Subject: Studies in the News 03-53 (August 18, 2003)

Studies in the News
Health Care Supplement

Contents This Week

Introductory Material HEALTH
   Health care access gap
   Hormone therapy and Alzheimer's
   Drug treatment for prostate cancer
   Human embryo research
   National trauma data bank report
   Consumer health and nutrition initiative
   Rising health care cost in U.S.
   Improving quality of care
   Employment-based health insurance is failing
   Federal guidelines for prehypertension
   Medical errors and system safety
   State grades on infant hearing screening
   Global health challenges
   Investing in healthcare information technology
   Many lack health insurance
   Independence plus initiative
   Language barrier in health services
   Survey of HMO enrollees
   Decline in Medicaid use by noncitizens
   Medi-Cal enrollment barriers
   California skilled nursing industry
   National birth rate data
   Prescription drug savings for uninsured seniors
   Prescription drug price control
   Public health laboratories unprepared
   School-based health insurance
   Health centers at schools
   Cigarette taxes and revenue
   Influences in adolescent smoking
   Impact of father absence
   Cost of covering the uninsured
   Young adults uninsured
   TANF and women's health
   Studies in the News, June 17, 2003
   Studies in the News, July 3, 2003
   Studies in the News, July 16, 2003
   Studies in the News, July 29, 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 or by calling 654-0261.

The following studies are currently on hand:



Does the Health Care Safety Net Narrow the Access Gap? By Brenda Spillman and others, Urban Institute. Discussion Paper 03-02. (The Institute, Washington, DC) April 2003. 38 p.

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["This study examines the role of the health care safety net in increasing utilization and access for uninsured adults and narrowing the gap between the uninsured and the insured.... We estimate how insurance coverage, safety net capacity, and safety net stresses are related to physician and emergency room visits, hospital use, usual source of care, and confidence.... Our results suggest that expanding insurance coverage would be more effective as a means of increasing use and access among low-income adults than expanding the safety net."]

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“Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women: The Women's Health Initiative Memory Study: A Randomized Controlled Trial.” By Sally A. Shumaker and others. IN: Journal of American Medical Association: JAMA, vol. 289 no. 20 (May 28, 2003) pp. 2651-2662.

[“Hormone therapy doubled the risk of Alzheimer’s disease and other types of dementia in a large study of women who began the treatment at age 65 or older, researchers are reporting today. The findings disappointed many researchers and doctors who had hoped for the opposite result, that hormone therapy would prevent Alzheimer’s disease.” Sacramento Bee (May 28, 2003) A1.]

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The Influence of Finasteride on the Development of Prostate Cancer." By Ian M. Thompson and others. IN: New England Journal of Medicine, vol. 349 no. 3 (July 17, 2003) pp. 215-224.

["A drug that doctors had hoped might prevent prostate cancer had been found to be both more effective and potentially more dangerous than expected." Sacramento Bee (July 25, 2003) A1.]

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"Cryopreserved Embryos in the United States and Their Availability for Research." By David Hoffman and others. IN: Fertility and Sterility, vol. 79, no. 5 (May 2003) pp. 1063-1069.

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["The team designed and implemented a survey to determine the number and current disposition of embryos frozen and stored since the mid-1980s at fertility clinics in the United States and the number of those embryos designated for research.... The results show that as of April 11, 2002, a total of 396,526 embryos have been placed in storage." Rand Law & Health Research Brief (May 2002) 1.]

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National Trauma Data Bank Report 2002. By American College of Surgeons (The College, Chicago, Illinois) 2003. 57 p.

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["While one-fifth of the nation's trauma patients remain uninsured, congressional appropriations to trauma facilities have been substantially less than original estimates and should be increased to provide a more organized system for emergency care, said the American College of Surgeons." Health Care Policy Report, (June 2, 2003) P. 732]

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Consumer Health Information for Better Nutrition Initiative: Task Force Final Report. By U.S. Food and Drug Administration. (The Administration, Washington, DC) 2003. Various pagings.

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["Food producers will be given more leeway to make claims about the health benefits of their products, the government said as it announced a far-reaching policy shift presented as giving shoppers information they can use to make smarter choices at the supermarket. Under the plan, companies would be allowed to petition the Food and Drug Administration for approval to make health claims based on a wide range of evidence" Sacramento Bee (July 11, 2003) 1.]

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American Health Care Why So Costly. By Karen Davis and Barbara S. Cooper. The Commonwealth Fund. (The Fund, New York, New York) June 2003. 33 p.

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[“Rising health care costs are of concern to policymakers, employers, health care leaders, and insured and uninsured Americans. The U.S. had relied on a mixed public-private system of insurance, managed care, and market competition to shape the health care system. Yet, the U.S. has the highest health care spending per capita in the world, and during the 1990’s health spending in the U.S. rose faster than in other industrial nations.”]

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“Improving the Quality of Care — Can We Practice What We Preach?” By Earl P. Steinberg. IN: New England Journal of Medicine, vol. 348 no. 26 (June 26, 2003) pp. 2681-2683.

[“Americans have a slightly better than 50-50 chance their medical problems will be addressed in an optimal way when they visit a doctor’s office or enter a hospital, according to a new survey. The study … sketches a dark and disturbing portrait of American health care. It adds to the rapidly growing body of research showing a huge gap between what is known by medical scientists and what is done by medical practitioners.” Washington Post (June 26, 2003) A2.]

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Employment-Based Health Insurance is Failing: Now What? By Alain Enthoven, Stanford University. IN: Health Affairs vol. 22, no. 3 (May/June 2003) 13 p.

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["In a paper ... Stanford University professor Alain C. Enthoven said his aim is for employers to increase competition by offering employees a wide choice of health insurance carriers and plan designs while making employees responsible for making up premium differences associated with higher-cost offerings." Health Care Policy Report (June 2, 2003) 733]

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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. By National Heart, Lung and Blood Institute. (The Institute, Washington, DC) May 2003. 52 p.

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["As many as 45 million Americans who once thought they had normal blood pressure in fact are 'prehypertensive' and need to take steps to bring it down, according to new federal guidelines.... Hypertension is the most common chronic health condition in America, affecting about 50 million people." San Francisco Chronicle (May 15, 2003) A1.]

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"Medical Errors & System Safety: State Strategies to Avoid 'Blame Game.'" By Kala Landenheim. IN: State Health Notes, vol. 24, no. 398 (June 16, 2003) pp. 1, 5-6.

["A growing number of states have put in place hospital reporting programs. Now, there's a new generation of initiatives aimed at making the system less error-prone, and technology is a key ingredient."]

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State Report Card: Listen Up! Is Your State Making the Grade on Infant Hearing Screenings? By the National Campaign For Hearing Health (The Campaign, Washington, DC) May 2003.

["The fourth annual state-by-state report card releases the 2003 findings to promote awareness, advocacy, education, and legislation related to the number one birth defect in the United States -- hearing loss. The report card includes information on the total number of births in each state, the percentage of infants screened for hearing loss in each state, and which states have policies or mandates supporting early hearing loss detection and intervention." MCH Alert (July 25, 2003).]

Report Card 2 p.:

Map 1 p.:

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Global Health: Global Fund to Fight AIDS, TB and Malaria Has Advanced in Key Areas, but Difficult Challenges Remain. By the U.S. General Accounting Office. (The Office, Washington, DC) May 2003. 75 p.

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["By the end of 2002, more than 40 million people worldwide were living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), with 5 million newly infected that year. HIV/AIDS, along with tuberculosis (TB) and malaria, causes nearly 6 million deaths per year and untold human suffering. Established in January 2002, the Global Fund aims to rapidly disburse grants to augment existing spending on the prevention and treatment of these three diseases while maintaining sufficient oversight of financial transactions and program effectiveness. As of April 1, 2003, the United States had pledged $1.65 billion to the Fund and is expected to remain its single larges donor."]

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Spending Our Money Wisely: Improving America's Healthcare System By Investing in Healthcare Information Technology. By Molly Joel Coye, Health Technology Center; and others (The Center, San Francisco, California) April 2003. 39 p.

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["The U.S. health care system lacks proper resources in information technology and should create revolving loan fund programs similar to federal government initiatives designed to provide states with money for local transportation and environmental needs, according to a report released by the nonprofit Health Technology Center." Health Care Policy Report vol.11, no.22 (June 2, 2003) 734]

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How Many People Lack Health Insurance and For How Long? By Lyle Nelson. Congressional Budget Office. (The Office, Washington, DC) May 12, 2003. Various pagings.

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["Nearly 60 million people lack health insurance at some point in the year.... The report said 57 million people ... lacked insurance at some time in 1998, the most recent year for which reliable comparitive figures were available.... At the same time, the budget office said, government surveys suggest that the number of people uninsured for the entire year was 21 million to 31 million, or 9 to 13 percent of nonelderly Americans." New York Times (May 13, 2003) 1.]

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Long-Term Care Waivers and the Independence Plus Initiative. By Jody Ruskamp, National Conference of State Legislatures. Legisbrief. Vol. 11, No. 29. (NCSL, Denver, Colorado) June/July 2003. 2 p.

["States spend at least a third of their Medicaid budgets on long-term care for the elderly and people with disabilities.... The new federal Independence Plus Initiative gives states tools to create programs that allow people with disabilities and their families to decide how to use community-based services."]

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HMO Services in Other Languages: A Portrait of California Health Plans and Linguistic Services for Limited English Proficient Members. By Cori Reifman and Cheri Agonia, Office of the Patient Advocate, Business, Transportation and Housing Agency. (The Office, Sacramento, California) April 2003. 150 p.

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["The new study surveyed the state's largest HMOs and other health-care providers on language and cultural issues and identified areas where language is still a formidable hurdle for patients. The survey found that translation services vary widely and are not always available in hospitals, where they can be critical....The state managed care department will seek two key changes in language regulations, partly as a result of the survey. Los Angeles Times (May 23, 2003) B6.]

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Profile of California HMO Enrollees: Findings from the 2001 California Health Interview Survey. By Gerald Kominski, and others, UCLA Center for Health Policy Research. (California Office of the Patient Advocate, Sacramento, California) January 2003. 62 p.

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["A study released by the state's Office of the Patient Advocate found that communication is a barrier to getting quality health care for many Californians, and the problem isn't confined to non-English-speaking minority groups. The problem is just as big for English speakers, according to the report....'HMOs are very complicated, and learning to use the system is difficult for anyone,' said Ed Mendoza, acting director of the OPA. 'Even when they send out handbooks to explain, 92 percent of the material is written at a college level or higher.'" Stockton Record (June 2, 2003) 1.]

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The Decline in Medicaid Use by Noncitizens Since Welfare Reform. By Marie Wang and John Holahan, the Urban Institute (The Institute, New York, New York ) 2003. 6 p.

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["The percentage of noncitizens receiving Medicaid coverage has declined as intended by the enactment of the 1996 welfare reform law limiting noncitizens' access to entitlement programs, according to a report from the Urban Institute. In contrast, Medicaid enrollment for native-born U.S. citizens increased during years 2000 to 2001, while enrollment stayed constant for noncitizens." Health Care Policy Report vol.11, no.22 (June 2, 2003) pg. 731.]

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Simplifying Medi-Cal Enrollment: Opportunities and Challenges in Tight Fiscal Times. By Medi-Cal Policy Institute. (California Healthcare Foundation, Oakland, California) June 2003. 12 p.

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["According to a recent survey of California residents, some 820,000 people may be eligible for Medi-Cal ... but are currently uninsured. Two recent surveys of this population found that the complexity of the enrollment process is a primary barrier to enrollment."]

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The Financial Health of the California Skilled Nursing Industry. And The Financial Health of the California Skilled Nursing Industry: Briefing Book. By Shattuck Hammond Partners LLC. Prepared for the California Healthcare Foundation . (The Foundation, Oakland, California) May 23 2003. Various pagings.

["California's nursing home industry is at a critical juncture.... This study seeks to provide an objective assessment of the financial performance of the skilled nursing industry in California.... We highlight some critical public policy issues and provide financial context for the decisions that industry leaders, policy makers, and patient advocates must make to resolve these challenges."]

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Births: Preliminary Data for 2002. By Brady E. Hamilton and others. National Vital Statistics Reports. Vol. 51, No. 11. (National Center for Health Statistics, Hyattsville, Maryland) June 25, 2003. 20 p.

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["The CDC's latest report indicates that the U.S. birth rate fell to the lowest level since national data collection began. The rate of teen births fell to a new record low, but the percent of low birth-weight babies increased to 7.8 percent, the highest level in more than 30 years. More than one-third of all births were to unmarried women." Connect for Kids (June 30, 2003).]

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PBM-Administered Prescription Drug Discount Cards: Savings For Uninsured Seniors. By Cindy Parks Thomas and others, Brandeis University Schneider Institute For Health Policy (Pharmaceutical Care Management Association, Arlington, Virginia) March 11, 2003. 16 p.

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["Using data derived from more than 3 million reimbursement claims the study showed that the average discount seniors received for brand-name drugs was $11, or 14 percent per prescription. The average discount for generic drugs was $7, or 26 percent for each prescription." Health Care Policy Report (March 17, 2003) p. 371.]

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This Is Maine On Drugs: If You Love Rent Control, You'll Die for Drug Price Controls. By Ronald Bailey. IN: Reason (May 21, 2003) [online.]

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["The Supreme Court ruled that Maine can essentially set the prices its residents pay for prescription drugs. The confused court decision -- justices issued four different mutually conflicting opinions -- allows the Pine Tree State to require that pharmaceutical companies offer their drugs to qualifying citizens at the same discounted prices that Maine Medicaid recipients receive."]

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Public Health Laboratories: Unprepared and Overwhelmed. By Trust for America's Health (The Trust, Washington, DC) June 2003. 28 p.

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["Despite repeated warnings by the Bush administration that chemical agents are among the most readily available terrorist weapons, the nation's public health laboratories are "dangerously unprepared" for a chemical attack, according to a state-by-state analysis. The vast majority of labs do not have the equipment or expertise to identify a wide range of potential chemical weapons, including ricin, cyanide, sarin, VX and most pesticides, the nonprofit, nonpartisan Trust for America's Health reported." The Washington Post (June 4, 2003) A11.]

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Building for a Healthy Future: Sustaining School-Based Enrollment in Health Insurance Programs. By Michelle Harper. (Consumers Union, ) May 2003. 58 p.

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["Children need to be healthy to attend school regularly and succeed academically, so schools are a natural base for outreach activities to help eligible students enroll in state-sponsored health insurance programs. Given tight finances, this Consumers Union report describes how four California initiatives -- Healthy Start, Proposition 10, School Lunch Programs, and health coordinators -- can be used as platforms to fund and support school-based health insurance outreach, enrollment, and utilization activities." Connect for Kids (July 7, 2003)]

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School-Based Health Centers: Surviving A Difficult Economy. By Jane Koppelman, with Annette Ferebee and Nancy Eichner, the Center for Health and Health Care in Schools, Georgetown University. (The Center, Washington, DC) June 2003. 6 p.

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["This paper examines the status of state funding sources that school-based health centers have come to rely on and considers lessons that might be drawn from states where, despite fiscal crises, the centers have survived and, in some cases, have forged ahead. Finally, the brief concludes with suggestions for stabilizing funding." CA's Healthy Start - Resource Update (July 29, 2003) online.]

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State Cigarette Excise Taxes: Implications for Revenue and Tax Evasion: Final Report. By Matthew C. Farrelly and others, RTI International. Prepared for the Tobacco Technical Assistance Consortium, Rollins School of Public Health. (The Consortium, Atlanta, Georgia) May 2003. 26 p.

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["State cigarette excise taxes have long been used to raise revenue, curb smoking, and fund tobacco prevention and smoking cessation programs.... To better inform the debate over excise tax increases and their impact on revenue and tax evasion, we examine the impact of tax increases on cigarette sales and revenue from recent state experiences."]

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Effect of Viewing Smoking in Movies on Adolescent Smoking Initiation: A Cohort Study. By Madeline A Dalton and others. IN: Lancet, vol. 361, no. 9374 (June 10, 2003) Various pagings.

[“Teenagers are significantly more likely to start smoking if they watch movies featuring stars who smoke cigarettes, and teens whose parents don’t smoke are the most likely to be swayed by actors lighting up onscreen. According to a study … teens who watched the most movies with smoking were almost three times more likely to start smoking than those who watched the fewest number of movies with smoking.” Washington Post (June 10, 2003) 1.]

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"Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy?" By Bruce J. Ellis and others. IN: Child Development, vol. 74, no. 3 (May/June 2003) pp. 801-821.

["Father absence was an overriding risk factor for early sexual activity and adolescent pregnancy. Conversely, father presence was major protective factor against early sexual outcomes, even if other risk factors were present. These findings may support social policies that encourage fathers to form and remain in families with their children."]

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"Covering the Uninsured: How Much Would it Cost?" By Jack Hadley and John Holahan, The Urban Institute. IN: Health Affairs (June 4, 2003) [online.]

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["The cost of health coverage for all uninsured U.S. residents 'may be relatively small or at least a very worthwhile investment' and would add at least 3% to 6% per year to total U.S. health care expenditures, according to this study. This study shows that the direct cost of providing care to the 41 million uninsured would be less than the annual inflation in health spending -- 8.7% in 2001 -- but would still require a commitment of new resources in a time of fiscal deficits." California HealthLine (June 5, 2003).]

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Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help. By Sara R. Collins and others. The Commonweatlth Fund. (The Fund, Washington, DC) May 2003. 8 p.

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["Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health insurance in the United States. Often dropped from their parents' policies or public insurance programs at age 19 or on graduation day, young adults are left to find insurance on their own.... New analysis ... reveals that nearly two of five college graduates and one-half of high school graduates who do not go on to college will endure a time without health insurance in the first year after graduation. Moreover, if past patterns continue, two-thirds of all young adults ages 19 to 23 today are likely to lack insurance at some point over the next four years."]

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Welfare, Women, and Health: The Role of Temporary Assistance for Needy Families. By Jodie Levin-Epstein, Center for Law and Social Policy. Prepared for the Kaiser Family Foundation. (The Foundation, Menlo Park, California) April 2003. 12 p.

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["Women comprise 90 percent of the adult caseload receiving welfare assistance through the TANF program. TANF’s influence on women’s health and well-being is broad and is driven by multiple aspects of the program, including access to health insurance, work requirements and training options, links to health care services, and reproductive health provisions. This issue brief reflects on lessons learned from recent research on the connection between welfare policies and low-income women’s health."]

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[This section links to items in Studies in the News since the last Environmental Supplement.]


"Health." IN: Studies in the News, 03-39 (June 17, 2003).

[Includes: "Growth of autistic disorders;" "Public hospital crisis;" "Personal income shifts;" "Nursing home allotments to states;" and others.]

[Request #S8857]

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Health." IN: Studies in the News, 03-42 (July 3, 2003).

[Includes: "Most expensive operating rooms;" "Proposed Medi-Cal reductions;" "California nursing homes in jeopardy;" "Tobacco policy making in California;" and others.]

[Request #S8858]

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"Health." IN: Studies in the News, 03-46 (July 16, 2003).

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[Includes: "Quality of care for adults;" "Availabilty of SCHIP funds;" "Gaps in California's emergency rooms;" "Universal health care;" "Physician participation in Medi-Cal;" "Medicare presciption drug benefit;" and others.]

[Request #S8859]

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"Health." IN: Studies in the News, 03-48 (July 29, 2003).

[Includes: Genetic signs of autism;" "Autistic spectrum disorders increasing;" "Caffeine and kid's health;" "Breast cancer treatment;" "HMO's profitability and premiums;" "Patient satisfaction with California hospitals;" "Disputing malpractice lawsuits;" "California nursing shortage;" and others.]

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