Bulletin of the New York Academy of Medicine最新文献

Far too many children in this country are unable to obtain the health care they need because of barriers that prohibit easy access. Among the most significant obstacles are financial barriers, including lack of adequate health insurance and inadequate funding of programs for low-income children and those with special health-care needs. Another set of "non-financial" barriers are related to the categorical nature of addressing children's health-care needs, which impedes access by increasing the complexity and burden of seeking care and discourages providers from providing care. Decategorization represents an appealing partial remedy to these problems because it can lead to fundamental and lasting changes in financing and delivering health services. The greatest appeal of decategorization is its potential to improve access to care with the expenditure of little or no new funds. Decategorization also holds considerable risk. Depending on how it is designed and implemented, decategorization may lead to diminished access to care by serving as a foil for budget cuts or by undermining essential standards of care. However, these risks do not negate the value of exploring decategorization as an approach that can be taken today to better organize services and ensure that existing resources adequately meet children's needs. In this report we examine the role of decategorization as a mechanism for removing the barriers to care that are created by categorical funding of health programs.

As the New York Academy of Medicine celebrates its 150th year as a leader in the field of urban health, it is instructive to review the events and decisions that influenced and shaped it. Since its inception, the Academy has taken an active role in lobbying state and local governments to enact more-effective public health laws and in educating the public about improving health conditions. During 1996 and 1997, the Academy Library's Historical Collections is mounting a series of six exhibitions that are intended to tell the story of public health in New York as influenced by the New York Academy of Medicine. The story will be told using printed books, pamphlets, posters, photographs, and manuscripts drawn from the Library's collections, as well as the Academy's archives. Each exhibition will highlight the Academy's accomplishments in the subject areas presented. In this article, we summarize all six of the exhibitions and offer an in-depth look at the first two exhibitions.

The Rochester Child Resilience Project is a coordinated set of studies of the correlates and antecedents of outcomes relating to resilience among profoundly stressed urban children. The studies have been conducted over the course of the past decade. Based on child test data, parent, teacher, and self ratings of child adjustment, and in-depth individual interviews with parents and children, a cohesive picture has developed of child and family milieu variables that consistently differentiate children with resilient versus stress-affected outcomes within this highly stressed sample. Resilient children are characterized by an easy temperament and higher IQ; sound parent/child relationships; a parent's sense of efficacy; the parent's own wellness, especially mental health; and the child's perceived competence, realistic control, empathy, and social problem-solving.