Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.92.9.1421

Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting

We use the 1990 National Health Interview Survey supplement on Family Resources to examine the health care utilization patterns of immigrant and native-born adults in the United States. We modify a standard health care utilization framework by including duration of residence in the United States and measures of immigrant adaptation and family health context to model both the probability and number of physician contacts in the previous year. We find that duration of residence has a strong effect. Recently-arrived immigrants are much less likely to have had a contact in the previous year and had fewer contacts than either native-born or longer-term immigrant adults. Once the measures of adaptation--age at immigration and language of survey interview--are included, immigrants who have been in the United States for 10 years or more are not statistically different from the native-born. Family characteristics, including measures of exposure to the formal health care system, slightly reduce the size of the effects but do not alter the basic relationship between duration of residence and health care utilization. These results suggest that, net of socioeconomic characteristics, access to health insurance, and differences in morbidity, recent immigrants are much less likely than both the native-born and those immigrants of longer duration, to receive timely health care.

https://www.jstor.org/stable/pdfplus/2137215.pdf

Health care utilization, family context, and adaptation among immigrants to the United States.

No real progress towards equity: Health of migrants and ethnic minorities on the eve of the year 2000

Research has shown that Latinos average fewer physician visits per year than other ethnic groups.1,2 Many factors may contribute to Latinos' lower use of physician services, including lower rates of health insurance coverage,3 lower levels of income and education,3,4 and limited English proficiency.5–7 One study found that Latinos with limited English proficiency reported fewer visits than native English-speaking patients,8 while an analysis of the 1987 National Medical Expenditure Survey found that insurance was the predominant determinant of the number of physician visits and inability to speak English was not a significant predictor of physician visits.9

Patients with limited English proficiency may also utilize health care less because of dissatisfaction with the health care they have received in the past. Baker et al. found that Latino patients who communicated through an interpreter or who did not have an interpreter when they thought one was necessary were less satisfied with the patient-provider relationship.10 Similarly, Carrasquillo et al. reported that emergency department patients who said that English was not their first language were less satisfied overall and reported more communication problems.11 There may also be differences in how physicians care for Latino patients, and this may affect their satisfaction and future health care use. Todd et al. reported that Hispanics with isolated long-bone fractures were twice as likely as non-Hispanic whites to receive no pain medication in an emergency department.12

Latinos with limited English proficiency may also be less likely to receive follow-up appointments after an initial physician visit because of discrimination, communication barriers leading to misdiagnosis or lack of awareness of a problem, or even physician frustration over difficulty communicating. To our knowledge, no study has investigated the effects of limited English proficiency or communicating through an interpreter on physician referral patterns. Finally, Latinos with limited English proficiency might be less likely to comply with referral appointments because of dissatisfaction, or poor understanding of the reason for the referral, or simply because they are unaware that they are supposed to have a follow-up appointment. Manson found that asthmatic patients receiving extended follow-up care in an ambulatory care setting from a language-discordant physician were more likely to miss office appointments than were patients with a language-concordant physician.13 To further examine these issues, we conducted this study to determine the association between language barriers and (1) rates of referral for a follow-up appointment after an emergency department visit, (2) patients' knowledge that an appointment had been scheduled, and (3) actual compliance with scheduled follow-up appointments.

/pdf/effect-of-language-barriers-on-follow-up-appointments-after-1z6qgyuu2y.pdf

Effect of language barriers on follow-up appointments after an emergency department visit.

For two decades, the State of the Art series has provided comprehensive reviews of important topics in respiratory and critical care medicine. These articles have served as reference documents not only to pulmonologists, but also to the general medical community. The length of States of the Art necessary to adequately review broad topics in-depth have required that the articles often are published in sections in successive issues of the journal. The present State of the Art summarizes and interprets the available data concerning the respiratory health of minority populations in our country. This important topic has not received appropriate attention in the past, perhaps due to the lack of available data and a failure to appreciate the diversity of respiratory health in different segments of the population. Because of its importance, this State of the Art is published in toto in a separate binding so that it will be a convenient reference document that presents current information in a single source.

Respiratory Diseases in Minorities of the United States

Objective. —To examine the determinants of health insurance coverage for Latinos in the United States and how different targeted strategies for health care reform differentially affect the country's major ethnic groups, focusing on the implications for the Latino population. Design. —Data from the 1980 and 1990 Current Population Surveys were used to compare the insurance status of nonelderly ( Main Outcome Measures. —Percentage uninsured, percentage insured by Medicaid, and attributable fraction for covariates. Results. —Latinos have the worst health insurance coverage of any ethnic group in the country. Approximately 39% of Latinos are uninsured compared with 13.8% for the Anglo and 24% for the black population. Providing coverage to all the poor could reduce the uninsured rate for Anglos by about 23%, whereas the reduction among Latinos could be about 37% and among blacks about 42%. Similar reductions could be achieved by covering all workers and their minor dependents. Regardless of the approach to reform, however, Latinos would remain with high absolute rates of uninsured. Conclusions. —Differences in Medicaid eligibility, labor force characteristics, and family composition between Latinos and other ethnic groups suggest that policy initiatives may affect Latinos differently. Targeted strategies, such as employer mandates, "pay-or-play" programs, or Medicaid expansions, can improve coverage, but many Latinos could still remain uninsured. (JAMA. 1993;269:889-894)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=403562&pdfFileName=jama_269_7_031.pdf

Insuring Latinos Against the Costs of Illness

A GM cryocooler with new cold helium circulation system has been developed at Cryomech. A set of check valves connects to the cold heat exchanger to convert a small portion of AC oscillating flow in the cold head to a DC gas flow for circulating cold helium in the remote loop. A cold finger, which is used for remote cooling, is connected to the check valves through a pair of 5 m long vacuum insulated flexible lines. The GM cryocooler, Cryomech model AL125 having 120 W at 80 K, is employed in the testing. The cold finger can provide 50 W at 81 K for the power input of 4.1 kW and 70.5 W at 81.8 K for the power input of 6 kW. This simple and low cost design is very attractive for some applications in the near future.

/pdf/a-gm-cryocooler-with-cold-helium-circulation-for-remote-4wppof0wif.pdf

A GM cryocooler with cold helium circulation for remote cooling

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Insuring Latinos Against the Costs of Illness

A GM cryocooler with cold helium circulation for remote cooling