To explore what actions can be taken to help close the gap between what is required in the informed consent process and communicating it in a health-literate and meaningful manner to individuals, the Institute of Medicine's Roundtable on Health Literacy convened a one-day public workshop featuring presentations and discussions that examine the implications of health literacy for informed consent for both research involving human subjects and treatment of patients. Topics covered in this workshop included an overview of the ethical imperative to gain informed consent from patients and research participants, a review of the current state and best practices for informed consent in research and treatment, the connection between poor informed consent processes and minority underrepresentation in research, new approaches to informed consent that reflect principles of health literacy, and the future of informed consent in the treatment and research settings. Informed Consent and Health Literacy is the summary of the presentations and discussion of the workshop.
The Environmental Health Sciences Decision Making workshop, the first in a series, was convened to inform the Roundtable on Environmental Health Sciences, Research, and Medicine on emerging issues in risk management, "weight of evidence," and ethics that influence environmental health decision making.
The workshop, summarized in this volume, included an overview of the principles underlying decision making, the role of evidence and challenges for vulnerable populations, and ethical issues of conflict of interest, scientific integrity, and transparency. The workshop engaged science interest groups, industry, government, and the academic sector.
Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services. The book makes recommendations about priority actions in the update to the National Vaccine Plan that are intended to achieve the objectives of disease prevention and enhancement of vaccine safety. It is centered on the plan's five goals in the areas of vaccine development, safety, communication, supply and use, and global health.
Training Physicians for Public Health Careers focuses on the critical roles that physicians play in maintaining and strengthening the public health system, identifies what these physicians need to know to engage in effective public health actions, explores the kinds of training programs that can be used to prepare physicians for public health roles, and examines how these training programs can be funded. Medical schools, schools of public health, health care and public health care professionals, medical students and students of public health will find this of special interest.
Recent epidemiologic studies report an association between the development of ALS and prior service in the U.S. military. The studies evaluated either veterans of the 1991 Persian Gulf War or veterans who served in the military in the period 1910-1982. Due to these findings, the Department of Veterans Affairs (VA) asked the National Academies to conduct an assessment of the potential relationship between military service and the later development of ALS. The project was assigned to the Institute of Medicine (IOM), which appointed a committee and gave it the task of evaluating the scientific literature on ALS in veterans.
The committee began its work by identifying medical and scientific literature on ALS. PubMed, a database created and managed by the National Library of Medicine. Amyotrophic Lateral Sclerosis in Veterans; Review of the Scientific Literature presents the findings of this committee. The committee reviewed, evaluated, and summarized the scientific literature on ALS in veterans, composed primarily of peer-reviewed, published literature. This report includes the recommendations of the committee.
Although the United States produces a majority of the research on health literacy, Europe has strong multinational programs as well as research efforts, and health literacy experts in developing countries have created successful programs implemented on a community level. Given these distinct strengths of efforts worldwide, there are many opportunities for collaboration. International collaboration can harness the United States' research power, Europe's multilingual and multinational experience, and developing nations' community-based programs to create robust programs and research that reach people-not based on language or nationality but on need and value.
A workshop on international health literacy efforts that feature presentations and discussion about health literacy interventions from various countries as well as other topics related to international health literacy was held as the basis for this report. Health Literacy: Improving Health, Health Systems, and Health Policy Around the World summarizes the findings and discussions at the workshop.
To explore the aspects of health literacy that impact the ability of patients to understand and follow discharge instructions and to learn from examples of how discharge instructions can be written to improve patient understanding of-and hence compliance with-discharge instructions, the Roundtable on Health Literacy held a public workshop. The workshop featured presentations and discussions that examined the implications of health literacy for discharge instructions for both ambulatory and inpatient facilities. Facilitating Patient Understanding of Discharge Instructions summarizes the presentations and discussions of the workshop. This report gives an overview of the impact of discharge instructions on outcomes, and discusses the specifics of inpatient discharge summaries and outpatient after-visit summaries. The report also contains case studies illustrating different approaches to improving discharge instructions.
The Institute of Medicine convened a workshop to explore health literate practices in health information technology and then provide and consider the ramifications of this rapidly growing field on the health literacy of users. Health Literacy and Consumer-Facing Technology summarizes the discussions and presentations from this workshop, highlighting the lessons presented, practical strategies, and the needs and opportunities for improving health literacy in consumer-facing technology.
To commemorate the anniversary of the release of the 2004 health literacy report, the Institute of Medicine's Roundtable on Health Literacy convened a 1-day public workshop to assess the progress made in the field of health literacy over the past decade, the current state of the field, and the future of health literacy at the local, national, and international levels. Health Literacy: Past, Present, and Future summarizes the presentation and discussion of the workshop.
Given the importance of health literacy to the proper use of medications, and the apparent lack of progress in improving medication adherence, the Roundtable on Health Literacy formed an ad hoc committee to plan and conduct a 1-day public workshop that featured invited presentations and discussion of the role and challenges regarding clarity of communication on medication. Participants focused on using health literacy principles to address clarity of materials, decision aids, and other supportive tools and technologies regarding risks, benefits, alternatives, and health plan coverage. This publication summarizes the presentations and discussions from the workshop.
Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America.
Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers:
A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems.
Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year.
Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles -- including limits on nurses' scope of practice -- should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care.
In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
Safety of Silicone Breast Implants presents a well-documented, thoughtful exploration of the safety of these devices, drawing conclusions from the available research base and suggesting further questions to be answered. This book also examines the sensitive issues surrounding women's decisions about implants. In reaching conclusions, the committee reviews:
The history of the silicone breast implant and the development of its chemistry.
The wide variety of U.S.-made implants and their regulation by the Food and Drug Administration.
Frequency and consequences of local complications from implants.
The evidence for and against links between implants and autoimmune disorders, connective tissue disease, neurological problems, silicone in breast milk, or a proposed new syndrome.
Evidence that implants may be associated with lower frequencies of breast cancer.
Safety of Silicone Breast Implants provides a comprehensive, well-organized review of the science behind one of the most significant medical controversies of our time.
A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated systemwide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress.
To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine convened a workshop to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. The workshop, summarized in this volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers and outlining the opportunities for next steps.
The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.
The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.
The IOM brought together policy makers from the U.K. and U.S. for a workshop on October 22, 2009, to discuss the challenges of and promising approaches to the struggle against obesity. Presenters spoke about current policies, programs, and partnerships that are addressing the obesity epidemic and evidence for effective strategies to change perception and behaviors. The workshop, summarized in this document, provided an opportunity for both countries to learn from each other's efforts and to consider how to apply new strategies at home.
Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder maltreatment every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults aged 65 and older continues to grow, the implications of elder maltreatment for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem. Elder Abuse and Its Prevention discusses the prevalence and characteristics of elder abuse around the world, risk factors for abuse and potential adverse health outcomes, and contextually specific factors, such as culture and the role of the community.
This book provides a solid documentary base that can be used to develop an agenda to guide research and health policy formulation on female health--both for Sub-Saharan Africa and for other regions of the developing world. This book could also help facilitate ongoing, collaboration between African researchers on women's health and their U.S. colleagues. Chapters cover such topics as demographics, nutritional status, obstetric morbidity and mortality, mental health problems, and sexually transmitted diseases, including HIV.
However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sector--yet protect them as consumers and patients.
This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed care--how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters.
The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Patient-Centered Clinical Research Network, or PCORnet, is a nation-wide patient-centered clinical research network intended to form a resource of clinical, administrative, and patient data that can be used to carry out observational and interventional research studies and enhance the use of clinical data to advance the learning health care system. The primary goal of the first phase of PCORnet will be to establish the data infrastructure necessary to do such research.
In April and June 2014 the Institute of Medicine's Roundtable on Value and Science-Driven Health Care convened two workshops aimed at accelerating progress toward real-time knowledge generation through the seamless integration of clinical practice and research, one of the fundamental concepts of a continuously learning health system, centered on the development of the PCORnet. The first workshop brought together health care system leaders, both administrative and clinical, and researchers to consider issues and strategic priorities for building a successful and durable clinical research network and facilitate progress toward a continuously learning health care system more broadly, including issues related to science, technology, ethics, business, regulatory oversight, sustainability, and governance. The second workshop focused on implementation approaches. Health system CEOs convened to consider strategic priorities and explore approaches to implementation. These workshops will inform the decisions of field leaders moving forward, including PCORI, the PCORnet steering committee, and PCORnet grantees. Integrating Research and Practice is the summary of the presentations and discussions of the workshops.
On August 30, 2011, the Institute of Medicine (IOM) Board on Population Health and Public Health Practice hosted the workshop Sex-Specific Reporting of Scientific Research. The workshop explored the need for sex-specific reporting of scientific results; potential barriers and unintended consequences of sex-specific reporting of scientific results; experiences of journals that have implemented sex-specific requirements, including the challenges and benefits of such editorial policies; and steps to facilitate the reporting of sex-specific results. Presenters and participants included current and former editors of scientific journals, researchers, and scientists and policymakers from government, industry, and nonprofit organizations. Presentations and discussions highlighted the importance to both women and men of having sex-specific data, the problems with sample size and financial constraints for conducting the research, the appropriateness of sex-specific analyses, and the limitations of journal policies to change experimental designs.
Sex-Specific Reporting of Scientific Research summarizes the presentations and discussions by the expert panelists during the IOM workshop. The workshop's first session focused on why sex-specific reporting is important. Panelists highlighted historical and current events that have hindered or helped to advance the study of women. In the next session, panelists in academe discussed the challenges of collecting, analyzing, and reporting sex-specific data from the researcher's perspective. That was followed by two panels of leading journal editors who shared their experiences in developing and implementing editorial policies and the implications of sex-specific reporting policies for journals.
The symposium included three plenary panels that focused on food and physical activity products, portfolio shifts, and packaging innovations; retailing healthy lifestyles with regard to food and physical activity; and the business response to childhood obesity. Participants also engaged in two break-out sessions. The first session focused on marketing communication strategies that promote both healthful products and physical activity opportunities. The second session focused on public and private education campaigns and industry self-regulation of advertising to children. A program agenda is at the end of this summary. The symposium provided a useful forum for stakeholders to explore viable strategies and exchange information about promising practices for addressing barriers to obesity prevention initiatives, and to identify how public health interests can coincide with the business interests of companies to have a positive impact on reversing the childhood obesity trend.
This summary highlights the recurring themes for accelerating change and how industry collectively can move forward with obesity prevention efforts that emerged from the symposium. The themes include reverse the obesity trend; market health and nutrition; make a business commitment to health; change the food and physical activity environment; forge strategic partnerships; garner political support to ally public health and industry; educate stakeholders; collect, disseminate, and share local data; and evaluate programs and interventions. This summary, along with those of two other symposia summaries and a more detailed discussion of insights and regional examples, will be incorporated in the IOM committee's final report on progress in preventing childhood obesity that will be released in the fall of 2006.
The microbiome is integral to human physiology, health, and disease. The microbiome is arguably the most intimate connection that humans have with their external environment, mostly through diet. Given the emerging nature of research on the microbiome, some important methodology issues might still have to be resolved with respect to undersampling and a lack of causal and mechanistic studies. Dietary interventions intended to have an impact on host biology via their impact on the microbiome are being developed, and the market for these products is seeing tremendous success. However, the current regulatory framework poses challenges to industry interest and investment.
Blue Water Navy Vietnam Veterans and Agent Orange Exposure comprehensively examines whether Vietnam veterans in the Blue Water Navy experienced exposures to herbicides and their contaminants by reviewing historical reports, relevant legislation, key personnel insights, and chemical analysis to resolve current debate on this issue.
• The evolving role of EMS as an integral component of the overall health care system.
• EMS system planning, preparedness, and coordination at the federal, state, and local levels.
• EMS funding and infrastructure investments.
• EMS workforce trends and professional education.
• EMS research priorities and funding.
Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system.
During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk.
This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.
In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patientsâ€™ and providersâ€™ attitudes, expectations, and behavior are analyzed.
How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve providerâ€"patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Historically, drug repurposing has been largely an unintentional, serendipitous process that took place when a drug was found to have an offtarget effect or a previously unrecognized on-target effect that could be used for identifying a new indication. Perhaps the most recognizable example of such a successful repositioning effort is sildenafil. Originally developed as an anti-hypertensive, sildenafil, marketed as Viagra and under other trade names, has been repurposed for the treatment of erectile dysfunction and pulmonary arterial hypertension. Viagra generated more than $2 billion worldwide in 2012 and has recently been studied for the treatment of heart failure.
Given the widespread interest in drug repurposing, the Roundtable on Translating Genomic-Based Research for Health of the Institute of Medicine hosted a workshop on June 24, 2013, in Washington, DC, to assess the current landscape of drug repurposing activities in industry, academia, and government. Stakeholders, including government officials, pharmaceutical company representatives, academic researchers, regulators, funders, and patients, were invited to present their perspectives and to participate in workshop discussions. Drug Repurposing and Repositioning is the summary of that workshop. This report examines enabling tools and technology for drug repurposing; evaluates the business models and economic incentives for pursuing a repurposing approach; and discusses how genomic and genetic research could be positioned to better enable a drug repurposing paradigm.
The Medical Follow-up Agency is a living tribute to the vision, energy, and effectiveness of Michael E. DeBakey, M.D. Dr. DeBakey created the idea for the agency, obtained the appropriate approvals, staffed its initial creation, and 50 years later, spoke on the occasion of its golden anniversary. This sequence of events must be unique in the history of veterans' health and medical research.
Sex differences in health throughout the lifespan have been documented. Exploring the Biological Contributions to Human Health begins to snap the pieces of the puzzle into place so that this knowledge can be used to improve health for both sexes. From behavior and cognition to metabolism and response to chemicals and infectious organisms, this book explores the health impact of sex (being male or female, according to reproductive organs and chromosomes) and gender (one's sense of self as male or female in society).
Exploring the Biological Contributions to Human Health discusses basic biochemical differences in the cells of males and females and health variability between the sexes from conception throughout life. The book identifies key research needs and opportunities and addresses barriers to research.
Exploring the Biological Contributions to Human Health will be important to health policy makers, basic, applied, and clinical researchers, educators, providers, and journalists-while being very accessible to interested lay readers.
Despite their obvious importance, very little is actually known about the processes and factors that influence the assembly, function, and stability of microbial communities. Gaining this knowledge will require a seismic shift away from the study of individual microbes in isolation to inquiries into the nature of diverse and often complex microbial communities, the forces that shape them, and their relationships with other communities and organisms, including their multicellular hosts.
On March 6 and 7, 2012, the Institute of Medicine's (IOM's) Forum on Microbial Threats hosted a public workshop to explore the emerging science of the "social biology" of microbial communities. Workshop presentations and discussions embraced a wide spectrum of topics, experimental systems, and theoretical perspectives representative of the current, multifaceted exploration of the microbial frontier. Participants discussed ecological, evolutionary, and genetic factors contributing to the assembly, function, and stability of microbial communities; how microbial communities adapt and respond to environmental stimuli; theoretical and experimental approaches to advance this nascent field; and potential applications of knowledge gained from the study of microbial communities for the improvement of human, animal, plant, and ecosystem health and toward a deeper understanding of microbial diversity and evolution. The Social Biology of Microbial Communities: Workshop Summary further explains the happenings of the workshop.
In this report, the IOM determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses.
• The role and impact of the emergency department within the larger hospital and health care system.
• Patient flow and information technology.
• Workforce issues across multiple disciplines.
• Patient safety and the quality and efficiency of emergency care services.
• Basic, clinical, and health services research relevant to emergency care.
• Special challenges of emergency care in rural settings.
Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
At the request of the FDA, the Institute of Medicine (IOM) examined the 510(k) process. Medical Devices and the Public's Health examines the current 510(k) clearance process and whether it optimally protects patients and promotes innovation in support of public health. It also identifies legislative, regulatory, or administrative changes that will achieve the goals of the 510(k) clearance process. Medical Devices and the Public's Health recommends that the U.S. Food and Drug Administration gather the information needed to develop a new regulatory framework to replace the 35-year-old 510(k) clearance process for medical devices. According to the report, the FDA's finite resources are best invested in developing an integrated premarket and postmarket regulatory framework.
Thousands of US veterans of the Persian Gulf War have reported an array of unexplained illnesses since the war ended in 1991. Many veterans have believed that the illnesses were associated with their military service in southwest Asia during the war. This volume of Gulf War and Health evaluates the scientific literature on chemical, biologic, and physical agents to which military personnel in the gulf were potentially exposed and possible long-term adverse health outcomes.
In response to concerns and continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Veterans and Agent Orange provides a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam. The 2008 report is the eighth volume in this series of biennial updates. It will be of interest to policy makers and physicians in the federal government, veterans and their families, veterans' organizations, researchers, and health professionals.
Deployment to a war zone has a profound impact on the lives of troops and on their family members. There are a plethora of stressors associated with deployment, including constant vigilance against unexpected attack, difficulty distinguishing enemy combatants from civilians, concerns about survival, caring for the badly injured, and witnessing the death of a person. Less traumatic but more pervasive stressors include anxiety about home life, such as loss of a job and income, impacts on relationships, and absence from family.
The focus of this report, by the Institute of Medicine (IOM) Committee on Gulf War and Health: Physiologic, and Psychosocial Effects of Deployment-Related Stress, is the long-term effects of deployment-related stress. Gulf War and Health: Volume 6. Physiologic, and Psychosocial Effects of Development Related Stress evaluates the scientific literature regarding association between deployment-related stressors and health effects, and provides meaningful recommendations to remedy this problem.
Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 identifies domains and measures that capture the social determinants of health to inform the development of recommendations for the meaningful use of EHRs. This report is the second part of a two-part study. The Phase 1 report identified 17 domains for inclusion in EHRs. This report pinpoints 12 measures related to 11 of the initial domains and considers the implications of incorporating them into all EHRs. This book includes three chapters from the Phase 1 report in addition to the new Phase 2 material.
Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research. The recommendations of Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 will provide valuable information on which to base problem identification, clinical diagnoses, patient treatment, outcomes assessment, and population health measurement.
The resulting report identified some problems with procedures and documentation, but concluded that these issues did not compromise the results of the study. However, these issues have led to public scrutiny and continued controversy. Review of the HIVNET 012 Perinatal HIV Prevention Study critically and objectively evaluates the study's design and conduct, and assesses the impact of the initial procedural issues on the validity of the overall findings and conclusions of the trial.
In response to a request from the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) established the Committee on Leading Health Indicators for Healthy People 2020 to develop and recommend 12 indicators and 24 objectives for consideration by HHS for guiding a national health agenda and for consideration for inclusion in Healthy People 2020. The work of the committee built upon the 1999 IOM report, Leading Health Indicators for Healthy People 2010, and on the work of the Committee on the State of the USA Health Indicators. Leading Health Indicators for Healthy People 2020 lays out the proposed agenda for the current decade, which will end in 2020.
Hurricane Katrina was an unprecedented disaster for the United States. During the first weeks, the enormity of the event and the sheer response needs for public health became apparent. The tragic loss of human life overshadowed the ongoing social and economic disruption in a region that was already economically depressed. Hurricane Katrina reemphasized to the public and to policy makers the importance of addressing long-term needs after a disaster.
On October 20, 2005, the Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine held a workshop which convened members of the scientific community to highlight the status of the recovery effort, consider the ongoing challenges in the midst of a disaster, and facilitate scientific dialogue about the impacts of Hurricane Katrina on people's health. Environmental Public Health Impacts of Disasters: Hurricane Katrina is the summary of this workshop. This report will inform the public health, first responder, and scientific communities on how the affected community can be helped in both the midterm and the near future. In addition, the report can provide guidance on how to use the information gathered about environmental health during a disaster to prepare for future events.
Community-based prevention interventions offer three distinct strengths. First, because the intervention is implemented population-wide it is inclusive and not dependent on access to a health care system. Second, by directing strategies at an entire population an intervention can reach individuals at all levels of risk. And finally, some lifestyle and behavioral risk factors are shaped by conditions not under an individual's control. For example, encouraging an individual to eat healthy food when none is accessible undermines the potential for successful behavioral change. Community-based prevention interventions can be designed to affect environmental and social conditions that are out of the reach of clinical services.
Four foundations - the California Endowment, the de Beaumont Foundation, the W.K. Kellogg Foundation, and the Robert Wood Johnson Foundation - asked the Institute of Medicine to convene an expert committee to develop a framework for assessing the value of community-based, non-clinical prevention policies and wellness strategies, especially those targeting the prevention of long-term, chronic diseases. The charge to the committee was to define community-based, non-clinical prevention policy and wellness strategies; define the value for community-based, non-clinical prevention policies and wellness strategies; and analyze current frameworks used to assess the value of community-based, non-clinical prevention policies and wellness strategies, including the methodologies and measures used and the short- and long-term impacts of such prevention policy and wellness strategies on health care spending and public health. An Integrated Framework for Assessing the Value of Community-Based Prevention summarizes the committee's findings.