The nation faces a growing epidemic of childhood obesity that threatens the immediate health of our children and their prospects of growing up healthy into adulthood. During the past 30 years, obesity in the United States has more than doubled among young children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled among youth aged 6-11 years. Currently, more than 9 million children 6 years of age and older are considered to be obese. The sequelae of obesity among children and youth are also rapidly increasing, including an increased risk of type 2 diabetes, hypertension, metabolic syndrome, asthma, and social and psychological consequences including low self-esteem and depression. To develop a prevention-focused action plan to reduce the number of obese children and youth in the United States, the Institute of Medicine organized three regional symposia, and held its second regional symposium in Atlanta, Georgia on October 6-7, 2005. Progress in Preventing Childhood Obesity: Focus on Communities highlights the recurring themes that emerged from the symposium for accelerating change and moving forward with obesity prevention efforts: empower communities and neighborhoods, change the environment, forge strategic partnerships, garner and mobilize political support, educate stakeholders, identify leaders and build on cultural assets, collect and disseminate local data, evaluate programs and interventions, and translate successful interventions to other communities. Approximately 90 individuals active in childhood obesity prevention efforts in the southeastern region of the United States who represented a range of stake holder perspectives and innovative practices in local communities including students, community leaders, physicians, health educators, clergy, teachers, and state and federal government officials were invited to participate in the symposium. The contents of this summary reflect specific examples presented and discussed during the symposium, and unless otherwise noted, the general perspectives of the participants. This summary, along with 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.
Obesity is now an epidemic among children and adolescents in the United States. Nationwide, roughly nine million children over six years of age are obeseâ€"with elevated risks of both health conditions, such as diabetes and hypertension, and poor quality of life, possibly throughout adulthood. The Institute of Medicine (IOM) report, Preventing Childhood Obesity: Health in the Balance, was released in September 2004 and identified promising approaches for obesity prevention efforts and a set of recommendations for a variety of stake holders and sectors. The IOM is building on its previous work by initiating a new study to assess progress in childhood obesity prevention efforts. In 2005, the IOM organized three regional meeting in the Midwest, South, and Western United States to galvanize obesity prevention efforts of local, state, and national decision-makers, community and school leaders, grassroots organizations, and industry including the food, beverage, restaurant, leisure, and entertainment industries. In collaboration with the Kansas health Foundation (KHF), the IOM held the study's first regional symposium in Wichita, Kansas on June 27-28, 2005. The symposium was structured to include three panels that focused on challenges and innovations for obesity prevention and school policies, school programs, and additional steps that can be taken by numerous stakeholders to overcome barriers to progress. Three break-out sessions focused on creating and strengthening linkages with other sectors to promote childhood obesity prevention including links between schools and home, community, and health care; links between schools and industry; and links between schools and the built environment. This brief summary highlights the recurring themes for accelerating change and moving forward with obesity prevention efforts that emerged from the symposium; forge strategic partnerships; empower local schools and communities; educate stakeholders; evaluate obesity prevention efforts; document the benefits of obesity preventions; innovate to address barriers; use a systems approach; and develop a long-term strategic plan. The findings of this summary, along with those of two other symposia, and a more detailed discussion of insights and regional examples will be incorporated in the committee's final report that will be released in 2006.
The nation faces a growing epidemic of childhood obesity that threatens the immediate health of our children and their prospects of growing up healthy into adulthood. During the past 30 years, obesity in the United States has more than doubled among young children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled among youth aged 6-11 years. Currently, more than 9 million children 6 years of age and older are considered to be obese. The sequelae of obesity among children and youth are also rapidly increasing, including an increased risk of type 2 diabetes, hypertension, metabolic syndrome, asthma, and social and psychological consequences including low self-esteem and depression. To develop a prevention-focused action plan to reduce the number of obese children and youth in the United States, the Institute of Medicine organized three regional symposia, and held its second regional symposium in Atlanta, Georgia on October 6-7, 2005. Progress in Preventing Childhood Obesity: Focus on Communities highlights the recurring themes that emerged from the symposium for accelerating change and moving forward with obesity prevention efforts: empower communities and neighborhoods, change the environment, forge strategic partnerships, garner and mobilize political support, educate stakeholders, identify leaders and build on cultural assets, collect and disseminate local data, evaluate programs and interventions, and translate successful interventions to other communities. Approximately 90 individuals active in childhood obesity prevention efforts in the southeastern region of the United States who represented a range of stake holder perspectives and innovative practices in local communities including students, community leaders, physicians, health educators, clergy, teachers, and state and federal government officials were invited to participate in the symposium. The contents of this summary reflect specific examples presented and discussed during the symposium, and unless otherwise noted, the general perspectives of the participants. This summary, along with 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 remarkable increase in the prevalence of obesity among children and youth in the United States over a relatively short timespan represents one of the defining public health challenges of the 21st century. The country is beginning to recognize childhood obesity as a major public health epidemic that will incur substantial costs to the nation. However, the current level of investment by the public and private sectors still does not match the extent of the problem. There is a substantial underinvestment of resources to adequately address the scope of this obesity crisis. At this early phase in addressing the epidemic, actions have begun on a number of levels to improve the dietary patterns and to increase the physical activity levels of young people. Schools, corporations, youth-related organizations, families, communities, foundations, and government agencies are working to implement a variety of policy changes, new programs, and other interventions. These efforts, however, generally remain fragmented and small in scale. Moreover, the lack of systematic monitoring and evaluation of interventions have hindered the development of an evidence base to identify, apply, and disseminate lessons learned and to support promising efforts to prevent childhood obesity. Progress in Preventing Childhood Obesity: How Do We Measure Up? examines the progress made by obesity prevention initiatives in the United States from 2004 to 2006. This book emphasizes a call to action for key stakeholders and sectors to commit to and demonstrate leadership in childhood obesity prevention, evaluates all policies and programs, monitors their progress, and encourages stakeholders to widely disseminate promising practices. This book will be of interest to federal, state, and local government agencies; educators and schools; public health and health care professionals; private-sector companies and industry trade groups; media; parents; and those involved in implementing community-based programs and consumer advocacy.
According to Transforming Health Care Scheduling and Access, long waits for treatment are a function of the disjointed manner in which most health systems have evolved to accommodate the needs and the desires of doctors and administrators, rather than those of patients. The result is a health care system that deploys its most valuable resource-highly trained personnel-inefficiently, leading to an unnecessary imbalance between the demand for appointments and the supply of open appointments. This study makes the case that by using the techniques of systems engineering, new approaches to management, and increased patient and family involvement, the current health care system can move forward to one with greater focus on the preferences of patients to provide convenient, efficient, and excellent health care without the need for costly investment. Transforming Health Care Scheduling and Access identifies best practices for making significant improvements in access and system-level change. This report makes recommendations for principles and practices to improve access by promoting efficient scheduling. This study will be a valuable resource for practitioners to progress toward a more patient-focused "How can we help you today?" culture.
Shortly after 1998, leading members of Georgia's government, medical community, and public-spirited citizenry began considering ways in which some of Georgia's almost $5 billion, 25-year settlement from the tobacco industry's Master Settlement Agreement with the 50 states could be used to benefit Georgia residents. Given tobacco's role in causing cancer, they decided to create an entity and program with the mission of making Georgia a national leader in cancer prevention, treatment, and research. This new entity-called the Georgia Cancer Coalition, Inc. (GCC)-and the state of Georgia subsequently began implementing a far-reaching state cancer initiative that includes five strategic goals: (1) preventing cancer and detecting existing cancers earlier; (2) improving access to quality care for all state residents with cancer; (3) saving more lives in the future; (4) training future cancer researchers and caregivers; and (5) turning the eradication of cancer into economic growth for Georgia. Assessing the Quality of Cancer Care identifies a set of measures that could be used to gauge Georgia's progress in improving the quality of its cancer services and in reducing cancer-related morbidity and mortality.
Despite the changing demographics of the nation and a growing appreciation for diversity and inclusion as drivers of excellence in science, engineering, and medicine, Black Americans are severely underrepresented in these fields. Racism and bias are significant reasons for this disparity, with detrimental implications on individuals, health care organizations, and the nation as a whole. The Roundtable on Black Men and Black Women in Science, Engineering, and Medicine was launched at the National Academies of Sciences, Engineering, and Medicine in 2019 to identify key levers, drivers, and disruptors in government, industry, health care, and higher education where actions can have the most impact on increasing the participation of Black men and Black women in science, medicine, and engineering. On April 16, 2020, the Roundtable convened a workshop to explore the context for their work; to surface key issues and questions that the Roundtable should address in its initial phase; and to reach key stakeholders and constituents. This proceedings provides a record of the workshop.
Recent outbreaks of illnesses traced to contaminated sprouts and lettuce illustrate the holes that exist in the system for monitoring problems and preventing foodborne diseases. Although it is not solely responsible for ensuring the safety of the nation's food supply, the U.S. Food and Drug Administration (FDA) oversees monitoring and intervention for 80 percent of the food supply. The U.S. Food and Drug Administration's abilities to discover potential threats to food safety and prevent outbreaks of foodborne illness are hampered by impediments to efficient use of its limited resources and a piecemeal approach to gathering and using information on risks. Enhancing Food Safety: The Role of the Food and Drug Administration, a new book from the Institute of Medicine and the National Research Council, responds to a congressional request for recommendations on how to close gaps in FDA's food safety systems. Enhancing Food Safety begins with a brief review of the Food Protection Plan (FPP), FDA's food safety philosophy developed in 2007. The lack of sufficient detail and specific strategies in the FPP renders it ineffectual. The book stresses the need for FPP to evolve and be supported by the type of strategic planning described in these pages. It also explores the development and implementation of a stronger, more effective food safety system built on a risk-based approach to food safety management. Conclusions and recommendations include adopting a risk-based decision-making approach to food safety; creating a data surveillance and research infrastructure; integrating federal, state, and local government food safety programs; enhancing efficiency of inspections; and more. Although food safety is the responsibility of everyone, from producers to consumers, the FDA and other regulatory agencies have an essential role. In many instances, the FDA must carry out this responsibility against a backdrop of multiple stakeholder interests, inadequate resources, and competing priorities. Of interest to the food production industry, consumer advocacy groups, health care professionals, and others, Enhancing Food Safety provides the FDA and Congress with a course of action that will enable the agency to become more efficient and effective in carrying out its food safety mission in a rapidly changing world.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
Volume II of Medicare: A Strategy for Quality Assurance provides extensive source materials on quality assurance, including results of focus groups with the elderly and practicing physicians, findings from public hearings on quality of care for the elderly, and many exhibits from site visits and the literature on quality measurements and assurance tools. The current Medicare peer review organization program and related hospital accreditation efforts are comprehensively described as background for the recommendations in Volume I of this report. Like the companion volume, this substantial book will be a valuable reference document for all groups concerned with quality of health care and the elderly.
In the past 30 years, the population of prisoners in the United States has expanded almost 5-fold, correctional facilities are increasingly overcrowded, and more of the country's disadvantaged populations—racial minorities, women, people with mental illness, and people with communicable diseases such as HIV/AIDS, hepatitis C, and tuberculosis—are under correctional supervision. Because prisoners face restrictions on liberty and autonomy, have limited privacy, and often receive inadequate health care, they require specific protections when involved in research, particularly in today's correctional settings. Given these issues, the Department of Health and Human Services' Office for Human Research Protections commissioned the Institute of Medicine to review the ethical considerations regarding research involving prisoners. The resulting analysis contained in this book, Ethical Considerations for Research Involving Prisoners, emphasizes five broad actions to provide prisoners involved in research with critically important protections: • expand the definition of "prisoner"; • ensure universally and consistently applied standards of protection; • shift from a category-based to a risk-benefit approach to research review; • update the ethical framework to include collaborative responsibility; and • enhance systematic oversight of research involving prisoners.
The Association of Nurses in AIDS Care (ANAC) presents the essential information needed by every nurse working with HIV/AIDS patients in any setting. The text provides an educational framework for HIV/AIDS clinical content and serves those preparing for specialty certification in HIV/AIDS training. The text covers: A) Infection, transmission, and prevention B) Clinical management of a variety of patient types C) Symptomatic conditions and symptom management D) Special populations E) Psychosocial concerns for patients. ANAC's Core Curriculum for HIV/AIDS Nursing, Third Edition includes the following new topics: Updates to the evidence basis underlying the nursing care of persons with HIV/AIDS. New issues and challenges including the care for pediatric patients and adults with giardia, syphilis and bipolar disease. New text features including case studies and quizzes.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
Emergency Medical Services (EMS) is a critical component of our nation's emergency and trauma care system, providing response and medical transport to millions of sick and injured Americans each year. At its best, EMS is a crucial link to survival in the chain of care, but within the last several years, complex problems facing the emergency care system have emerged. Press coverage has highlighted instances of slow EMS response times, ambulance diversions, trauma center closures, and ground and air medical crashes. This heightened public awareness of problems that have been building over time has underscored the need for a review of the U.S. emergency care system. Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns: • 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.
Catastrophic disasters occurring in 2011 in the United States and worldwide-from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand-have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources. Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles. Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.
In 1950 men and women in the United States had a combined life expectancy of 68.9 years, the 12th highest life expectancy at birth in the world. Today, life expectancy is up to 79.2 years, yet the country is now 28th on the list, behind the United Kingdom, Korea, Canada, and France, among others. The United States does have higher rates of infant mortality and violent deaths than in other developed countries, but these factors do not fully account for the country's relatively poor ranking in life expectancy. International Differences in Mortality at Older Ages: Dimensions and Sources examines patterns in international differences in life expectancy above age 50 and assesses the evidence and arguments that have been advanced to explain the poor position of the United States relative to other countries. The papers in this deeply researched volume identify gaps in measurement, data, theory, and research design and pinpoint areas for future high-priority research in this area. In addition to examining the differences in mortality around the world, the papers in International Differences in Mortality at Older Ages look at health factors and life-style choices commonly believed to contribute to the observed international differences in life expectancy. They also identify strategic opportunities for health-related interventions. This book offers a wide variety of disciplinary and scholarly perspectives to the study of mortality, and it offers in-depth analyses that can serve health professionals, policy makers, statisticians, and researchers.
Throughout history, perhaps no other disease has generated the level of social, scientific, and political discourse or has had the degree of cultural significance as cancer. A collective in the truest sense of the word, "cancer" is a clustering of different diseases that afflict individuals in different ways. Its burdens are equally broad and diverse, from the physical, financial, and psychological tolls it imposes on individuals to the costs it inflicts upon the nation's clinical care and public health systems, and despite decades of concerted efforts often referred to as the "war on cancer", those costs have only continued to grow over time. The causes and effects of cancer are complexâ€"in part preventable and treatable, but also in part unknown, and perhaps even unknowable. Guiding Cancer Control defines the key principles, attributes, methods, and tools needed to achieve the goal of implementing an effective national cancer control plan. This report describes the current structure of cancer control from a local to global scale, identifies necessary goals for the system, and formulates the path towards integrated disease control systems and a cancer-free future. This framework is a crucial step in establishing an effective, efficient, and accountable system for controlling cancer and other diseases.
Every day in the United States, children and adolescents are victims of commercial sexual exploitation and sex trafficking. Despite the serious and long-term consequences for victims as well as their families, communities, and society, efforts to prevent, identify, and respond to these crimes are largely under supported, inefficient, uncoordinated, and unevaluated. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States examines commercial sexual exploitation and sex trafficking of U.S. citizens and lawful permanent residents of the United States under age 18. According to this report, efforts to prevent, identify, and respond to these crimes require better collaborative approaches that build upon the capabilities of people and entities from a range of sectors. In addition, such efforts need to confront demand and the individuals who commit and benefit from these crimes. The report recommends increased awareness and understanding, strengthening of the law's response, strengthening of research to advance understanding and to support the development of prevention and intervention strategies, support for multi-sector and interagency collaboration, and creation of a digital information-sharing platform. A nation that is unaware of these problems or disengaged from solutions unwittingly contributes to the ongoing abuse of minors. If acted upon in a coordinated and comprehensive manner, the recommendations of Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States can help advance and strengthen the nation's emerging efforts to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States.
Information technology (IT) is widely understood to be the enabling technology of the 21st century. IT has transformed, and continues to transform, all aspects of our lives: commerce and finance, education, energy, health care, manufacturing, government, national security, transportation, communications, entertainment, science, and engineering. IT and its impact on the U.S. economyâ€"both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)â€"continue to grow in size and importance. IT’s impacts on the U.S. economyâ€"both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)â€"continue to grow. IT enabled innovation and advances in IT products and services draw on a deep tradition of research and rely on sustained investment and a uniquely strong partnership in the United States among government, industry, and universities. Past returns on federal investments in IT research have been extraordinary for both U.S. society and the U.S. economy. This IT innovation ecosystem fuels a virtuous cycle of innovation with growing economic impact. Building on previous National Academies work, this report describes key features of the IT research ecosystem that fuel IT innovation and foster widespread and longstanding impact across the U.S. economy. In addition to presenting established computing research areas and industry sectors, it also considers emerging candidates in both categories.
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