Although 97%-98% of children in the United States are vaccinated before or shortly after starting school, the proportion of preschool children who have completed a full series for all recommended vaccines is considerably lower. Although low immunization coverage among preschoolers has been attributed to difficulties in reaching certain groups, such as the urban poor and racial and ethnic minorities, more recent evaluations suggest that the health-care delivery system itself bears much of the responsibility. To eliminate barriers and obstacles (e.g., appointment-only systems and unnecessary prevaccination physical examinations) that impede efficient vaccine delivery and to encourage providers to take advantage of all health-care visits as opportunities to provide vaccinations, the National Vaccine Advisory Committee (NVAC) called for the development of standards for immunization policies and practices. Eighteen standards were developed in collaboration with a 35-member working group representing 22 public and private agencies. These 18 standards have since been recommended by the NVAC, approved by the U.
The awareness of diabetes as a serious public health problem has increased among the diabetes professional community since 1974, when Congress mandated development of a Long-Range Plan to Combat Diabetes.' Surveillance data on the morbidity and mortality of diabetes, published by the Centers for Disease Control (CDC), have shown that the overall burden of diabetes has increased since 1974. Ad-
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