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Cancer Control Opportunities In Low- And Middle-income Countries

by Institute of Medicine of the National Academies

Cancer is low or absent on the health agendas of low- and middle-income countries (LMCs) despite the fact that more people die from cancer in these countries than from AIDS and malaria combined. International health organizations, bilateral aid agencies, and major foundations&#8212which are instrumental in setting health priorities&#8212also have largely ignored cancer in these countries. This book identifies feasible, affordable steps for LMCs and their international partners to begin to reduce the cancer burden for current and future generations. Stemming the growth of cigarette smoking tops the list to prevent cancer and all the other major chronic diseases. Other priorities include infant vaccination against the hepatitis B virus to prevent liver cancers and vaccination to prevent cervical cancer. Developing and increasing capacity for cancer screening and treatment of highly curable cancers (including most childhood malignancies) can be accomplished using &#34resource-level appropriateness&#34 as a guide. And there are ways to make inexpensive oral morphine available to ease the pain of the many who will still die from cancer.

Cancer In Elderly People: Workshop Proceedings

by Institute of Medicine of the National Academies

A high proportion of cancer occurs primarily in older persons, and incidence of the major cancers is greater. This, combined with the expansion of an aging America, is bound to have far reaching effects on the nation's healthcare industry. This summary of a workshop held in October 2006, reviews the various important implications of changing demographics and the cancer disease burden in the United States.

CANCER-RELATED GENETIC TESTING AND COUNSELING: Workshop Proceedings

by Institute of Medicine of the National Academies

The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.

Cardiovascular Disability: Updating the Social Security Listings

by Institute of Medicine of the National Academies

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.

The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies

by Institute of Medicine of the National Academies

Neglected tropical diseases (NTDs) afflict more than 1.4 billion people, many of whom live on less than $1.25 a day. While there are effective ways to manage NTDs, policy-makers and funders have only recently begun to recognize the economic and public health importance of controlling NTDs. The IOM's Forum on Microbial Threats held a workshop September 21-22, 2010, to discuss the science of and policy surrounding NTDs.

Certifying Personal Protective Technologies: Improving Worker Safety

by Institute of Medicine of the National Academies

When you purchase a product, you expect it to work. Construction workers on high-rise buildings need to be confident that their safety harnesses will arrest a fall. Firefighters need to know that their gloves and other protective equipment can withstand high temperatures. Healthcare workers administering highly toxic chemotherapy agents need to know that their gloves will withstand penetration. For personal protective technologies (PPT)-- where the major purpose of the product is to protect the wearer against a hazard -- a deficit in product effectiveness can mean injury, illness, or death. Examining the extent to which products meet specific performance or design criteria is the focus of conformity assessment efforts. For PPT conformity assessment, the ultimate goal is preventing worker illness, injury, or death from hazardous working conditions. Certifying Personal Protective Technologies focuses on conformity assessment for occupational PPT -- ensuring that PPT are effective in preventing or reducing hazardous exposures or situations that workers face in their jobs. Because respirators already have an extensive testing and conformity assessment process in place, this book specifically addresses conformity assessment processes for other types of PPT, including eye and face protection, gloves, hearing protectors, and protective clothing.

Challenges and Opportunities in Using Residual Newborn Screening Samples for Translational Research: Workshop Summary

by Institute of Medicine of the National Academies

Newborn screening samples are used to test more than 4 million infants each year for life-threatening diseases that are treatable if found at birth. These specimens also represent a potentially invaluable resource for public health and biomedical research. The IOM held a workshop to examine issues surrounding the use of residual specimens for translational research.

CHALLENGES AND SUCCESSES IN REDUCING HEALTH DISPARITIES: Workshop Summary

by Institute of Medicine of the National Academies

In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable’s first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on July 31, 2007, and examined (1) the importance of differences in life expectancy within the United States, (2) the reasons for those differences, and (3) the implications of this information for programs and policy makers.

Challenges For The Fda: The Future Of Drug Safety

by Institute of Medicine of the National Academies

The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.

Challenges in Adolescent Health Care: Workshop Report

by National Research Council Institute of Medicine of the National Academies

Several positive and negative lifelong behaviors are established during adolescence including diet and exercise, sexual conduct, practices related to oral health, smoking, drinking, and the use if legal and illegal substances. The complex issues that adolescents deal with on a daily basis can turn into health problems that persist throughout adulthood. Unfortunately the adolescents who are frequently the most disconnected from routine health care services - those who lack insurance and family support - are often those at greatest risk for multiple and chronic health problems. Therefore, those that are responsible for delivering health care services to adolescents must address the health conditions that require immediate attention while preparing young people to adopt practices that can help improve their future health status and prevent unhealthy behaviors. Challenges in Adolescent Health Care studies adolescent health care in the United States, highlights critical health care needs, and identifies service models and components of care that may strengthen and improve health care services, settings, and systems for adolescents. The book explores the nature of adolescent challenges and how they reflect larger societal issues such as poverty, crime and the prevalence of violence. These issues, in addition to lack of comprehensive health coverage, dysfunctional families and the lack of support systems, make providing adequate health care incredibly challenging. Challenges in Adolescent Health Care defines high-quality health care, identifies the strengths and weaknesses of various service models and explores various training programs. The book recommends that health care providers must be sensitive to socioeconomic factors and incorporate health care in a broad array of settings including schools, neighborhoods and community centers.

Child and Adult Care Food Program: Aligning Dietary Guidance for All

by Institute of Medicine of the National Academies

The Child and Adult Care Food Program (CACFP) is a federally-funded program designed to provide healthy meals and snacks to children and adults while receiving day care at participating family day care homes, traditional child care centers, afterschool facilities, adult care facilities, and emergency shelters. CACFP has the broadest scope of any of the U.S. Department of Agriculture (USDA) food program, serving more than 3 million children and 114,000 adults across the nation. To receive reimbursement for the foods served, participating programs must abide by requirements set by the USDA. Child and Adult Care Food Program assesses the nutritional needs of the CACFP population based on Dietary Guidelines for Americans and the Dietary Reference Intakes (DRIs) and makes recommendations for revisions to the CACFP meal requirements. The book outlines meal requirements that include food specifications that could be used for specific meals and across a full day, covering all age groups from infants to older adults and meal patterns designed for use in a variety of settings, including in-home care and in large centers. By implementing these meal requirements, consumption of fruits, vegetables, and whole-grain rich foods will increase while consumption of solid fats, added sugars, and sodium will decrease. Not only will this address the high prevalence of childhood obesity, it will also help to achieve consistency with the standards and regulations of other USDA nutrition assistance programs, particularly the Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the National School Lunch and School Breakfast programs. Child and Adult Care Food Program makes practical recommendations that would bring CACFP meals and snacks into alignment with current dietary guidance. The book will serve as a vital resource for federal and state public health officials, care providers working in child and adult day care facilities, WIC agencies, officials working with the National School Lunch and School Breakfast programs, and other organizations serving at-risk populations.

Childhood Obesity Prevention in Texas: Workshop Summary

by Institute of Medicine of the National Academies

Childhood Obesity Prevention in Texas summarizes the information gathered at a workshop held February 5-6, 2009, in Austin, Texas. At this workshop, committee members met with Texas lawmakers, public officials, and community leaders to exchange ideas and to view first-hand strategies that are being implemented effectively at the state and local levels to prevent and reverse childhood obesity. Texas leaders at the workshop expressed the strong belief that the state's economic vitality and security depend on the health of its population. Accordingly, the state is no longer simply describing the personal, community, and financial costs of its obesity crisis; it is taking proactive steps to address the problem through strategic initiatives. An overarching strategy is to address obesity by targeting the state's youth, in whom it may be possible to instill healthy behaviors and lifestyles to last a lifetime. A guiding principle of these efforts is that they should be evidence based, community specific, sustainable, cost-effective, and supported by effective partnerships. Moreover, the goal is for the responsibility to be broadly shared by individuals, families, communities, and the public and private sectors.

Children's Health, The Nation's Wealth: Assessing And Improving Child Health

by National Research Council Institute of Medicine of the National Academies

Children&#39s health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health -- and, thus, the health of future generations -- it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.

Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good - Workshop Summary

by Institute of Medicine of the National Academies

Successful development of clinical data as an engine for knowledge generation has the potential to transform health and health care in America. As part of its Learning Health System Series, the Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss expanding the access to and use of clinical data as a foundation for care improvement.

Clinical Practice Guidelines We Can Trust

by Institute of Medicine of the National Academies

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review--guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

CNS Clinical Trials: Suicidality And Data Collection - Workshop Summary

by Institute of Medicine of the National Academies

The Food and Drug Administration (FDA) now requires that all clinical trials for drugs that affect the central nervous system--including psychiatric drugs--are assessed for whether that drug might cause suicidal ideation or behavior. The IOM's Forum on Neuroscience and Nervous System Disorders hosted a meeting on June 26, 2009, to discuss the FDA's new policy and how to analyze best whether suicidal thoughts predict actual suicidal behavior in the near future.

COMMUNITY PERSPECTIVES ON OBESITY PREVENTION IN CHILDREN: Workshop Summaries

by Institute of Medicine of the National Academies

As the public health threat of childhood obesity has become clear, the issue has become the focus of local, state, and national initiatives. Many of these efforts are centered on the community environment in recognition of the role of environmental factors in individual behaviors related to food and physical activity. In many communities, for example, fresh produce is not available or affordable, streets and parks are not amenable to exercise, and policies and economic choices make fast food cheaper and more convenient than healthier alternatives. Community efforts to combat obesity vary in scope and scale; overall, however, they remain fragmented, and little is known about their effectiveness. At the local level, communities are struggling to determine which obesity prevention programs to initiate and how to evaluate their impact. In this context, the Institute of Medicine held two workshops to inform current work on obesity prevention in children through input from individuals who are actively engaged in community- and policy-based obesity prevention programs. Community perspectives were elicited on the challenges involved in undertaking policy and programmatic interventions aimed at preventing childhood obesity, and on approaches to program implementation and evaluation that have shown promise. Highlights of the workshop presentations and discussions are presented in this volume.

Complementary and Alternative Medicine IN THE UNITED STATES

by Institute of Medicine of the National Academies

The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.

Construction Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health

by National Research Council Institute of Medicine of the National Academies

The National Institute for Occupational Safety and Health (NIOSH) conducts construction-relevant research activities. From 1996 through 2005, the program focused on four research goals: reducing traumatic injuries and fatalities; reducing exposure to health hazards; reducing major risks associated with musculoskeletal disorders; increasing the understanding of construction industry attributes and factors for improving health and safety outcomes. In this book, the National Research Council evaluates the relevance and impact of the NIOSH Construction Research Program in terms of its research priorities and its connection to improvements in the protection of workers in the workplace. It also assesses the program' s identification and targeting of new research areas, to identify emerging research issues, and to provide advice on ways that the program might be strengthened. The book finds that the efforts of the Construction Research Program have made meaningful contributions to improving construction worker safety and health, and provides overreaching and specific recommendations for continuing progress. While NIOSH cannot set and enforce research-based standards on its own, the program can be expected to help reduce construction workplace fatalities, injuries, and illnesses through its research, its research dissemination, and transfer into practice.

Creating A Business Case For Quality Improvement Research: Expert Views

by Institute of Medicine of the National Academies

Creating a Business Case for Quality Improvement Research focuses on issues related to improving the science supporting health care quality and eliminating communication barriers that prevent advances in the field. In 2007, the Institute of Medicine convened a workshop designed to identify the economic and business disciplines that encourage sustained efforts to improve the quality of health care. Workshop presenters and participants included representatives from academia, government and industry. A business case for quality improvement depends heavily on the progress made in the following areas: systems change and leadership, data transparency, funding, enhanced training programs and ongoing dialogue between industry officials, patients and their families. They identified a major barrier to these efforts as the nationwide institutional reluctance to invest in quality improvement and documentation of outcomes, due largely to limited resources and competing priorities as to how these resources are spent in the industry. Too often priorities are placed on creating highly-visible technology-driven programs, with less emphasis in meeting the needs and expectations of the patients. In Creating a Business Case for Quality Improvement Research, a diverse group of stakeholders identifies and assesses these and other challenges to attain a better understanding of how to create a high-value health care system for the general population.

Crisis Standards of Care: Summary of a Workshop Series

by Institute of Medicine of the National Academies

During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable healthcare providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.

Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes - Workshop Report

by Institute of Medicine of the National Academies

A single tick bite can have debilitating consequences. Lyme disease is the most common disease carried by ticks in the United States, and the number of those afflicted is growing steadily. If left untreated, the diseases carried by ticks--known as tick-borne diseases--can cause severe pain, fatigue, neurological problems, and other serious health problems. The Institute of Medicine held a workshop October 11-12, 2010, to examine the state of the science in Lyme disease and other tick-borne diseases.

Damp Indoor Spaces and Health

by Institute of Medicine of the National Academies

Almost all homes, apartments, and commercial buildings will experience leaks, flooding, or other forms of excessive indoor dampness at some point. Not only is excessive dampness a health problem by itself, it also contributes to several other potentially problematic types of situations. Molds and other microbial agents favor damp indoor environments, and excess moisture may initiate the release of chemical emissions from damaged building materials and furnishings. This new book from the Institute of Medicine examines the health impact of exposures resulting from damp indoor environments and offers recommendations for public health interventions. Damp Indoor Spaces and Health covers a broad range of topics. The book not only examines the relationship between damp or moldy indoor environments and adverse health outcomes but also discusses how and where buildings get wet, how dampness influences microbial growth and chemical emissions, ways to prevent and remediate dampness, and elements of a public health response to the issues. A comprehensive literature review finds sufficient evidence of an association between damp indoor environments and some upper respiratory tract symptoms, coughing, wheezing, and asthma symptoms in sensitized persons. This important book will be of interest to a wide-ranging audience of science, health, engineering, and building professionals, government officials, and members of the public.

Demographic Changes, a View from California: Implications for Framing Health Disparities

by Institute of Medicine of the National Academies

The IOM held a workshop on July 28, 2008, to examine strategies for discussing health disparities in ways that engage the public and motivate change. Speakers focused on health disparities in California, which continues to see dramatic demographic shifts.

Design Considerations For Evaluating The Impact Of Pepfar: Workshop Summary

by Institute of Medicine of the National Academies

Design Considerations for Evaluating the Impact of PEPFAR is the summary of a 2-day workshop on methodological, policy, and practical design considerations for a future evaluation of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) interventions carried out under the President’s Emergency Plan for AIDS Relief (PEPFAR), which was convened by the Institute of Medicine (IOM) on April 30 and May 1, 2007. Participants at the workshop included staff of the U.S. Congress; PEPFAR officials and implementers; major multilateral organizations such as The Global Fund to Fight AIDS, Malaria, and Tuberculosis (The Global Fund), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the World Bank; representatives from international nongovernmental organizations; experienced evaluation experts; and representatives of partner countries, particularly the PEPFAR focus countries. The workshop represented a final element of the work of the congressionally mandated IOM Committee for the Evaluation of PEPFAR Implementation, which published a report of its findings in 2007 evaluating the first 2 years of implementation, but could not address longer term impact evaluation questions.

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