Trichinosis in Southeast Asian refugees in the United States.

Between 1975 and 1984, the incidence of trichinosis in the United States (per million person years at risk) was 25 times greater for the Southeast Asian refugee population than for the general United States population. Cases in the southeast Asian refugees differed from those reported previously in the general population in geographic distribution and source of infected meat. Cambodians and Laotians accounted for over 90 per cent of the cases in the Southeast Asian refugees, but comprised less than 50 per cent of that total population.     

Health status, use of health care resources, and treatment strategies of Ethiopian and Nigerian immigrants in the United States

Although different health risks and behaviors displayed by contemporary U.S. immigrants create challenges for health care providers, knowledge on the health of and variations among African immigrant groups in the United States lags behind. This study compared health status, use of health care resources, and treatment strategies of 362 Ethiopian and Nigerian immigrants. The results indicated that mental health and English-speaking ability varied by country of birth. Furthermore, the study sample reported a low use of health care resources. These results suggest the existence of potential health issues among subsections of the African immigrant population that may threaten the maintenance of good health.     

Health Status,Use of Health Care Resources,and Treatment Strategies of Ethiopian and Nigerian Immigrants in the United States

Although different health risks and behaviors displayed by contemporary U.S. immigrants create challenges for health care providers, knowledge on the health of and variations among African immigrant groups in the United States lags behind. This study compared health status, use of health care resources, and treatment strategies of 362 Ethiopian and Nigerian immigrants. The results indicated that mental health and English-speaking ability varied by country of birth. Furthermore, the study sample reported a low use of health care resources. These results suggest the existence of potential health issues among subsections of the African immigrant population that may threaten the maintenance of good health.     

Health care technology in the United States

The US health care system reflects the free market of the US economy--there is no fixed budget and no limit on expenditures in the loosely structured matrix of largely private-sector health industry components. Mainly because of the inaccessibility of adequate health care for a large segment of the population, and because of the enormous cost of care threatens financial ruin for many more people, the first major reform of the system was debated in Congress for most of 1994, though, in the end, no leglislation was passed. One focus of the debate on spending has been the problem of excessive use of expensive medical technology and the need for some control, which, by and large, is lacking in the existing system. Health care technology assessment itself is a thriving industry in the United States, used by government, insurers, medical societies, hospitals, and other groups for their own purposes. At the national policy level, few opportunities for technology assessment to affect the health care industry exist, so most effort is directed at trying to affect medical practice at the level of the individual hospital and practitioner. The discernible effect of technology assessment has been minimal.     

Health care reform in the United States

The need for change in the system of health care delivery in the United States has finally emerged as a political issue alongside continuing budget deficits, a growing national debt, declining educational outcomes, and decreased competitiveness of American business in the global economy. The two most pressing health care problems at the present time are rapidly increasing costs and lack of access to the system. A more distant but potentially more recalcitrant problem is the ageing of our population. This paper outlines and discusses some of the options for reform which are currently under consideration in the United States.     

Epidemiological patterns of scurvy among Ethiopian refugees

In the Horn of Africa, scurvy is a serious public health problem for refugees who are dependent on standard relief food (cereals, legumes, and oil). To assess the risk factors and to quantify the potential magnitude of scurvy among these displaced communities, we reviewed data collected from 1985 to 1987 by relief programmes in five refugee camps in Somalia and one in the Sudan. Outbreaks of clinical scurvy occurred among refugees in all the camps from 3 to 4 months after their arrival. The incidence of scurvy in two camps was, respectively, 14% over a period of 4 months and 19.8% over a period of 18 months. Prevalences of scurvy estimated from random population samples in the six study camps ranged from 13.6% to 44%. The risk of developing scurvy increased significantly with the length of time that refugees had been in the camps and was also significantly higher among those who were older and among females, particularly those of childbearing age. The prevalence of scurvy among refugees was similar, irrespective of whether or not they had attended supplementary feeding programmes. The control measures that were implemented had a moderate and slow impact on the disease. In both Somalia and the Sudan the relief food distributed to the refugees was almost completely deficient in vitamin C, while the environment where the camps were located precluded an adequate supply of fresh food. To avoid scurvy among refugee communities in this area of Africa it is therefore recommended that vitamin C supplements be added to the relief food at an early stage of a crisis.