- Copyright -- Foreword -- Preface -- CONDUCT OF THE STUDY -- Contents -- 1 Executive Summary -- ORGANIZATION AND FRAMEWORK -- CONCLUSIONS ABOUT HEALTH OUTCOMES -- Health Outcomes with Sufficient Evidence of an Association -- Health Outcomes with Limited/Suggestive Evidence of an Association -- Health Outcomes with Limited/Suggestive Evidence of No Association -- Health Outcomes with Inadequate/Insufficient Evidence to Determine Whether an Association Exists -- Increased Risk in Vietnam Veterans -- RESEARCH RECOMMENDATIONS -- Epidemiologic Studies of Vietnam Veterans -- Mandated Research Efforts -- REFERENCES -- 2 History of the Controversy Over the Use of Herbicides -- MILITARY USE OF HERBICIDES IN VIETNAM -- Herbicide Development and Testing -- Use of Herbicides in Vietnam -- EARLY CONCERNS ABOUT THE USE OF HERBICIDES IN VIETNAM -- Early Accounts of Dioxin (TCDD) -- Concerns Over the Long-Term Use of Herbicides -- CONCERNS ABOUT EXPOSURE TO AGENT ORANGE -- Vietnam Veterans Return Home -- The Beginning of the Controversy -- AGENT ORANGE PRODUCT LIABILITY LITIGATION -- Class Action Suit -- CONCERNS ABOUT OTHER EXPOSURES TO 2,4,5-T AND TCDD -- Occupational Exposure -- Production Workers -- Agricultural and Forestry Workers -- Pulp and Paper Mill Workers -- Major Event Associated with Occupational Exposure to Dioxin (TCDD) -- Environmental Exposures -- Domestic Use of Herbicides -- Major Events Associated with Environmental Exposure to Dioxin (TCDD) -- THE FEDERAL GOVERNMENT'S RESPONSE TO PUBLIC CONCERNS -- White House -- U.S. Congress -- Hearings -- Legislation on Agent Orange -- Office of Technology Assessment -- General Accounting Office -- Department of the Air Force -- Department of Veterans Affairs -- Health Care -- Research Efforts -- Compensation and Benefits -- Outreach Activities.

Effectiveness and Outcomes in Health Care -- Copyright -- ACKNOWLEDGMENTS -- PREFACE -- EFFECTIVENESS VERSUS EFFICACY -- METHODOLOGIES -- IMPACT UPON COSTS -- RISK ADJUSTMENTS AND OUTCOMES -- CONCLUSIONS -- Contents -- PART I INTRODUCTION -- 1 Genesis of the Effectiveness Initiative and IOM's Role -- THE BROADER CONTEXT -- The Institute of Medicine's Contribution -- The IOM Clinical Workshop -- The Condition-Specific Workshops -- Effectiveness and Outcomes Conference -- Proceedings -- 2 Promise and Limitations of Effectiveness and Outcomes Research -- IMPORTANCE OF EFFECTIVENESS RESEARCH -- Medicare Data Bases -- KEY ASPECTS OF EFFECTIVENESS RESEARCH -- Reliability and Validity of Data -- Longitudinal Studies -- Tracking the Patient -- Health Status Assessment -- Risk Stratification -- Prevention -- The Aging Process -- PRINCIPLES TO GUIDE FEDERAL EFFORTS -- Range of Study Designs -- Funding -- Balance of Approaches -- Coordination -- Technology Assessment -- Influencing Provider Behavior -- The Confluence of Biomedical, Health Services, and Effectiveness Research -- PART II OVERVIEW -- 3 Research on the Effectiveness of Medical Treatment: New Challenges and Opportunities -- Medical Treatment Effectiveness Program -- Implementation of the Program -- Priorities for Research -- New Patterns of Collaboration -- References -- 4 The Health Care Financing Administration and the Effectiveness Initiative -- HCFA'S INTEREST IN EFFECTIVENESS -- THE EFFECTIVENESS INITIATIVE -- FUTURE ACTIVITIES -- ACKNOWLEDGEMENTS -- 5 The Effectiveness Initiative: Retrospective and Prospects -- THE GOVERNMENT'S ROLE IN EFFECTIVENESS RESEARCH -- PROSPECTS -- 6 The Social Perspective -- THE PRESENT SCENARIO -- COSTS OF HEALTH CARE -- VARIATIONS IN MEDICAL COSTS AND PRACTICE -- REASONS FOR THE EFFECTIVENESS INITIATIVE -- HOW TO PROCEED IN EFFECTIVENESS AND OUTCOMES RESEARCH.

Controlling Costs and Changing Patient Care? -- Copyright -- Contents -- Preface -- Executive Summary -- CURRENT STATUS OF UTILIZATION MANAGEMENT -- HOW UTILIZATION MANAGEMENT IS EVOLVING -- ISSUES FOR THE FUTURE -- RECOMMENDATIONS FOR THE NEAR TERM -- Responsibilities of Employers and Purchasers -- Responsibilities of Utilization Management Organizations -- Responsibilities of Practitioners and Institutions -- Responsibilities of Patients -- LONGER-TERM RECOMMENDATIONS AND QUESTIONS -- Research On Effectiveness -- Practice Guidelines and Review Criteria -- Oversight of Utilization Management -- 1 Utilization Management: Introduction and Definitions -- WHAT IS UTILIZATION MANAGEMENT? -- Prior Review -- High-Cost Case Management -- Retrospective Utilization Review -- Other Cost-Containment Methods -- TWO NOTES OF CAUTION -- Obstacles To Evaluation -- Intrinsic Conceptual and Methodological Problems -- Common Behavioral Biases Against Evaluation -- Competition and Evaluation -- Forces Behind Rising Health Care Costs -- REFERENCES -- 2 Origins of Utilization Management -- THE GROWTH OF THIRD-PARTY FINANCING OF HEALTH CARE -- EARLY COST-MANAGEMENT EFFORTS BY THIRD PARTIES -- Management of the Risk Pool -- Design of the Benefit Plan -- Controls On Payments To Providers -- Constraints On Supply -- Utilization Review -- GOVERNMENT AND EMPLOYER INVOLVEMENT -- Federal Government Initiatives -- Private Purchasers Become an Force -- OTHER FACTORS GIVING RISE TO UTILIZATION MANAGEMENT -- Inappropriate Utilization as an Cost-Containment Target -- Variations in Utilization -- Inappropriate Utilization -- Linking Cost and Quality -- Improving the Tools and Structures for Utilization Management -- Information Resources -- Assessment and Education Strategies -- New Organizations -- CONCLUSION -- REFERENCES.

Allied Health Services -- Copyright -- Preface -- STUDY BACKGROUND -- INTERPRETATION OF THE CONGRESSIONAL CHARGE -- STUDY APPROACH -- MAJOR STUDY THEMES -- ORGANIZATION OF THE REPORT -- Acknowledgments -- Contents -- Executive Summary -- ALLIED HEALTH PERSONNEL: WHO ARE THEY AND WHAT DO THEY DO? -- ESTIMATING SUPPLY AND DEMAND -- Data Limitations -- Factors That Affect The Demand for and Supply of Allied Health Personnel -- THE CURRENT EMPLOYMENT SITUATION -- THE FUTURE EMPLOYMENT SITUATION -- EDUCATION -- HEALTH CARE INSTITUTIONS -- LICENSURE, CERTIFICATION, AND ACCREDITATION -- LONG-TERM CARE -- COLLABORATIVE ACTION -- 1 What Does "Allied Health" Mean? -- CLINICAL LABORATORY TECHNOLOGY -- DENTAL HYGIENISTS -- DIETETIC SERVICES -- EMERGENCY MEDICAL SERVICES -- MEDICAL RECORD SERVICES -- OCCUPATIONAL THERAPY -- PHYSICAL THERAPY -- RADIOLOGIC TECHNOLOGY -- RESPIRATORY THERAPY -- SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SERVICES -- NEW ALLIED HEALTH FIELDS -- Perfusion -- Cardiovascular Technology -- CONCLUSION -- REFERENCES -- 2 Approaches to Measuring Demand and Supply -- DATA FOR ASSESSING DEMAND AND SUPPLY -- ASSESSING CURRENT DEMAND AND SUPPLY -- Indicators of A Labor Shortage -- Vacancies -- Compensation Levels -- Unemployment Levels -- Data for Assessing Current Vacancies -- Data on Salaries and Wages -- How to Improve Data on Current Allied Health Personnel Demand and Supply -- ASSESSING FUTURE DEMAND AND SUPPLY -- HOW BLS MAKES EMPLOYMENT PROJECTIONS -- FUTURE SUPPLY -- DATA FOR PROJECTING THE FUTURE SUPPLY OF ALLIED HEALTH WORKERS -- Current (Base Year) Supply -- New Entrants -- Other Inflows -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- 3 Forces and Trends in Personnel Demand and Supply -- RESPIRATORY THERAPY'S MOVE INTO THE HOME: THE ROLE OF INTERACTIVE FORCES -- FORCES THAT DRIVE THE DEMAND FOR ALLIED HEALTH PRACTITIONERS.

For-Profit Enterprise in Health Care -- Copyright -- Contents -- ACKNOWLEDGMENTS -- INTRODUCTION TO THE VOLUME -- ORIGINS OF THIS INQUIRY -- FOCUS OF THIS STUDY -- THE COMPLICATIONS OF CHANGE -- SOURCES OF INFORMATION -- THE PRODUCTS OF THIS INQUIRY -- CONCLUSION -- PART I COMMITTEE REPORT -- 1 Profits and Health Care: An Introduction to the Issues -- QUESTIONS EXAMINED IN THIS REPORT -- THE DIVERSE OWNERSHIP OF AMERICAN HEALTH CARE ORGANIZATIONS -- THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION -- Investor Ownership -- Not-For-Profit Organizations -- Problems with the For-Profit/Not-For-Profit Distinction -- THE VALUE QUESTION -- Health Care as Economic Good -- Health Care as Social Good -- Economic Good Versus Social Good -- Relationship of Physicians to Health Care Organizations -- NOTES -- References -- APPENDIX TO CHAPTER 1 -- Economic Rationale for the Three Sectors -- Models of the Behavior of For-Profit and Not-For-Profit Organizations -- Why For-Profit Hospitals May be Inefficient -- Notes -- 2 Changes in the Ownership, Control, and Configuration of Health Care Services -- HOSPITALS -- Investor-Owned Hospital Systems -- Not-For-Profit Hospital Systems -- COMPARISONS OF INVESTOR-OWNED AND NOT-FOR-PROFIT SYSTEMS -- Psychiatric Hospitals -- NURSING HOMES -- HEALTH MAINTENANCE ORGANIZATIONS -- HOME CARE -- NEW TYPES OF PROVIDERS -- Freestanding Primary Care Centers -- Other Services -- VERTICAL INTEGRATION AND DIVERSIFICATION -- FOR-PROFIT/NOT-FOR-PROFIT HYBRIDS -- CONCLUSIONS -- NOTES -- References -- 3 Financial Capital and Health Care Growth Trends -- WHAT IS CAPITAL? -- SOURCES OF CAPITAL FUNDS FOR HEALTH CARE PROVIDERS -- Trends in Sources of Financial Capital -- Relationship of Ownership to Sources of Capital -- THE COSTS OF CAPITAL -- Philanthropy and Governmental Grants -- Debt Financing -- Equity Financing.

Improving the Quality of Care in Nursing Homes -- Copyright -- Preface -- Acknowledgments -- Contents -- 1 Introduction and Summary -- PURPOSE OF THE STUDY -- THE PUBLIC POLICY CONTEXT OF THE STUDY -- PERSPECTIVE ON THE ISSUES -- The Role of Nursing Homes -- Quality of Care and Quality of Life -- The Regulatory System -- Other Factors Affecting Quality of Care in Nursing Homes -- Other Regulatory Policies -- Consumers, the Community, and Nursing Home Management and Staff -- CONCLUSIONS -- SUMMARY OF RECOMMENDATIONS -- Regulatory Criteria -- Monitoring Nursing Home Performance -- Enforcing Compliance with Federal Standards -- Other Factors Affecting Quality of Care and Quality of Life in Nursing Homes -- Issues Requiring Further Study -- Information Systems -- Medicaid Payment Policies -- Nursing Home Bed Supply -- Staffing of Nursing Homes -- Single- Versus Multiple-Occupancy Rooms -- 2 Concepts of Quality, Quality Assessment, and Quality Assurance -- QUALITY OF CARE IN NURSING HOMES -- Characteristics of the Residents -- Care Needs -- The Care Setting -- Requirements for High-Quality Care -- Planning And Providing Care -- QUALITY OF LIFE -- QUALITY ASSESSMENT CRITERIA -- Structure -- Process -- Outcomes -- ASSESSING QUALITY OF CARE -- Functional Competency/Impairment -- Intellectual Impairment/Behavioral Problems -- PERSPECTIVE ON QUALITY ASSURANCE -- INTERPRETING AND USING INFORMATION FOR QUALITY ASSURANCE -- Measurement of Care Quality -- Standards -- Case Mix -- Standard Instruments -- National, Regional, and Local Uses -- QUALITY ASSURANCE AND THE REGULATORY SYSTEM -- 3 Regulatory Criteria -- THE ISSUES -- CONSOLIDATING THE TWO SETS OF CRITERIA -- RESIDENT ASSESSMENT -- REVISING AND STRENGTHENING THE CONDITIONS AND STANDARDS -- Quality of Life -- Quality of Care -- Residents' Rights -- Administration -- Training of Nurse's Aides.

Prevention and Treatment of Alcohol Problems: Research Opportunities -- Copyright -- PREFACE -- REFERENCES -- Contents -- SUMMARY -- RESEARCH OPPORTUNITIES IN THE PREVENTION OF ALCOHOL PROBLEMS: A PUBLIC HEALTH PERSPECTIVE -- The Epidemiology of Alcohol-Related Problems -- Individual-Environment Interactions: Focus on the Individual -- The Life-Course Developmental Perspective -- Social Learning Models -- Genetic Determinants of Risk -- Individual-Environment Interactions: Focus on the Environment -- Community Approaches and Perspectives from Other Health Fields -- Methodological Issues in Alcohol Prevention Research: Conclusions and Recommendations -- RESEARCH OPPORTUNITIES IN THE TREATMENT OF ALCOHOL PROBLEMS -- Historical Factors in Treatment Research -- Conceptual and Technical Advances in Assessment -- Effectiveness of Treatment Modalities: Studies of Process and Outcome -- Early Identification and Treatment -- Patient-Treatment Matching and Outcome Improvement in Alcohol Rehabilitation -- Advances in the Treatment of Other Psychoactive Substance-Use Disorders: Implications for Alcohol Treatment Research -- Health Consequences of Alcohol Abuse -- Treatment Costs, Benefits, and Cost Offsets: Public Policy Considerations -- FUNDING MECHANISMS AND THE NECESSARY INFRASTRUCTURE FOR TREATMENT AND PREVENTION RESEARCH -- Supporting the Scientific Infrastructure for Prevention Research -- Supporting the Scientific Infrastructure for Treatment Research -- I RESEARCH OPPORTUNITIES IN THE PREVENTION OF ALCOHOL-RELATED PROBLEMS -- References -- 1 A Public Health Perspective on the Prevention of Alcohol Problems -- A PUBLIC HEALTH MODEL OF ALCOHOL-RELATED PROBLEMS -- PREVENTION RESEARCH FROM A PUBLIC HEALTH PERSPECTIVE -- A SYSTEMS APPROACH -- References -- 2 Epidemiology of Alcohol-Related Problems -- INJURIES.

Mortality of Veteran Participants in the Crossroads Nuclear Test -- Copyright -- Preface -- Acknowledgments -- Glossary and Acronyms -- Contents -- Summary -- 1 Study Rationale and Overview -- RATIONALE -- OVERVIEW -- 2 Other Studies of the Human Health Effects of Radiation Exposure -- 3 Epidemiology Primer -- CHOICE OF COMPARISON GROUP -- FINE TUNING OF EXPOSED GROUP -- CONFOUNDERS -- DATA COLLECTION -- INTERPRETING DATA FINDINGS -- EPIDEMIOLOGY SUMMARY RELATED TO THIS STUDY -- 4 Description of Operation Crossroads -- 5 Data Sources for the Crossroads Study -- 6 The Participant Cohort -- INDEPENDENT VERIFICATION OF PARTICIPANT COHORT -- EXCLUSION OF "POST-CROSSROADS" PARTICIPANTS -- CROSSROADS PARTICIPANTS WHO PARTICIPATED IN OTHER NUCLEAR TESTS -- PRIMARY ANALYSIS-NAVY PERSONNEL ONLY -- EXCLUSIVITY OF PARTICIPANT AND COMPARISON COHORTS -- 7 The Comparison Cohort -- COMPARISON COHORT SELECTION -- Navy and Shipboard Marines -- Army and Army Air Corps -- MILITARY PERSONNEL RECORDS -- ADDITIONAL CONTROLS -- 8 Exposure Definition, Measurement, and Verification -- INTRODUCTION -- DOSIMETRY BACKGROUND -- Definition of Potential Surrogate Dose Groups -- DNA-Provided Dose Estimates -- Overall -- Alternatives -- PARTICIPANT VERSUS NONPARTICIPANT COHORTS AS AN EXPOSURE SURROGATE -- BOARDERS VERSUS NONBOARDING PARTICIPANTS VERSUS NONPARTICIPANTS AS EXPOSURE SURROGATES -- ENGINEERING & HULL VERSUS OTHER SPECIALTY STATUS AS AN EXPOSURE SURROGATE -- RELATIONSHIPS OF SURROGATES WITH DNA DOSE DATA -- DECISIONS FOR THE ANALYSES IN THIS REPORT -- 9 Mortality Ascertainment -- PROCEDURE -- Vital Status Ascertainment -- Cause and Date-of-Death Ascertainment -- SUMMARY OF MORTALITY ASCERTAINMENT QUALITY AND ITS POTENTIAL EFFECTS ON VALID INTERPRETATION OF THE... -- 10 Characterization of the Cohorts and Analysis Plan -- DATA DECISIONS TAKEN BEFORE ANALYSIS.

Cover -- Front Matter -- REVIEWERS -- Preface -- Acknowledgments -- Contents -- Tables, Figures, and Boxes -- Executive Summary -- 1 Introduction -- 2 Defining the Contents of the Data Set: The National Health Care Quality Framework -- 3 Selecting Measures for the National Health Care Quality Data Set -- 4 Data Sources for the National Health Care Quality Report -- 5 Designing the National Health Care Quality Report -- APPENDIX A Workshop: Envisioning a National Quality Report on Health Care -- APPENDIX B Designing a Comprehensive National Report on Effectiveness of Care: Measurement, Data Collection, and Reporting Strategies -- APPENDIX C Submissions in Response to the IOM Committee's Call for Measures from the Private Sector -- APPENDIX D Selected Approaches to Thinking About Quality and the National Health Care Quality Report -- APPENDIX E Quality Measure Selection Criteria -- Glossary -- Acronyms and Abbreviations -- Biographical Sketches of Committee Members.

Confronting AIDS -- Copyright -- Preface -- ACKNOWLEDGMENTS -- Contents -- Executive Summary -- INTRODUCTION -- HIV INFECTION AND ITS EPIDEMIOLOGY -- The Spectrum of HIV Infection -- Modes and Efficiencies of HIV Transmission -- Prevalence and Incidence of Infection in the United States -- UNDERSTANDING THE EPIDEMIC'S COURSE -- ALTERING THE EPIDEMIC'S COURSE -- Antidiscrimination Protections -- Education -- Screening and Testing for HIV Antibody -- Other Public Health Measures -- AIDS and IV Drug Abuse -- Resources for Public Health Measures -- CARE OF PERSONS INFECTED WITH HIV -- Care Needs of Special Patients -- Health Care Providers -- Costs of Health Care for Persons with AIDS -- Financing Health Care for Persons with AIDS and Other HIV-Infected Individuals -- Possible Financing Mechanisms -- THE BIOLOGY OF HIV AND BIOMEDICAL RESEARCH NEEDS -- HIV Biology -- Drug Development and Testing -- Vaccine Development and Testing -- Roundtable on Drugs and Vaccines -- Animal Models of AIDS -- Resources for the Campaign -- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION -- A NATIONAL COMMISSION ON HIV INFECTION AND AIDS -- 1 Introduction -- REFERENCES -- 2 HIV Infection and Its Epidemiology -- HIV: THE ETIOLOGIC AGENT OF AIDS -- PROPORTION OF INFECTED INDIVIDUALS WHO WILL DEVELOP AIDS -- THE SPECTRUM OF HIV INFECTION -- MODES AND EFFICIENCIES OF HIV TRANSMISSION -- Heterosexual Transmission -- Efficiencies of Transmission -- Relative Efficiencies of HIV Transmission -- PREVALENCE AND INCIDENCE OF HIV INFECTION IN THE UNITED STATES -- HIV Prevalence in Groups at Recognized Risk -- HIV Prevalence Among Selected Segments of the General Population -- Incidence of New Infections -- National Estimates of HIV Infection -- The Program of HIV Surveys and Studies -- AIDS CASES IN THE UNITED STATES -- THE DEMOGRAPHIC IMPACT OF AIDS -- FUTURE RESEARCH NEEDS.

America's Aging -- Copyright -- Preface -- Acknowledgments -- Contents -- Summary -- INTRODUCTION -- PREVIOUS STUDIES -- THE CURRENT FRAMEWORK -- The Demography of Current and Future Aging Cohorts -- The Concept of Vulnerability among the Oldest Old -- Federal Housing Policies -- Public Intervention in Housing Programs for the Aging -- Mobility and Social Integration of the Aging -- The Swedish Perspective on Housing and Social Environments for the Elderly -- New Technology and the Productivity and Independence of the Elderly -- REFERENCES -- Proposals for Policy and Further Research -- AGE AND DISABILITY -- ENVIRONMENTAL SERVICES AND THE WELL-BEING OF OLDER PEOPLE -- PERSON AND ENVIRONMENTAL IN LIFE-SPAN PERSPECTIVE -- SELF-DETERMINATION IN ENVIRONMENTAL DECISION MAKING -- RESEARCH AND POLICY NEEDS -- Population Issues -- Housing Programs -- Technology -- Productivity and New Environmental Forms -- The Vulnerable Aged -- Transportation -- CONCLUSION -- REFERENCES -- The Demography of Current and Future Aging Cohorts -- THE EVOLUTION OF THE OLDER U.S. POPULATION -- Components of Change -- Age Composition of the Elderly Population -- Sex Composition -- Ethnic or Racial Composition -- Regional Distribution of the Elderly -- Urban-Rural Differences -- Marital Composition and Living Arrangements -- THE ''OLD OLD -- THE NEW AGED -- THE FUTURE OLDER POPULATION -- REFERENCES -- Social and Physical Environments for the Vulnerable Aged -- NOTIONS OF VULNERABILITY -- THE VULNERABLE AGED -- Functional Dependency -- Disability and Other Markers of Vulnerability -- RESPONSES TO DEPENDENCY -- Service Responses -- Environmental Responses to Dependency -- Retirement Communities -- Indirect Environmental Influences -- FUTURE CONSIDERATIONS -- NOTES -- REFERENCES -- Current and Emerging Issues in Housing Environments for the Elderly.

Healthy People 2000 -- Copyright -- Contents -- Preface -- Acknowledgments -- NOTE ON AUTHORSHIP -- 1. Introduction -- HISTORY AND PURPOSE OF THE OBJECTIVES -- HEARINGS AND TESTIMONY -- Questions for Testifiers -- Scope of the Testimony -- PURPOSE AND STRUCTURE OF THIS REPORT -- Structure of This Document -- REFERENCES -- TESTIFIERS CITED IN CHAPTER 1 -- 2. Objectives Process And Structure -- NATURE OF THE OBJECTIVES -- Need to Address Social Conditions -- Concepts of Health Promotion and Disease Prevention -- FORMAT AND FOCUS OF THE OBJECTIVES -- Measurement Issues -- Group Objectives by Population Subgroups -- Missing Objectives -- PRIORITY SETTING -- Need for Priorities Among the Objectives -- Models for Setting Prloritles -- REFERENCES -- TESTIFIERS CITED IN CHAPTER 2 -- 3. Implementing the Objectives at State and Local Levels -- STATE AND LOCAL PUBLIC HEALTH INITIATIVES -- State and Local Health Department Experience -- The Model Standards -- Federal Funding -- INTERSECTORAL COOPERATION: ROLE OF THE PRIVATE SECTOR -- Community Participation -- Corporate Partnerships -- SURVEILLANCE AND INFORMATION RESOURCES -- State and Local Data Systems -- Specific Diseases and Problems -- Special Needs of Minority Populations -- Information Resources -- REFERENCES -- TESTIFIERS CITED IN CHAPTER 3 -- 4. Children and Adolescents -- CROSSCUTTING TOPICS -- Access to Care -- Child-Care Centers and Health -- The Media and Children's Health -- Coordination of Adolescent Health Services -- Chronic Illness and Disability in Children -- HEALTH PROMOTION -- Nutrition -- PHYSICAL FITNESS -- Substance Abuse -- Mental Health and Suicide -- HEALTH PROTECTION -- Unintentional Injury -- Child Abuse and Family Violence -- Lead Poisoning -- Preventive Services -- Infectious Diseases -- Oral Health -- Screening for Chronic Health Problems in Children -- DATA NEEDS.

Vaccine Supply and Innovation -- Copyright -- Preface -- Contents -- Vaccine Supply and Innovation -- 1 Summary -- OVERVIEW -- VACCINE AVAILABILITY: MAJOR BARRIERS AND IMPEDIMENTS -- Impediments to Vaccine Innovation -- ECONOMIC CHARACTERISTICS OF THE VACCINE INDUSTRY -- VACCINE INJURY -- THE LEGAL SITUATION AND ITS CONSEQUENCES -- CONSEQUENCES OF THE STATE OF VACCINE INJURY LIABILITY LAW FOR VACCINE PRODUCTION AND INNOVATION -- A NATIONAL VACCINE COMMISSION -- COMPENSATION AND LIABILITY FOR VACCINE-RELATED INJURY -- 2 Vaccines: Past, Present, and Future -- TYPES OF IMMUNIZATION -- HISTORY OF IMMUNIZATION -- THE PRESENT -- Development of Vaccines and Recommendations for Vaccine Use -- THE FUTURE -- REFERENCES AND NOTES -- 3 Vaccine Availability: Concerns, Barriers, and Impediments -- CONCERNS ABOUT THE CURRENT SITUATION -- Supply -- Stockpiling of Vaccines -- Problems with Sole Reliance on Foreign Manufacturers -- Federal Action to Ensure Vaccine Supply -- BARRIERS AND IMPEDIMENTS TO VACCINE INNOVATION -- Identification of Need and Establishing Priorities -- Establishing the Technical Feasibility of Vaccine Development -- Economic Disincentives to Innovation and Production -- Factors Influencing the Market for Vaccines -- VACCINE UTILIZATION -- System Factors -- Client Factors -- Provider Factors -- CONCLUSIONS -- Barriers and Impediments to Vaccine Innovation -- REFERENCES AND NOTES -- 4 Economic Aspects of Vaccine Innovation and Manufacturing -- POTENTIAL CAUSES OF INDUSTRY DECLINE -- Property Rights and Innovation -- Regulation -- Market Size -- Liability and Risk -- DESCRIPTIVE STATISTICS -- The Market and Participants -- Pricing -- Research and Development -- CONCLUSIONS -- REFERENCES AND NOTES -- 5 Vaccine Injury -- The Pertussis Controversy -- Identifying Individuals at High Risk of Adverse Effects -- VACCINES USED IN CHILDHOOD.