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Achieving Sustainable Global Capacity For Surveillance And Response To Emerging Diseases Of Zoonotic Origin: Workshop Report

by Institute of Medicine National Research Council of the National Academies

One of the biggest threats today is the uncertainty surrounding the emergence of a novel pathogen or the re-emergence of a known infectious disease that might result in disease outbreaks with great losses of human life and immense global economic consequences. Over the past six decades, most of the emerging infectious disease events in humans have been caused by zoonotic pathogens--those infectious agents that are transmitted from animals to humans. In June 2008, the Institute of Medicine's and National Research Council's Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin convened a workshop. This workshop addressed the reasons for the transmission of zoonotic disease and explored the current global capacity for zoonotic disease surveillance.

Adolescent Development and the Biology of Puberty : Summary of a Workshop on New Research

by Institute of Medicine National Research Council

Adolescence is one of the most fascinating and complex transitions in the human life span. Its breathtaking pace of growth and change is second only to that of infancy. Over the last two decades, the research base in the field of adolescence has had its own growth spurt. New studies have provided fresh insights while theoretical assumptions have changed and matured. This summary of an important 1998 workshop reviews key findings and addresses the most pressing research challenges.

Adolescent Risk And Vulnerability: Concepts And Measurement

by Institute of Medicine National Research Council

Adolescents obviously do not always act in ways that serve their own best interests, even as defined by them. Sometimes their perception of their own risks, even of survival to adulthood, is larger than the reality; in other cases, they underestimate the risks of particular actions or behaviors. It is possible, indeed likely, that some adolescents engage in risky behaviors because of a perception of invulnerability--the current conventional wisdom of adults' views of adolescent behavior. Others, however, take risks because they feel vulnerable to a point approaching hopelessness. In either case, these perceptions can prompt adolescents to make poor decisions that can put them at risk and leave them vulnerable to physical or psychological harm that may have a negative impact on their long-term health and viability. A small planning group was formed to develop a workshop on reconceptualizing adolescent risk and vulnerability. With funding from Carnegie Corporation of New York, the Workshop on Adolescent Risk and Vulnerability: Setting Priorities took place on March 13, 2001, in Washington, DC. The workshop's goal was to put into perspective the total burden of vulnerability that adolescents face, taking advantage of the growing societal concern for adolescents, the need to set priorities for meeting adolescents' needs, and the opportunity to apply decision-making perspectives to this critical area. This report summarizes the workshop.

Alliances for Obesity Prevention

by Institute of Medicine Lynn Parker Standing Committee on Childhood Obesity Prevention Elena Ovaitt Stephen Olson Food and Nutrition Board Emily Ann Miller

Many organizations are making focused efforts to prevent obesity. To achieve their goals, accelerate their progress, and sustain their success, the assistance of many other individuals and groups--not all of them with a singular focus on obesity prevention--will be essential. In October 2011 the Institute of Medicine held a workshop that provided an opportunity for obesity prevention groups to hear from and hold discussions with many of these potential allies in obesity prevention. They explored common ground for joint activities and mutual successes and lessons learned from efforts at aligning diverse groups with goals in common.

Allied Health Workforce and Services

by Institute of Medicine Steve Olson Board on Health Care Services

The demand for health care is growing as the nation ages and seeks to provide coverage for the millions of Americans who lack health insurance. At the same time, escalating costs have led to a variety of initiatives to make the delivery of health care more effective and efficient. The allied health workforce is critical to the success of these efforts. The IOM held a workshop May 9-10, 2011, to examine the current allied health care workforce and consider how it can contribute to improving health care access, quality, and effectiveness.

America's Uninsured Crisis: Consequences for Health and Health Care

by Institute of Medicine

When policy makers and researchers consider potential solutions to the crisis of uninsurance in the United States, the question of whether health insurance matters to health is often an issue. This question is far more than an academic concern. It is crucial that U.S. health care policy be informed with current and valid evidence on the consequences of uninsurance for health care and health outcomes, especially for the 45.7 million individuals without health insurance. From 2001 to 2004, the Institute of Medicine (IOM) issued six reports, which concluded that being uninsured was hazardous to people's health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all. The goal of this book is to inform the health reform policy debate--in 2009--with an up-to-date assessment of the research evidence. This report addresses three key questions: What are the dynamics driving downward trends in health insurance coverage? Is being uninsured harmful to the health of children and adults?Are insured people affected by high rates of uninsurance in their communities?

Americas's Health Care Safety Net: Intact but Endangered

by Institute of Medicine

America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety net--with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety net--public hospitals, community clinics, local health departments, and federal and state programs.Mounting pressures on the system--rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more.Specific consequences for providers and their patients from the competitive, managed care environment--detailing the evolution and impact of Medicaid managed care.Key issues highlighted in four populations--children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

Assessing and Improving Value in Cancer Care: Workshop Summary

by Institute of Medicine

Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex. First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease. Second, treatments are often both life sparing and highly toxic. Third, distinctive payment structures for cancer medicines are intertwined with practice. Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life. Finally, the newest and most novel treatments in oncology are among the most costly in medicine. This volume summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.

Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report

by Institute of Medicine

A nuclear attack on a large U.S. city by terrorists--even with a low-yield improvised nuclear device (IND) of 10 kilotons or less--would cause a large number of deaths and severe injuries. The large number of injured from the detonation and radioactive fallout that would follow would be overwhelming for local emergency response and health care systems to rescue and treat, even assuming that these systems and their personnel were not themselves incapacitated by the event. The United States has been struggling for some time to address and plan for the threat of nuclear terrorism and other weapons of mass destruction that terrorists might obtain and use. The Department of Homeland Security recently contracted with the Institute of Medicine to hold a workshop, summarized in this volume, to assess medical preparedness for a nuclear detonation of up to 10 kilotons. This book provides a candid and sobering look at our current state of preparedness for an IND, and identifies several key areas in which we might begin to focus our national efforts in a way that will improve the overall level of preparedness.

ASSESSING THE MEDICAL RISKS OF HUMAN OOCYTE DONATION FOR STEM CELL RESEARCH: Workshop Report

by Institute of Medicine National Research Council 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.

Assessment of Future Scientific Needs for Live Variola Virus

by Institute of Medicine

In 1980, the World Health Organization (WHO) officially declared that smallpox had been eradicated. In 1986, WHO's international Ad Hoc Committee on Orthopox Virus Infections unanimously recommended destruction of the two remaining official stocks of variola virus, one at the Centers for Disease Control and Prevention and the other at the VECTOR laboratory in Siberia. In June 1999, WHO decided to delay the destruction of these stocks. Informing that decision was Assessment of Future Scientific Needs for Variola Virus, which examines:-- Whether the sequenced variola genome, vaccinia, and monkey pox virus are adequate for future research or whether the live variola virus itself is needed to assist in the development of antiviral therapies.-- What further benefits, if any, would likely be gained through the use of variola in research and development efforts related to agent detection, diagnosis, prevention, and treatment.-- What unique potential benefits, if any, the study of variola would have in increasing our fundamental understanding of the biology, host-agent interactions, pathogenesis, and immune mechanisms of viral diseases.

Assuring Data Quality and Validity in Clinical Trials for Regulatory Decision Making: Workshop Report

by Institute of Medicine

A report Assuring Data Quality and Validity in Clinical Trials for Regulatory Decision Making

Barriers to Integrating Crisis Standards of Care Principles into International Disaster Response Plans

by Institute of Medicine Bruce M. Altevogt Clare Stroud Board on Health Sciences Policy Forum on Medical and Public Health Preparedness for Catastrophic Events Theresa Wizemann

When a nation or region prepares for public health emergencies such as a pandemic influenza, a large-scale earthquake, or any major disaster scenario in which the health system may be destroyed or stressed to its limits, it is important to describe how standards of care would change due to shortages of critical resources. At the 17th World Congress on Disaster and Emergency Medicine, the IOM Forum on Medical and Public Health Preparedness sponsored a session that focused on the promise of and challenges to integrating crisis standards of care principles into international disaster response plans.

Beyond Bias and Barriers: Fulfilling and Potential of Women in Academic Science and Engineering

by National Academy of Science National Academy of Engineering Institute of Medicine

The United States economy relies on the productivity, entrepreneurship, and creativity of its people. To maintain its scientific and engineering leadership amid increasing economic and educational globalization, the United States must aggressively pursue the innovative capacity of all its people-women and men. However, women face barriers to success in every field of science and engineering; obstacles that deprive the country of an important source of talent. Without a transformation of academic institutions to tackle such barriers, the future vitality of the U.S. research base and economy are in jeopardy. Beyond Bias and Barriers explains that eliminating gender bias in academia requires immediate overarching reform, including decisive action by university administrators, professional societies, federal funding agencies and foundations, government agencies, and Congress. If implemented and coordinated across public, private, and government sectors, the recommended actions will help to improve workplace environments for all employees while strengthening the foundations of America's competitiveness.

Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research

by Institute of Medicine

In the realm of health care, privacy protections are needed to preserve patients' dignity and prevent possible harms. Ten years ago, to address these concerns as well as set guidelines for ethical health research, Congress called for a set of federal standards now known as the HIPAA Privacy Rule. In its 2009 report, Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research, the Institute of Medicine's Committee on Health Research and the Privacy of Health Information concludes that the HIPAA Privacy Rule does not protect privacy as well as it should, and that it impedes important health research.

Biowatch and Public Health Surveillance: Evaluating Systems for the Early Detection of Biological Threats - Abbreviated Version

by Institute of Medicine National Research Council of the National Academies

Following the attacks of September 11, 2001 and the anthrax letters, the ability to detect biological threats as quickly as possible became a top priority. In 2003 the Department of Homeland Security (DHS) introduced the BioWatch program--a federal monitoring system intended to speed detection of specific biological agents that could be released in aerosolized form during a biological attack. The present volume evaluates the costs and merits of both the current BioWatch program and the plans for a new generation of BioWatch devices. BioWatch and Public Health Surveillance also examines infectious disease surveillance through hospitals and public health agencies in the United States, and considers whether BioWatch and traditional infectious disease surveillance are redundant or complementary.

Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences

by Institute of Medicine

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.

Building Public-Private Partnerships in Food and Nutrition

by Institute of Medicine Food Forum Food and Nutrition Board Leslie Pray Laura Pilsbury

The leading challenges in public health--ranging from rising obesity rates to the fast-growing population of older adults--are complex and cannot be solved effectively by any one silver bullet or any one sector in isolation. Instead, their solutions require collaborative actions of many sectors, including industry, government, academia, and nongovernmental organizations. To better understand how to build multisectoral food and nutrition partnerships that achieve meaningful public health results, the IOM's Food Forum held a workshop on November 1-2, 2011, in Washington, D.C. The workshop brought together stakeholders from various sectors to discuss the benefits and risks of pursuing cross-sector partnerships, foster communication between sectors, and explore opportunities of mutual interest in food and nutrition that are most conducive for partnerships. Participants also discussed the perspectives of the various sectors, key features of successful partnerships, and what needs to be done to facilitate partnership development. This report, Building Public-Private Partnerships in Food and Nutrition: Workshop Summary, summarizes the workshop.

Calling the Shots: Immunization Finance Policies and Practices

by Institute of Medicine

Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores: The evolution of the system in light of changing U.S. demographics, development of new vaccines, and other factors. The effectiveness of public health and health insurance strategies, with special emphasis on the performance of the "Section 317" program. The condition of the infrastructure for control and prevention of infectious disease, surveillance of vaccines rates and safety, and efforts to sustain high coverage.Calling the Shots will be an indispensable resource to those responsible for maintaining our nation's vaccine vigilance.

Cancer Care for the Whole Patient

by Institute of Medicine Board on Health Care Services Nancy E. Adler Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting Ann E. K. Page

Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer--including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life--cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.

Cardiovascular Disability: Updating the Social Security Listings

by Institute of Medicine Board on the Health of Select Populations Committee on Social Security Cardiovascular Disability Criteria

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.

Children of Immigrants: Health, Adjustment, and Public Assistance

by National Research Council Institute of Medicine

Immigrant children and youth are the fastest-growing segment of the U.S. population, and so their prospects bear heavily on the well-being of the country. Children of Immigrants represents some of the very best and most extensive research efforts to date on the circumstances, health, and development of children in immigrant families and the delivery of health and social services to these children and their families.This book presents new, detailed analyses of more than a dozen existing datasets that constitute a large share of the national system for monitoring the health and well-being of the U.S. population. Prior to these new analyses, few of these datasets had been used to assess the circumstances of children in immigrant families. The analyses enormously expand the available knowledge about the physical and mental health status and risk behaviors, educational experiences and outcomes, and socioeconomic and demographic circumstances of first- and second-generation immigrant children, compared with children with U.S.-born parents.

Clearing the Air: Asthma and Indoor Air Exposures

by Institute of Medicine

Since about 1980, asthma prevalence and asthma-related hospitalizations and deaths have increased substantially, especially among children. Of particular concern is the high mortality rate among African Americans with asthma. Recent studies have suggested that indoor exposures--to dust mites, cockroaches, mold, pet dander, tobacco smoke, and other biological and chemical pollutants--may influence the disease course of asthma. To ensure an appropriate response, public health and education officials have sought a science-based assessment of asthma and its relationship to indoor air exposures. Clearing the Air meets this need. This book examines how indoor pollutants contribute to asthma-- its causation, prevalence, triggering, and severity. The committee discusses asthma among the general population and in sensitive subpopulations including children, low-income individuals, and urban residents. Based on the most current findings, the book also evaluates the scientific basis for mitigating the effects of indoor air pollutants implicated in asthma. The committee identifies priorities for public health policy, public education outreach, preventive intervention, and further research.

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