Subject: Studies in the News 01-29


CALIFORNIA RESEARCH BUREAU
CALIFORNIA STATE LIBRARY
Studies in the News:
Health Supplement


California -- One Hundred and Fifty Years Ago

September 1851 - "A notice to the public, dated 'Durkee’s Ferry, Klamath River, October 8, 1851,' states that 'A treaty of peace' had been concluded on behalf of the United States with certain tribes, giving their names. 'These tribes promise to live hereafter in peace among themselves and with all the whites.'  Early Days of Klamath

Health Care Policy Supplement - "The last item listed today is Request #S2506 Listing of Recent Testimonies and Reports on Homeland Security and Terrorism. All other items on this specialized list pertain to an aspect of health care policy. Next week's list of Studies in the News will include the standard arrangement of topics of interest to policymakers. In the following weeks, separate supplements to Studies in the News will feature lists focused on the following issues: Children and Families; Employment and Workforce; and Environment and Natural Resources. Studies in the News and specialized supplements will alternate in order to reflect the quantity of material made available to the Legislature and the Governor's Office."    

Contents This Week

Introductory Material HEALTH
   Access to care programs
   Spread of drug-related AIDS
   Virus acts as AIDS treatment
   Caregivers training initiative
   Increasing dentists' participation in Medicaid
   States' experiences with SCHIP crowd out
   New options for children's health insurance
   Abuse of prescription drugs
   College athletes' substance abuse
   Emergency room diversions
   Oversight for edible shellfish
   Forecast for California health care
   State health care expenditures
   Health care improvement initiatives
   Budget changes regarding health care
   Neighborhood indicators of heart disease
   Quality of Internet health information
   Children at risk for lead poisoning
   Understanding Medi-Cal long-term care
   Community-based long-term care
   Managed care dental program evaluation
   Reforming Medicaid
   Discouraging Medicaid fraud
   Barriers to farm worker participation in Medicaid
   Diversifying the nursing workforce
   Nurses staffing survey analysis
   Nursing shortages in California
   Health privacy project
   Patient privacy issues
   DDT and pre-term births
   California physician workforce
   Survey of physician satisfaction
   Health plans delayed coverage of new drugs
   Prescription drug expenditures
   Formulary use and medication denials
   Perspectives on rising drug costs
   New policy options for drug coverage
   Mergers and drug costs
   Future shortages of flu vaccine
STUDIES TO COME
   Both boys and girls enter puberty earlier
   21st century health system
   Review of hospitals
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • Items in the State Library collection can be checked out to state officials and staff.

  • Access to all materials listed will be provided by the State Information Reference Center, either by e-mail to cslsirc@library.ca.gov or by calling 654-0261.

The following studies are currently on hand:

HEALTH

ACCESS TO CARE

California Program on Access to Care: Program Accomplishments: 1997 to 2000. By the California Policy Research Center, University of California Office of the President (The Center, Berkeley, California) 2001. 46 p.

["This report reviews CPAC's first three years of service to the California policy community, between 1997 and 2000.... The California Program on Access to Care is an applied policy research program established by the University of California at the request of the California State Legislature to address critical policy issues related to health conditions and access to health care for California's low-income populations."]

[Request #S2500]

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AIDS

Health Emergency 2001: The Spread of Drug-Related AIDS and Hepatitis C Among African Americans and Latinos. By Dawn Day, Dogwood Center. (The Center, Princeton, New Jersey) 2001. 29 p.

Full Text at: www.dogwoodcenter.org/whatsnew.html

["Sociologist and activist scholar Dawn Day points out in her report that more than half of HIV/AIDS deaths were caused by injections with contaminated needles.... The most immediate and effective plan for reducing the spread of HIV among injection drug users must include increasing access to sterile needles and syringes through free distribution programs." Pittsburgh Post-Gazette (March 6, 2001) A6.]

[Request #S2463]

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“Effect of Coinfection With GB Virus C on Survival Among Patients With HIV Infection.” By Jinhua Xiang and others. IN: New England Journal of Medicine, vol. 345, no. 10 (September 6, 2001) pp. 707-711.

["A harmless virus discovered in 1995 and carried by tens of millions of people worldwide appears to prolong the lives of people who are also infected with the AIDS virus. The microbe, called GB virus C, decreases mortality, slows damage to the immune system and even seems to boost the effects of AIDS drugs." Sacramento Bee (September 6, 2001) A7.]

[Request #S2464]

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CAREGIVERS

The Quest for Caregivers: Helping Seniors Age with Dignity. By the Employment Development Department. (The Department, Sacramento, California) 2001. Various pagings.

["California is facing a potential crisis in caring for the elderly as the over-65 population is expected to nearly double by 2020.... The Caregivers Training Initiative (CTI) focuses on the recruitment, training, and retention of direct caregiver occupations. The Initiative funds a series of regional partnerships to test service delivery methods."]

[Request #S2465]

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CHILDREN

Increasing Dentists' Participation in Medicaid and SCHIP. By Shelly Gehshan and others, National Conference of State Legislatures. Promising Practices Issue Brief. (NCSL, Denver, Colorado) 2001. 20 p.

["The report ... examines state efforts to encourage dentists to participate in Medicaid and the Children's Health Insurance Program. The survey revealed a wide range of issues being addressed in the states, including administrative simplification, expanding the use of dental hygienists, increasing outreach to providers and adjustment of reimbursement rates."]

[Request #S2466]

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Has the Jury Reached a Verdict? States' Early Experiences with Crowd Out under SCHIP. By Amy Westpfahl Lutzky and Ian Hill. An Urban Institute Program to Assess Changing Social Policies. Occasional Paper Number 47. (The Institute, Washington, DC) June 2001. 26 p.

Full Text at: newfederalism.urban.org/pdf/occa47.pdf

["This qualitative study examines how 18 states are addressing crowd out [SCHIP substituting for private health insurance coverage], the degree to which state officials perceive crowd out to be occurring, and the implications of crowd-out prevention strategies on enrollment."]

[Request #S2467]

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Exploring a New Option: Section 1115 Demonstration Waivers Under the State Children's Health Insurance Program. By Gabriela Alcalde, NCSL's Forum for State Health Policy Leadership. (NCSL, Denver, Colorado) April 2001. 35 p.

["This report provides background information on Section 1115 demonstration projects under SCHIP and provides general guidance for states that may consider this new alternative. Up-to-date information, current as of January 31, 2001, is presented and examples are included from states that have submitted proposals to HCFA."]

[Request #S2468]

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DRUG USE

Prescription Drugs Abuse and Addiction. By Alan I. Leshner. National Institute on Drug Abuse Research Report Series. (The Institute, Washington D.C.) April 2001. 12 p.

Full Text at: 165.112.78.61/PDF/RRPrescription.pdf

["The nonmedical use or abuse of prescription drugs remains a serious public health concern.... An estimated 9 million people ... used prescription drugs for nonmedical reasons in 1999; more than a quarter of that number reported using prescription drugs nonmedically for the first time in the previous year."]

[Request #S2469]

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NCAA Study of Substance Use Habits of College Student-Athletes. By the NCAA Research Staff. Presented to the Committee on Competitive Safeguards and Medical Aspects of Sports, National Collegiate Athletic Association. (The Association, Indianapolis, Indiana) June 2001. Various pagings.

Full Text at: www.ncaa.org/library/research.html

["Nearly 60 percent of college athletes use some form of nutritional supplement, and a steadily increasing number are using stimulants and other substances designed to improve their athletic performance, according to a survey.... Some of these supplements contain stimulants that are being investigated in the deaths of two college football players during the off-season." Chronicle of Higher Education Daily News (August 15, 2001) 3.]

[Request #S2470]

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EMERGENCY CARE

Emergency Room Diversions: A Symptom of Hospitals Under Stress. By Linda R. Brewster and others, Center for Studying Health System Change. Issue Brief No. 38. (The Center, Washington, DC) May 2001. 4 p.

Full Text at: www.hschange.org/CONTENT/312

["ER Overcrowding Spreads Into Crisis Territory: A report by a Washington-based health policy group found that 'serious threats to patient care are emerging'.... Researchers visited emergency rooms in 12 urban areas ... and found that the diversion problem is a symptom of a deeper crisis in the delivery of emergency care." Los Angeles Times (May 14, 2001) 1.]

[Request #S2471]

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FOOD SAFETY

Food Safety: Federal Oversight of Shellfish Safety Needs Improvement. By the U.S. General Accounting Office. GAO-01-702. (The Office, Washington, DC) July 9, 2001. 20 p.

Full Text at: www.gao.gov/cgi-bin/getrpt?gao-01-702

["GAO Seeks Better Shellfish Safety Rules; Report Finds the FDA's Lack of Staff and Regulations is Leaving Consumers At Risk: The report recommends that the FDA require processors to put in place new bacterium control techniques, such as cold pasteurization, and require handlers to refrigerate oysters after they are harvested." Los Angeles Times (July 20, 2001) A16.]

[Request #S2472]

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HEALTH CARE

View of the Future: Public Policy Environment and Update. By the California Healthcare Association. (The Association, Sacramento, California) 2001. 8 p.

["In 1999, CHA published California Health Care 1999-2005: View of the Future. That document examined trends in health care and what appeared to be their likely consequences as we entered the 21st century.... This report takes stock of the current public policy environment and selectively updates CHA's 1999 forecasts in several key areas for 2001-2005."]

[Request #S2473]

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HEALTH CARE FINANCING

1998-1999 State Health Care Expenditure Report. By Greg Von Behren and others, National Association of State Budget Officers. Prepared for the Milbank Memorial Fund. (The Fund, New York, New York) 2001. 185 p.

["This report places the state portion of public spending, and hence the influence of the states in health care markets, in perspective by cataloging the various forms of state health care purchasing -- from Medicaid to state employees' health benefits to state facility-based expenditures. It provides an overview of the states' role in health care both as purchasers of services and as employers."]

[Request #S2474]

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HEALTH CARE POLICY

Leading Well: Californians' Beliefs About Health Survey. By the California Center for Health Improvement. (The Center, Sacramento, California) [2001.] 6 p.

Full Text at: www.cchi.org/cgi-bin/cchi/default.asp

["The Center commissioned a statewide health survey designed to better understand the opinions of Californians about a range of health-related problems in their lives and communities, as well as the policies and programs they support to prevent these problems. That survey is the basis of this report."]

[Request #S2475]

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Health Policy Changes in the 2001-02 California Budget. By the California Budget Project. Prepared for the Medi-Cal Policy Institute. (The Institute, Oakland, California) July 2001. 4 p.

Full Text at: admin.chcf.org/documents/mcpi/MCPIBudgetSummary2001.pdf

["Medi-Cal Policy Institute Releases Analysis of Health Care Spending in 2001-02 Budget: Total state spending is set at $78.8 billion for the next fiscal year, and the spending plan appropriates $13.6 billion for health programs, an increase of 9.8% over current spending levels. According to the analysis, the new dollars will fund a 'variety of eligibility expansions, provider reimbursements increases and other program modifications.'" California Healthline (August 8, 2001) 1.]

[Request #S2476]

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HEART DISEASE

Neighborhood of Residence and Incidence of Coronary Heart Disease. By Ana V. Diez Roux and others. The New England Journal of Medicine. Volume 345:99-106, Number 2, July 12, 2001, 9 p.

["People in poor neighborhoods are more likely than those in well-to-do areas to have heart attacks, even when individual differences in income, education and occupation are taken into account." San Francisco Chronicle (July 12, 2001) A2.]

[Request #S2478]

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INFORMATION TECHNOLOGY

Proceed With Caution: A Report on the Quality of Health Information on the Internet: Report Summary. By the California Healthcare Foundation. (The Foundation, Oakland, California) May 2001. 96 p.

Full Text at: ehealth.chcf.org/view.cfm?section=Industry&itemID=3973

["Federal Health Web Sites Best, Study Says; Others Often Incomplete, Conflicting: Although the best information came from sites put up by the National Institutes of Health, no site received a perfect score. The researchers conclude that consumers are best off spending time at several sites and then discussing what they find with their doctor." San Francisco Chronicle (May 23, 2001) A3.]

[Request #S2479]

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LEAD POISONING

"Lead Poisoning: Getting a Handle on a Stubborn Public Health Problem." IN: State Health Notes. Vol. 22, No. 351 (June 18, 2001) pp. 1-2.

["Although blood lead levels are significantly lower than 15 years ago, 1.7 million kids -- a majority of them poor -- remain at risk for lead poisoning. Screening and treatment are spotty, but states are working to improve tracking, education efforts."]

[Request #S2480]

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LONG TERM CARE

Understanding Medi-Cal: Long-Term Care. By the Medi-Cal Policy Institute. (The Institute, Oakland, California) April 2001. 28 p.

["Medi-Cal is the primary funder of public long-term care services in California, spending more than $5 billion in 1998.... Beyond funding nursing home care, Medi-Cal covers a wide array of additional long-term care services, including personal care and chore services, in-home medical care, hospice, adult day health care, services for people with developmental disabilities, case management, and assistance with purchasing private long-term care insurance."]

[Request #S2481]

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Community-Based Long-Term Care. By Wendy Fox-Grage and others, Forum for State Health Policy Leadership, National Conference of State Legislatures. Promising Practices Issue Brief. (NCSL, Denver, Colorado) 2001. 12 p.

["Faced with increasing consumer demands and legal requirements such as the Supreme Court's Olmstead ruling, states are revamping their long-term care systems.... States are creating innovative service delivery models that enable such services to respond more quickly and flexibly to the needs of older people and people with disabilities. Among these models are consumer directed care, managed long-term care and enhanced respite care. These three emerging models are discussed in this paper."]

[Request #S2482]

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MANAGED CARE

Geographic Managed Care Dental Program Evaluation: Executive Summary. By William M. Mercer, Inc. Prepared for the Medi-Cal Policy Institute. (The Institute, Oakland, California) April 2001. 27 p.

Full Text at: admin.chcf.org/documents/mcpi/GMCDentalExecSumm.pdf

["Medi-Cal Policy Institute Report Analyzes Dental Programs: According to the report, the Geographic Managed Care dental program has a 'greater accountability for quality' of care than Denti-Cal, the state's larger Medicaid dental program. Denti-Cal, however, provides treatment 'more expeditiously.' Both programs also 'performed poorly' in providing preventive services." California Healthline (April 18, 2001) 1.]

[Request #S2483]

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MEDICAID

Reforming Medicaid: The Experiences of Five Pioneering States With Mandatory Managed Care and Eligibility Expansions. By Randall Brown and others, Mathematica Policy Research Center. Prepared for The Office of Strategic Planning, Health Care Financing Administration. (The Administration, Baltimore, Maryland) April 30, 2001. 124 p.

Full Text at: www.mathematica-mpr.com/PDFs/reformmed.pdf

["This report summarizes the findings of our 6-year evaluation of five Medicaid Section 115 demonstrations -- in Hawaii, Maryland, Oklahoma, Rhode Island and Tennessee -- that were initiated between 1994 and 1997. The evaluation ... assessed the impacts of the demonstrations on states, plans, providers, and beneficiaries. This document summarizes findings from 23 separate reports prepared by the evaluation team over the past six years.

[Request #S2484]

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MEDICAID: State Efforts to Control Improper Payments Vary: Report to the Chairman, Committee on Energy and Commerce, House of Representatives. By the U. S. General Accounting Office. (The Office, Washington, DC) June 2001. 69 p.

Full Text at: energycommerce.house.gov/107/reports/d01662.pdf

["'Medicaid is at risk for billions of dollars in improper payments' because states are not doing enough to control payment accuracy and fraud.... Although it is 'impossible' for states to check every claim and payment, the report found that 'lax administration' increases the risk of improper reimbursement.... But the report also found 'promising recent activities' to control improper payments."]

[Request #S2485]

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Removing Barriers to Farmworker Participation in SCHIP and Medicaid. By the National Center for Farmworker Health. (The Center, Austin, Texas) [2001.] 1 p.

Full Text at: www.ncfh.org/barriers.htm

["The low rate of farmworker participatiion is due to health systems problems in the regulation and administration of child health insurance programs that make it difficult for farmworkers to obtain or retain access to benefits.... Special efforts to remove access barriers are required at the national, state and community levels if the enrollment efforts are to be successful in allowing farmworker participation in both the State Child Health Insurance and Medicaid programs."}

[Request #S2486]

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NURSES

Diversifying the Nursing Workforce: A California Imperative. By Catherine Dower, California Workforce Initiative, UCSF Center for the Health Professions, and others. (The Center, San Francisco, California) February 2001. 52 p.

["The state faces severe nursing shortages; current projections based on population increases estimate that the state's demand for nurses will likely exceed supply by 25,000 over the next two decades. Perhaps more critical is the fact that some racial and ethnic groups are woefully underrepresented in nursing.... Future pools of potential nurses in California must include the racially and ethnically diverse population of young people in the state considering career options."]

[Request #S2487]

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Analysis of American Nurses Association Staffing Survey. Presented by Cornerstone Communications Group. (The Group, Warwick, Rhode Island) February 6, 2001. 20 p.; Appendices.

["Nearly 7,300 nurses took the opportunity to express their opinions about their working conditions and the current state of health care in America.... The survey featured questions relating to staffing and patient care [and] collected the demographics of the nurses answering the survey."]

[Request #S2488]

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Nursing In California: A Workforce Crisis. By Janet Coffman, UCSF Center for the Health Professions, and others. (The Center, San Francisco, California) January 2001. 92 p.

["For a host of complex and interrelated reasons, over the coming decades California may not have adequate numbers of nurses with appropriate skills.... This study is an effort to capture the complexity of the problem and to identify those longer-term strategies that can assist California in positioning nursing education, practice, and professionalism to meet the challenges of the coming years."]

[Request #S2489]

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PATIENTS' RIGHTS

Health Privacy Project. By Joanne Hustead and Joy Pritts, Institute for Health Care Research and Policy, Georgetown University. (The Institute, Washington, DC) 2001. Various pagings.

Full Text at: www.healthprivacy.org

[Includes: "Federal Health Privacy Rule Went Into Effect on April 14." "Myths and Facts About the Health Privacy Regulation." "Comments on Final Federal Standards For Privacy of Individually Identifiable Health Information." "Highlights of HIPAA Health Privacy Regulation." and others.]

[Request #S2490]

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"Bogus Scare Tactics Delay Medical-Privacy Reforms: Editorial." And "Opposing View: Review of Rules Necessary." By Mary R. Grealy, Healthcare Leadership Council. IN:USA Today (March 20, 2001) 11A.

["'Intense lobbying by groups that benefit from the status quo has delayed reforms' of patient privacy guidelines, and the Bush Administration's decision to review the federal privacy rules is 'compounding' that delay.... In an opposing op-ed, Mary Grealy writes that although leaders support strong protections of patient privacy, they do want to fix a number of problems posed by the rules." California Healthline (March 20, 2001) 1.]

[Request #S2491]

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PESTICIDES

"Association Between Maternal Serum Concentration of the DDT Metabolite DDE and Preterm and Small-for-gestational-age Babies at Birth." By Matthew P. Longnecker and others. IN: The Lancet, vol. 358, no. 9276 (July 14, 2001) pp. 110-118.

["Exposure of pregnant women to DDT, the 'highly effective' insecticide that is 'widely used in malaria-endemic areas' to kill mosquitoes, may increase the risk of preterm births, a 'major contributor to infant mortality,' according to a new study." Kaiser Daily Reproductive Health Report (July 17, 2001) 1.]

[Request #S2492]

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PHYSICIANS

The Practice of Medicine in California: A Profile of the Physician Workforce. By Catherine Dower and others, California Workforce Initiative, University of California, San Francisco. (The Initiative, San Francisco, California) February 2001. 61 p.

Full Text at: futurehealth.ucsf.edu/CWI/mdassess.html

["We present facts and figures and also provide some analysis of practice setting, physician organization, managed care involvement, Medi-Cal participation, financial incentives, earnings and physicians' experience of the practice climate in California.... The ratio of physicians to population has outpaced population growth in California over the past six years."]

[Request #S2493]

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And Then There Were None: The Coming Physician Supply Problem. By California Medical Association. (The Association, San Francisco) 93 p.

Full Text at: www.cmanet.org/upload/Physician_Supply_(Acrobat).pdf

["More than half of California's doctors say they are so frustrated with managed care they will quit, retire early or leave the state within three years... If even half the physicians who say they will retire early or leave do so, we will have unprecedented crisis in access to care. Respondents cited low payments from HMOs for their services and bureaucratic hassles as the primary source of frustration." Fresno Bee (July 17, 2001) A1.]

[Request #S2501]

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PRESCRIPTION DRUGS

Issues in Drug Benefit Management: What Will Be the Consequences of Health Plans' Coverage Delay of New Drugs? By Debi Reissman. IN: Drug Benefit Trends, vol. 13, no. 4 (2001) pp. 44-46.

["A new trend in prescription outpatient benefit designs is a clever little clause that is showing up under benefit exclusions. It reads 'newly approved pharmaceutical products are not covered until reviewed and approved by the Pharmacy and Therapeutics committee.'... The beauty of such a clause is that it allows the health plan time to fully review the product ... without having to pay for the product in the interim."]

[Request #S2494]

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Prescription Drug Use and Expenditures in California: Key Trends and Drivers. By Lori Bymark and Kevin Waite, AdvancePCS. Prepared for the California HealthCare Foundation (The Foundation, Oakland, California) April 2001. 44 p.

["The major causes of drug spending increases are generally recognized to be the increased availability of new drugs and the increased use of drugs (more prescriptions being filled each year). To explain these forces and explore meaningful solutions, the California HealthCare Foundation commissioned this analysis of the key trends and drivers affecting California's changing pharmaceutical utilization and costs."]

[Request #S2495]

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Prescription Drug Coverage and Formulary Use in California: Different Approaches and Emerging Trends. By William M. Mercer, Inc. Prepared for the California HealthCare Foundation. (The Foundation, Oakland, California) May 2001. 52 p.

["This report reviews prescription drug coverage and the use of formulary in California, and offers a forecast of future prescription drug benefit and formulary design possibilities. It brings together facts and opinions from published sources, national surveys, and stakeholder interviews with California health plans, national stand-alone PBMs with clients in California, California-based employer plan sponsors and employer coalitions, pharmaceutical companies, and industry experts."]

[Request #S2496]

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Causes and Cures: Stakeholder Perspectives on Rising Prescription Drug Costs in California. By Abt Associates, Inc. Prepared for Advance PCS, California HealthCare Foundation. (The Foundation, Oakland, California) April 2001. 44 p.

["Abt Associates interviewed 30 stakeholders across California who play a major role in defining the trends and in determining the future direction of prescription drug cost and use.... Each tends to blame the others for contributing to current conditions -- all agree that they must find a way to cooperate if workable solutions are to be found and implemented."]

[Request #S2497]

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California Analysis and Policy Recommendations. By the California Public Interest Research Group. (The Group, Sacramento, California) July 23, 2001. 8 p.

Full Text at: www.calpirg.org/reports/prescriptionpolicy.htm

["California's Vulnerable Senior Population Severely Impacted by the Rising Prescription Drug Costs: Prescription drugs have experienced the greatest annual cost increases over the last decade.... Out-of-pocket expenditures for prescription drugs are likely to double over the next five years.... The report is an extensive study, based on government and industry data and a freedom of information-obtained report from the National Institutes of Health."]

[Request #S2498]

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"Big Pharma:" Mergers, Drug Costs and Health Caregiver Staffing Ratios. By the Institute for Health & Socio-Economic Policy. (The Institute, Orinda, California) May 2, 2001. 125 p.

Full Text at: www.calnurse.org/cna/pdf/PharmaStudy.pdf

["This study explores the relationship between patient access, merger and acquisition activity within the pharmaceutical industry and health caregiver staffing ratios.... Increasing volume and values of pharmaceutical mergers and acquisitions may impact drug prices and drug prices will strongly influence hospitals to reduce caregiver to patient staffing ratios -- the national nursing shortage notwithstanding."]

[Request #S2499]

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VACCINES

Flu Vaccine: Supply Problems Heighten Need to Ensure Access for High-Risk People. By U.S. General Accounting Office. GAO-01-624 (The Office, Washington, DC) May 2001. 36 p.

Full Text at: www.gao.gov/new.items/d01624.pdf

["Report on Flu Vaccine Shortage Takes Government to Task: Last winter's flu vaccine shortage left many people most at risk for the flu unprotected, while government efforts to boost supplies came too late to be of help.... The study included a survey of 58 physician groups around the country to determine what impact the shortage had on patients." San Diego Union-Tribune (May 21, 2001) E3.]

[Request #S2502]

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STUDIES TO COME
[The following studies, reports, and documents have been ordered or requested, but have not yet arrived. Requests may be placed, and copies will be provided when the material arrives.]

ADOLESCENCE

“Have the Onset and Tempo of Puberty Changed?” IN: Archives of Pediatric and Adolescent Medicine, vol. 155 no. 9 (September 2001) pp. 988-989.

[“A new study suggests that boys in the United States, like girls, are entering puberty slightly earlier then previously thought, with African Americans the most likely to develop the first signs by age 10…. Potential reasons for earlier development include rising obesity rates, better nutrition, exposure to environmental chemicals that can mimic sex hormones and use of infant formula and other products containing soy, which also can mimic sex hormones.” Sacramento Bee (September 14, 2001) A7.]

[Request #S2505]

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HEALTH CARE REFORM

Crossing the Quality Chasm: A New Health System for the 21st Century. By the Committee on Quality of Health Care in America, Institute of Medicine. (National Academy Press, Washington, DC. 2001. 337 p. TC

Full Text at: www.nap.edu/books/0309072808/html/

["The report ... [which] was met with a unified front from physician groups ... says key things need to happen if health care quality is to substantially improve. It must become more patient centered, efforts should be focused on treating chronic conditions and technology must play a much more significant role in health care communications and delivery." American Medical News (March 19, 2001) 1.]

[Request #S2503]

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HOSPITALS

Results from the Patients' Evaluation of Performance (PEP-C) Survey: Executive Summary. 2001 Edition. By the California Institute for Health Systems Performance and the California Health Care Foundation. (The Institute, Oakland, California). 2001. 29 p.

["Hospitals Get Mixed Reviews: Patients in California hospitals usually receive needed pain medication, do not experience long waits and are treated with respect and care before surgery.... But the survey also found that many hospitals fail to sufficiently educate patients about medication or resuming day-to-day activities once they go home.... Though it may not be entirely representative of care in California hospitals, the survey is the best overall picture for consumers so far. Slightly less than a third of hospitals--which house 42% of the licensed beds in the state--responded to the survey." Los Angeles Times (August 29, 2001) B1.]

[Request #S2504]

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NATIONAL READER

NATIONAL READER

Listing of Recent Testimonies Reports on Homeland Security and Terrorism. Compiled Michael Pujals, California Research Bureau, California State Library. (CRB, Sacramento, California) September 2001. 4 p.

[Includes: "Aviation: Terrorist Acts Illustrate severe Weakness in Aviation Security;" "Combating Terrorism: Actions Needed to Improve DOD Antiterrorism Program Implementation and Management;" "Defending America: Terrorist Organizations and States and Weapons of Mass Destruction;" "Health Aspects of Biological and Chemical Weapons: Unofficial Draft;" "Homeland Defense: New Challenges for and Old Responsibility;" "Protecting the Homeland;" and others.]

[Request #S2506]

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