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The environmental problem that has been addressed in this work relates to the decontamination of land either formerly or presently under the control of the US Department of Defense (DoD). Relevant programs include Base Realignment and Closure (BRAC) and Formerly Used Defense Sites (FUDS). There are a large number of sites with a known decontamination problem, and based on 2003 figures these include 1700 FUDS and 25 BRAC sites and active installations. The land could be contaminated with unexploded ordnance (UXO), exploded ordnance debris, buried obsolete munitions and other refuse, all of which have been emplaced during military activities such as warfare (battlefields), training (weapons ranges), munitions manufacturing or waste products from everyday activities at military installations that is buried in landfills. Generally, the problem arises when the land is designated for a new land use that involves a change of ownership (and responsibility) to another government agency or to the civilian sector for such uses as recreation and housing. Given the potential threat to the general public, of some of these buried hazardous materials, there will obviously be some land that needs to be decontaminated to a very high standard.

Background and objectives. The number of US residents with limited English proficiency (LEP) is 14 million and rising. The goal of this study was to estimate the effects of LEP on physician time and resource use. Design. This was a prospective, observational study. Setting and Subjects. The study included 285 Medicaid patients speaking English (n = 112), Spanish (n = 62), or Russian (n = 111) visiting the General Medicine and Family Practice Clinics at the UC Davis Medical Center in 1996-1997 (participation rate, 85%). Bilingual research assistants administered patient questionnaires, abstracted the medical record, and conducted detailed time and motion studies. Main outcome measures. We used seemingly unrelated regression models to evaluate the effect of language on visit time, controlling for patient demographics and health status, physician specialty, visit type, and resident involvement in care. We also estimated the effect of LEP on cross-sectional utilization of health care resources and adherence to follow-up with referral and testing appointments. Results. The 3 language groups differed significantly by age, education, and reason for visit but not gender, number of active medical conditions, physical functioning, or mental health. Physician visit time averaged 38+/-20 minutes (mean+/-SD). Compared with English-speaking patients and after multivariate adjustment, Spanish and Russian speakers averaged 9.1 and 5.6 additional minutes of physician time, respectively (P P = 0.003) and Spanish speakers were less likely to follow-up with recommended laboratory studies (P = 0.031). Conclusions. In these academic primary care clinics, some groups of patients using interpreters required more physician time than those proficient in English. Additional reimbursement may be needed to ensure continued access and high-quality care for this special population.