Subject: Studies in the News 04-5 (January 27, 2004)


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


Contents This Week

Introductory Material HEALTH
   Behavior risks for adolescents
   HIV linked to subtle brain damage
   Antiobiotic used for Alzheimer's disease
   Cancer rates high in Marin
   Larger breast cancer tumors found
   Prevalence of diabetes
   Olmstead and California's long-term care
   Transitioning people with disabilities
   Preventing drug use among children and adolescents
   Computer based patient records
   Electronic medical records
   Guide to electronic medical records
   Medical insurance premiums rise
   Defibrillators in public locations
   National health information infrastructure
   Benefits of IT for health care
   Marijuana pill eases pain
   Premium support for Medicare
   States cutting mental health funding
   Youth in mental health programs
   Racial disparities in the quality of care
   Physician workforce
   Physician support for national health insurance
   Screening for Down's Syndrome
   Prescription drug use and cost
   Prescription drug profits benefiting companies
   Cigarette smoking and females
   Teen cigarette smoking and marijuana use
PREVIOUSLY IN STUDIES IN THE NEWS
   Studies in the News, October 2003
   Studies in the News, November 2003
   Studies in the News, December 2003
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

ADOLESCENCE

"Health and Behavior Risks of Adolescents with Mixed-Race Identity." By J. Richard Udry and others. IN: American Journal of Public Health, vol. 93, no. 11 (November 2003) pp. 1865-1870.

["Mixed-Race Students Report More Troubles: Students who consider themselves more than one race are more likely to feel depressed, have trouble sleeping, skip school, smoke and drink alcohol, [this] study says. Based on national surveys of 90,000 middle school and high school students, the study found that young people of mixed race are at higher risk for stress related health problems.... While the study suggests that mixed-race teenagers suffer more stress, it does not say why." CNN.com (November 1, 2003) 1.]

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AIDS

"Abnormal Contingent Negative Variation in HIV Patients Receiving Antiretroviral Therapy." By Linda Chao and others. IN: NeuroReport vol. 14, no. 16 (November 14, 2003) pp. 2111-2115.

["HIV Linked to Subtle Brain Damage: UCSF Study Finds Even Patients on Antiviral Drugs Are Affected: UCSF researchers have found hints that the AIDS virus can cause subtle damage to the brain even if the patients are using drugs that suppress the microbe below detectable levels.... It is unknown whether the abnormalities found by the brain scans were caused by the virus or the drugs used to treat it." San Francisco Chronicle (November 14, 2003) A5.]

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ALZHEIMER'S DISEASE

"Metal-Protein Attenuation with Iodochlorhyroxyquin(Clioquinol) Targeting AB(Beta) Amyloid Deposition and Toxicity in Alzheimer Disease: A Pilot Phase 2 Clinical Trial." By Craig W. Ritchie and others IN: Archives of Neurology, vol. 60, no. 12 (December 2003) pp. 1685-1691.

["Study: Shunned Antibiotic Promising vs. Alzheimer's: An antibiotic no longer in use may be resurrected as a treatment for Alzheimer's disease, according to new findings suggesting the drug may be able to dissolve the destructive plaques in the brains of Alzheimer's patients. The study is small and the results preliminary, but the experts say the drug, clioquinol, may be the first medication to strike at the heart of the disease." Sacramento Bee (December 16, 2003) A6.]

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CANCER

Marin Cancer Project: November 2002 Search for the Cause: Survey Results. By Linda L. Remy and others, Family Health Outcomes Project, University of California, San Francisco. (The Project, San Francisco, California) October 2003. 9 p.

Full Text at: www.marincancerproject.org/DOWNLOADS/NOV2002_SUM3.pdf

["Marin Cancer Rates High, Study Finds: Preliminary results from a new study examining cancer in Marin County show that the affluent Bay Area county's cancer rates are higher than a sampling of demographically similar counties across the nation.... Its breast cancer rate of 170 cases per 100,000 people was the highest among the 33 counties and its prostate cancer rate of 212 cases per 100,000 people was the second highest.... Future research will explore possible reasons to explain why cancer rates are higher." Contra Costa Times (November 2, 2003) F4.]

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"Trends in Breast Cancer by Race and Ethnicity." By Asma Ghafoor and others. IN: CA: A Cancer Journal for Clinicians, vol. 53, no. 6 (November/December 2003) pp. 342-355.

["More Large Tumors Found in Breast Cancer Patients: Experts are uncertain why this happened, but they speculate that obesity and hormone replacement therapy may have fueled the growth of larger cancers, even during a time when the discovery of small tumors rose dramatically.... The push during the 1990's to increase mammography may have led to the discovery of large tumors in those who had never been screened before." San Francisco Chronicle (November 18,2003) A2.]

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DIABETES

National Diabetes Fact Sheet. By Centers for Disease Control and Prevention. (The Centers, Atlanta, Georgia) November 2003. 8 p.

Full Text at: www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf

[”18.2 million U.S. residents have diabetes, including about 5.2 million people whose diabetes is undiagnosed.... The estimates are the highest ever, reflecting that ‘we are diagnosing more people who live with diabetes, and the overall prevalence of this disease continues to increase,’ (HHS Secretary Tommy) Thompson said. The report also found that among people who are at least 20 years old, diabetes affects 14.9% of American Indians and Alaska Natives, 11.4% of non-Hispanic blacks, 8.4% of non-Hispanic whites and 8.2% of Hispanics." California Healthline (November 14, 2003) 1.]

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DISABILITIES

The Olmstead Decision and Long-Term Care in California: Lessons on Services, Access, and Costs From Colorado, Washington, and Wisconsin. By Eliot Z. Fishman and others. (California HealthCare Foundation, Oakland, California) December 2003. 46 p.

Full Text at: www.chcf.org/documents/policy/OlmsteadLessonsForCalif.pdf

["Along with all other states, California is required to comply with the U.S. Supreme Court’s 1999 landmark Olmstead decision, which concluded that confining persons with disabilities in institutions without adequate medical reasons is a form of discrimination that violates the Americans with Disabilities Act. Instead, states must direct their health programs for persons with disabilities towards providing community-based care. This report finds that although California's long-term care system has distinct strong points, glaring problems will hinder the state’s ability to comply with Olmstead unless resolved."]

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An Overview of California's Draft Olmstead Plan: Transitioning Persons with Disabilities From Institutions to Community Settings Under U.S. Supreme Court Requirements. By Laurel Mildred, California Senate Office of Research. (The Office, Sacramento, California) October 2003. 18 p.

Full Text at: www.sen.ca.gov/sor/REPORTS/REPORTS_BY_SUBJ/HEALTH/OLMSTEADFYI102003.PDF

["The state's initial draft plan for determining how to serve people with disabilities in compliance with the Olmstead vs. L.C. decision was released in June by the California Health and Human Services Agency.... As this analysis is intended to show, the initial plan as proposed may not fully meet the court's guidelines for implementing its landmark 1999 ruling."]

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DRUG USE

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders. By the National Institute on Drug Abuse, U.S. Department of Health and Human Services. (The Institute, Bethesda, Maryland) October 2003. 50 p.

Full Text at: www.drugabuse.gov/pdf/prevention/RedBook.pdf

["The National Institute on Drug Abuse (NIDA) published the guide to share the latest NIDA-funded prevention research findings with parents, educators, and community leaders. The guide introduced the concept of 'research-based prevention' with questions and answers on risk and protective factors, community planning and implementation, and 14 prevention principles derived from effective drug abuse prevention research."]

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HEALTH CARE INDUSTRY

Use and Adoption of Computer-Based Patient Records. By David J. Brailet, Health Technology Center, and Emi L. Terasawa, CareScience. Prepared for the California HealthCare Foundation. (The Foundation, Oakland, California) October 2003. 42 p.

Full Text at: www.chcf.org/documents/ihealth/UseAdoptionComputerizedPatientRecords.pdf

["Much attention has been given to the adoption of computer-based patient records (CPRs) in hospitals, physician offices and ancillary care sites... Although multiple studies have been performed, their findings have been dissonant, and their methods unscientific.... Summarized here are the published reports about the adoption of CPRs by hospitals, physician groups, and ancillary care sites. This cohesive summary of studies may help clarify the debate so the public policy discussions can be based on reasonable facts about what and how CPRs are being used."]

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Electronic Medical Records: Lessons From Small Physician Practices. By Robert H. Miller and others, University of California, San Francisco. Prepared for the California HealthCare Foundation. (The Foundation, Oakland, California) October 2003. 30 p.

Full Text at: www.chcf.org/documents/ihealth/EMRLessonsSmallPhyscianPractices.pdf

["This project was designed to provide solo/small group physicians with practical information on electronic medical record (EMR) implementation and use. About 70 percent of active, practicing physicians in California work in solo/small groups of ten physicians or fewer, yet little has been published on their experience using EMRs. Understanding EMR use in solo/small groups also can help policymakers in government, employer coalitions, and public and private funding agencies to better craft policies to hasten EMR adoption."]

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Electronic Medical Records: A Buyer's Guide For Small Physician Practices. By Michael J. Barred and others, Forrester Research. Prepared for the California HealthCare Foundation. (The Foundation, Oakland, California) October 2003. 24 p.

Full Text at: www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf

["Increasing numbers of office-based doctors in smaller practices are deciding to buy electronic medical records (EMRs)... Equally important, new studies in journals are underlining the need for physicians to do a better job of reducing medical error rates in outpatient settings, as well as in hospitals. Another factor looming on the horizon is that health plans and large, self-insured employers are experimenting with bonus programs for doctors who document quality, which EMRs do quite well."]

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HEALTH INSURANCE

Employer Health Benefits: 2003 Annual Survey. By Gary Claxton and others, Kaiser Family Foundation. (The Foundation, Menlo Park, California) 2003.

["Medical Insurance Premiums Jump 14%: Those costs are increasingly shouldered by employees -- a trend predicted to continue unabated, according to the annual study of about 2,800 randomly selected small and large businesses ... Over the past three years, the amount workers pay for family premiums has jumped nearly 50 percent." Oakland Tribune (September 11, 2003) 1.]

Summary of Findings. 8 p.:
http://www.kff.org/insurance/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=20688

Complete Report. 165 p.:
http://www.kff.org/insurance/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=20672

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HEART DISEASE

"Cost-Effectiveness of Automated External Defibrillator Deployment in Selected Public Locations." By Peter Cram and others. IN: Journal of General Internal Medicine, vol. 18, no. 9 (September 2003) pp. 745-754.

["We sought to evaluate the cost-effectiveness of the American Heart Association recommendation and of automatic external defibrillator (AED)deployment in selected public locations with known cardiac arrest rates.... AED deployment is likely to be cost-effective across a range of public locations. The current guidelines are overly restrictive. Limited expansion of these programs can be justified on clinical and economic grounds."]

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INFORMATION TECHNOLOGY

How Information Technology Can Improve Health Care Quality: Core Lessons. By David Blumenthal, Institute for Health Policy, Massachusetts General Hospital/ Partners Health Care System, Inc. Prepared for the Alliance for Health Reform/Commonwealth Fund Roundtable. (The Alliance, Washington, DC) November 14, 2003. 2 p.

Full Text at: www.cmwf.org/programs/quality/afhrcmwf_itroundtablesum.pdf

["Establishing a national health information infrastructure is essential for achieving large-scale improvements in health care quality and realizing greater efficiencies in th U.S. health care system.... An array of leaders in industry and government examined real-world examples of IT-led improvements in health care quality, as well as the obstacles that currently limit broader adoption of such models."]

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Information Technology: Benefits Realized for Selected Health Care Functions. By the U.S. General Accounting Office. GAO-04-224. (The Office, Washington, DC) October 2003. 128 p.

Full Text at: www.gao.gov/new.items/d04224.pdf

["The 10 health care delivery organizations reported 13 examples of cost savings resulting from the use of IT, including reduction of costs associated with medication errors, communication and documentation of clinical care and test results, staffing and paper storage, and processing of information. Other benefits included improved quality of care [and others]."

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MARIJUANA

"Cannabinoids for Treatment of Spasticity and Other Symptoms Related to Multiple Sclerosis: Multicentre Randomised Placebo-Controlled Trial." By John Zajicek and others. IN: The Lancet, vol. 362, no. 9395 (November 8, 2003) pp. 1517-1526.

["Marijuana Pill Helpful in Easing MS Symptoms, Study Finds: A marijuana pill appeared to relieve some of the symptoms of multiple sclerosis in the first scientifically rigorous study of the strongly debated drug.... Patients reported improved sleep and fewer or less intense muscle spasms." San Francisco Chronicle (November 7, 2003) A8.]

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MEDICARE

Explaining Premium Support: How Medicare Reform Could Work. By Jeff Lemieux, Centrists.Org. (Centrists.Org, Washington, DC) November 6, 2003. Various pagings.

Full Text at: www.centrists.org/pages/2003/10/26_lemieux_health.html

["This report outlines the structure of a national (federal employees-style) premium support system in Medicare. It includes the basic rationale for premium support and a step-by-step example of how premiums would be calculated.... The Congressional role in Medicare would gradually shift from micromanagement to oversight and outcomes evaluation."]

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MENTAL HEALTH

“A Mental-Health Safety Net, Frayed and Torn As States Cut Funding for Mentally Ill: Patients Face a Care Crisis.” By Kris Axtman. IN: The Christian Science Monitor (November 14, 2003) A1.

[”Facing their ‘worst fiscal crises since World War II,’ 29 states during the last legislative session reduced spending on mental health care, and more cuts are under consideration, according to the National Alliance for the Mentally Ill. The impact of state cuts is already being felt. In Oregon, where the state budget for mental health services is currently being reduced by $200 million over the next two years, Oregon Health & Science University has experienced a 25% to 30% rise in its number of psychiatric patients.” California Healthline (November 14, 2003) 1.]

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Nearly 66,000 Youth Live in U.S. Mental Health Programs. By L.A. Warner and K.J. Pottick, Institute For Health, Health Care Policy, and Aging Research, Rutgers University. Latest Findings in Children's Mental Health. Vol. 2, No. 1. (The Institute, New Brunswick, New Jersey) Summer 2003. 2 p.

Full Text at: www.ihhcpar.rutgers.edu/

["Children in residential care facilities are 'system kids.' They live in mental health facilities and often shuttle in and out of the juvenile justice and child welfare systems and are -- separated from families and mainstream schools. Although their problems are usually severe and complex, most of these children could be helped to return successfully with timely, intensive care."]

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MINORITIES

"Patient-Physician Relationships and Racial Disparities in the Quality of Health Care." By Somnath Saha and others. IN: American Journal of Public Health, vol. 93, no. 10 (October 2003) pp. 1713-1719.

["We analyzed data from The Commonwealth Fund's 2001 Health Care Quality Survey to show that patient-physician interactions contribute to disparities in the quality of care between minority and white patients." Commonwealth Fund (December 10, 2003) 1.]

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PHYSICIANS

Physician Workforce: Physician Supply Increased in Metropolitan and Nonmetropolitan Areas But Geographic Disparities Persisted. By the U.S. General Accounting Office. GAO-04-124. (The Office, Washington, DC) October 2003. 36 p.

Full Text at: www.gao.gov/new.items/d04124.pdf

["The number of physicians in the United States increased about 26 percent from 1991 to 2001, twice as much as the nation's population.... Growth occurred in areas with relaltively low and high supplies of physicians per 100,000 people. The number of individual metropolitan and statewide nonmetropolitan areas with fewer than 100 physicians per 100,000 people decreased and more areas had at least 300 physicians per 100,000 people."]

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"Support for National Health Insurance Among U.S. Physicians: A National Survey." By Ronald Ackermann and Aaron E. Carroll. IN: Annals of Internal Medicine, vol. 139, no. 10 (November 18, 2003) pp. 795-801.

Full Text at: www.annals.org/cgi/reprint/139/10/795.pdf

["Nearly 40 million persons in the United States were without health insurance for all of 2000.... A survey was conducted to determine the general attitude of U.S. physicians toward the financing of national health care.... Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it."]

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PREGNANCY

"First-Trimester Screening for Trisomies 21 and 18." By Ronald Wapner and others. "Screening for Down's Syndrome -- Too Many Choices?" By Michael T. Mennuti and Deborah A. Driscoll. IN: New England Journal of Medicine, vol. 349, no. 15 (October 9, 2003) pp. 1405-1413; 1471-1473.

["Combined tests shown to better detect Down's Syndrome: A new combination of blood tests and ultrasound can detect fetuses with Down's Syndrome sooner and more accurately than standard U.S. screening tests, offering mothers-to-be ... more time to decide whether to end a pregnancy." Sacramento Bee, October 9, 2003. A12.]

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PRESCRIPTION DRUGS

"The Effect of Incentive-Based Formularies on Prescription-Drug Utilization and Spending." By Haiden A. Huskamp and others. IN: New England Journal of Medicine, vol. 349, no. 23 (December 4, 2003) pp. 2224-2232.

["A study found that when employers switch to a three-tier prescription drug plan that charges significantly more for brand-name medications, a disturbing number of people simply stop taking their blood-pressure and cholesterol pills instead of switching to cheaper varities." Oakland Tribune (December 4, 2003) 1.]

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61 Percent of Medicare's New Prescription Drug Subsidy Is Windfall Profit to Drug Makers. By Alan Sagar and Deborah Socolar, Health Reform Program, School of Public Health, Boston University. (The Program, Boston, Massachusetts) October 31, 2003. 24 p.

Full Text at: www.healthreformprogram.org/

["Medicare Bill Benefits Drug Companies, Health Insurers in Short Term: The Medicare Bill is intended to give 41 million Americans prescription drug coverage and is also a boon to the health industry.... An estimated 61.1 percent of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits." Associated Press (November 18, 2003) 1.]

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SMOKING

Making the Grade on Women's Health: Women and Smoking: A National and State-By-State Report Card. By National Women's Law Center and Oregon Health and Science University. (The Center, Washington, DC) 2003. 127 p.

Full Text at: www.nwlc.org/pdf/Women&SmokingReportCard2003.pdf

["This national and state-by-state evaluation of both smoking-related health status data and health policies addresses smoking as part of a comprehensive assessment of women's overall health. It presents background information on women and smoking [and] the national and state report cards and the federal policy agenda. The report provides information for policymakers, researchers, and others on the nation's progress in reaching key benchmarks related to women's health. The report also offers information on state policies and programs needed to reach those benchmarks." National Center for Maternal and Child Health's MCH Alert (October 31, 2003) 1.]

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Report on Teen Cigarette Smoking and Marijuana Use. By The National Center on Addiction and Substance Abuse, Columbia University and the American Legacy Foundation. (The Center, New York, New York) September 2003. 30 p.

Full Text at: www.casacolumbia.org/pdshopprov/files/teen_cigarette_smoking_and-marijuana_use_9_16_03.pdf

["Study Links Teen Use of Tobacco and Pot: The report said young cigarette smokers are 14 times more likely to try pot. Eighty-four percent of the kids who have tried marijuana have smoked cigarettes within the past 30 days. The study focusing on 12- to 17-year-olds also found those who smoke cigarettes are six times likelier to be able to buy marijuana in an hour or less." Find Law (September 16, 2003) 1.]

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PREVIOUSLY IN STUDIES IN THE NEWS
[This section links to items in Studies in the News since the last Environmental Supplement.]

HEALTH CARE

"Health." IN: Studies in the News, 03-68-71 (October 17 - 27, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0368.htm

[Includes: "Racial disparities in cancer screening;" "Health insurance for low-income children;" "Rating for HMOs;" "State Medicaid spending;" "Medi-Cal managed care for disabled adults;" "Economic perspectives on childhood obesity;" "Prescription drug discount cards;" "Issues related to the uninsured;" "Comprehensive asthma program;" "Impact of treating drug abusing offenders;" "Health care financing for retirees;" "Eligibility for critical access hospital program;" "Health care quality;" "Childhood predictors of Native American alcoholism;" "Heart disease treatments vary by race;" and others.]

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Health." IN: Studies in the News, 03-74 - 78 (November 7 - 21, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0374.htm

[Includes: "Roots of severe mental illness;" "Type 2 diabetes mellitus in children;" "Insured drive surge in emergency room visits;" "Uninsured workers at large firms;" "Federal Medicaid reimbursement for Native Americans;" "Adult disabled Medi-cal beneficiaries;" "Uninsured workers and the states;" "Health of older Callifornians;" "Access and quality of care among Hispanic populations;" "Medicare prescription drug benefits for retirees;" "Drug benefit for Medicare and Medi-Cal eligibles;" "Bioethics Advisory Commission's role;" "Court definition of disabled;" "Health insurance and immigrant children;" "Low-income children and health insurance;" "Health report cards for students;" "Children's emotional and behavioral problems;" "Pediatricians asked to address childhood obesity;" and others.]

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"Health." IN: Studies in the News, 03-80-86 (December 8 - 18, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0380.htm

[Includes: "Services for adults with disabilities;" "Health care costs continue double digit pace;" "Health coverage mandate challenges;" "ERISA conflicts with SB 2;" "New prescription drug initiative;" "Workers' chronic pain costly to employers;" "Role of U.S. government in health care;" "Reimbursement for immigrant health services;" "Provisions for free hospital care;" "Coverage of the uninsured;" "Effect of uninsured on hospital use;" and others.]

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