Board on Neuroscience and Behavioral Health - Böcker

Looks at the challenges of delivering important messages to different audiences. This work, using case studies in the areas of diabetes, mammography, and mass communication campaigns, examines the ways in which messages must be adapted to the unique informational needs of their audiences if they are to have any real impact.

Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated. This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives. The panel reviews existing knowledge and identifies key research questions, focusing on: * Research strategies that have the greatest potential to understand the bio- logical mechanisms of recovery and to translate findings into specific strategies for therapy. * How people adapt to MS and the research needed to improve the lives of people with MS. * Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others).The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.

Multiple Sclerosis: Current Status and Strategies for the Future identifies promising areas of multiple sclerosis (MS) research based on a strategic analysis of the current state of knowledge. The report was written by the Institute of Medicine (IOM) Committee on MS Research Strategies, and on April 2001, the Committee held a workshop to advance research recommended by the report. The specific goals of the workshop were to disseminate information about the report, foster collaboration, and serve as a launch pad for implementation of the report's recommendations. Summary of a Workshop on Research in Multiple Sclerosis, April5-6,2001 presents the reports from each breakout group and summarizes the plenary session discussion. This workshop summary contains particular viewpoints attributed to individual participants or to groups of participants (including breakout groups), but does not contain statements about what "the workshop" or "all its participants" concluded.

For many, thoughts of suicide are abundant and frequent. There exists a fear of death but an even greater fear of life due to the latter's hardships. Participants of the committee on the Pathophysiology and Prevention of Adult and Adolescent Suicide of the Institute of Medicine's workshop on suicide prevention; however, believe that there is potential for better suicide prevention. Two workshops were convened by the committee: Risk Factors for Suicide, March 14, 2001 and Suicide Prevention and Intervention, May 14, 2001. The two workshops were designed to allow invited presenters to share with the committee and other workshop participants their particular expertise in suicide, and to discuss and examine the existing knowledge base. Participants of the second workshop were selected to represent many areas including: design and analysis of prevention programs, suicide contagion, and firearm availability and suicide. The committee wanted to assess the science base of suicide etiology, evaluate the current status of suicide prevention, and examine current strategies for the study of suicide.Suicide Prevention and Intervention: Summary of a Workshop summarizes the major themes that arose during the workshop. It also includes the workshop agenda and a list of speakers that were present.

Thoughts of suicide can be abundant and frequent for some. These thoughts easily disrupt the lives of not only the suicidal person but the world around said person. It may, however, be possible to tell someone is suicidal before it's too late. Participants of committee on the Pathophysiology and Prevention of Adult and Adolescent Suicide of the Institute of Medicine's held two workshops, Risk Factors for Suicide, March 14, 2001 and Suicide Prevention and Intervention, May 14, 2001, to discuss the topic of suicide. The two workshops were designed to allow invited presenters to share with the committee and other workshop participants their particular expertise in suicide, and to discuss and examine the existing knowledge base. Risk Factors for Suicide: Summary of a Workshop summarizes the first workshop whose participants were selected to represent the areas of epidemiology and measurement, socio-cultural factors, biologic factors, developmental factors and trauma, and psychologic factors. They were asked to present current and relevant knowledge in each of their expertise areas.

Recent scientific breakthroughs, celebrity patient advocates, and conflicting religious beliefs have come together to bring the state of stem cell researcha "specifically embryonic stem cell researcha "into the political crosshairs. President Busha (TM)s watershed policy statement allows federal funding for embryonic stem cell research but only on a limited number of stem cell lines. Millions of Americans could be affected by the continuing political debate among policymakers and the public. Stem Cells and the Future of Regenerative Medicine provides a deeper exploration of the biological, ethical, and funding questions prompted by the therapeutic potential of undifferentiated human cells. In terms accessible to lay readers, the book summarizes what we know about adult and embryonic stem cells and discusses how to go about the transition from mouse studies to research that has therapeutic implications for people. Perhaps most important, Stem Cells and the Future of Regenerative Medicine also provides an overview of the moral and ethical problems that arise from the use of embryonic stem cells.This timely book compares the impact of public and private research funding and discusses approaches to appropriate research oversight. Based on the insights of leading scientists, ethicists, and other authorities, the book offers authoritative recommendations regarding the use of existing stem cell lines versus new lines in research, the important role of the federal government in this field of research, and other fundamental issues.

Every year, about 30,000 people die by suicide in the U.S., and some 650,000 receive emergency treatment after a suicide attempt. Often, those most at risk are the least able to access professional help. Reducing Suicide provides a blueprint for addressing this tragic and costly problem: how we can build an appropriate infrastructure, conduct needed research, and improve our ability to recognize suicide risk and effectively intervene. Rich in data, the book also strikes an intensely personal chord, featuring compelling quotes about peoplea (TM)s experience with suicide. The book explores the factors that raise a persona (TM)s risk of suicide: psychological and biological factors including substance abuse, the link between childhood trauma and later suicide, and the impact of family life, economic status, religion, and other social and cultural conditions. The authors review the effectiveness of existing interventions, including mental health practitionersa (TM) ability to assess suicide risk among patients. They present lessons learned from the Air Force suicide prevention program and other prevention initiatives. And they identify barriers to effective research and treatment.This new volume will be of special interest to policy makers, administrators, researchers, practitioners, and journalists working in the field of mental health.

To explore whether soccer playing puts youths at risk for lasting brain damage, the Institute of Medicine brought together experts in head injury, sports medicine, pediatrics, and bioengineering. In a workshop entitled "Youth Soccer: Neuropsychological Consequences of Head Impact in Sports," that was held in Washington D.C. on October 12, 2001, these experts presented the scientific evidence for long-term consequences of head injury from youth sports, especially soccer, possible approaches to reduce the risks, and policy issues raised by the subject. Some of the findings presented by the speakers raised concerns, such as the high concussion rate of high school soccer players, the frequent persistence of impaired brain functions even after other symptoms of a concussion disappear, and the need for a better understanding of when it is safe for players to resume playing after they have had a concussion. But other findings were reassuring, such as studies that suggest that with the type of soccer balls used in the United States, heading is not likely to cause brain injury in youths, nor is playing soccer likely to cause permanent brain damage.This is a summary of the reports from these experts in the field, and the lively discussions that followed them. Topics covered include: causes of head injuries in soccer; how to detect a concussion; the biology of concussion; studies of soccer and football players; the role of protective headgear; and policy implications, such as how to decide when a concussed player should be allowed to return to the playing field.

The Oklahoma City bombing, intentional crashing of airliners on September 11, 2001, and anthrax attacks in the fall of 2001 have made Americans acutely aware of the impacts of terrorism. These events and continued threats of terrorism have raised questions about the impact on the psychological health of the nation and how well the public health infrastructure is able to meet the psychological needs that will likely result. Preparing for the Psychological Consequences of Terrorism highlights some of the critical issues in responding to the psychological needs that result from terrorism and provides possible options for intervention. The committee offers an example for a public health strategy that may serve as a base from which plans to prevent and respond to the psychological consequences of a variety of terrorism events can be formulated. The report includes recommendations for the training and education of service providers, ensuring appropriate guidelines for the protection of service providers, and developing public health surveillance for preevent, event, and postevent factors related to psychological consequences.

The number of psychiatric researchers does not seem to be keeping pace with the needs and opportunities that exist in brain and behavioral medicine. An Institute of Medicine committee conducted a broad review of the state of patient-oriented research training in the context of the psychiatry residency and considered the obstacles to such training and strategies for overcoming those obstacles. Careful consideration was given to the demands of clinical training. The committee concluded that barriers to research training span three categories: regulatory, institutional, and personal factors. Recommendations to address these issues are presented in the committeea (TM)s report, including calling for research literacy requirements and research training curricula tailored to psychiatry residency programs of various sizes. The roles of senior investigators and departmental leadership are emphasized in the report, as is the importance of longitudinal training (e.g., from medical school through residency and fellowship).As there appears to be great interest among numerous stakeholders and a need for better tracking data, an overarching recommendation calls for the establishment of a national body to coordinate and evaluate the progress of research training in psychiatry.

New and improved therapies to treat and protect against drug dependence and abuse are urgently needed. In the United States alone about 50 million people regularly smoke tobacco and another 5 million are addicted to other drugs. In a given year, millions of these individuals attempta "with or without medical assistancea "to quit using drugs, though relapse remains the norm. Furthermore, each year several million teenagers start smoking and nearly as many take illicit drugs for the first time. Research is advancing on promising new means of treating drug addiction using immunotherapies and sustained-release (depot) medications. The aim of this research is to develop medications that can block or significantly attenuate the psychoactive effects of such drugs as cocaine, nicotine, heroin, phencyclidine, and methamphetamine for weeks or months at a time. This represents a fundamentally new therapeutic approach that shows promise for treating drug addiction problems that were difficult to treat in the past. Despite their potential benefits, however, several characteristics of these new methods pose distinct behavioral, ethical, legal, and social challenges that require careful scrutiny.Such issues can be considered unique aspects of safety and efficacy that are fundamentally related to the distinct nature and properties of these new types of medications.

Roughly half of all deaths in the United States are linked to behavioral and social factors. The leading causes of preventable death and disease in the United States are smoking, sedentary lifestyle, along with poor dietary habits, and alcohol consumption. To make measurable improvements in the health of Americans, physicians must be equipped with the knowledge and skills from the behavioral and social sciences needed to recognize, understand, and effectively respond to patients as individuals, not just to their symptoms. What are medical schools teaching students about the behavioral and social sciences? In the report, the committee concluded that there is inadequate information available to sufficiently describe behavioral and social science curriculum content, teaching techniques, and assessment methodologies in U.S. medical schools and recommends development of a new national behavioral and social science database. The committee also recommended that the National Board of Medical Examiners ensure that the U.S. Medical Licensing Examination adequately cover the behavioral and social science subject matter recommended in this report.

An estimated 11,000 spinal cord injuries occur each year in the United States and more than 200,000 Americans suffer from maladies associated with spinal cord injury. This includes paralysis, bowel and bladder dysfunction, sexual dysfunction, respiratory impairment, temperature regulation problems, and chronic pain. During the last two decades, longstanding beliefs about the inability of the adult central nervous system to heal itself have been eroded by the flood of new information from research in the neurosciences and related fields. However, there are still no cures and the challenge of restoring function in the wake of spinal cord injuries remains extremely complex. Spinal Cord Injury examines the future directions for research with the goal to accelerate the development of cures for spinal cord injuries.While many of the recommendations are framed within the context of the specific needs articulated by the New York Spinal Cord Injury Research Board, the Institute of Medicinea (TM)s panel of experts looked very broadly at research priorities relating to future directions for the field in general and make recommendations to strengthen and coordinate the existing infrastructure. Funders at federal and state agencies, academic organizations, pharmaceutical and device companies, and non-profit organizations will all find this book to be an essential resource as they examine their opportunities.

We are what we eat. That old expression seems particularly poignant every time we have our blood drawn for a routine physical to check our cholesterol levels. And, it's not just what we eat that affects our health. Whole ranges of behaviors ultimately make a difference in how we feel and how we maintain our health. Lifestyle choices have enormous impact on our health and well being. But, how do we communicate the language of good health so that it is uniformly received-and accepted-by people from different cultures and backgrounds? Take, for example, the case of a 66 year old Latina. She has been told by her doctor that she should have a mammogram. But her sense of fatalism tells her that it is better not to know if anything is wrong. To know that something is wrong will cause her distress and this may well lead to even more health problems. Before she leaves her doctor's office she has decided not to have a mammogram-that is until her doctor points out that having a mammogram is a way to take care of herself so that she can continue to take care of her family. In this way, the decision to have a mammogram feels like a positive step.Public health communicators and health professionals face dilemmas like this every day. Speaking of Health looks at the challenges of delivering important messages to different audiences. Using case studies in the areas of diabetes, mammography, and mass communication campaigns, it examines the ways in which messages must be adapted to the unique informational needs of their audiences if they are to have any real impact. Speaking of Health looks at basic theories of communication and behavior change and focuses on where they apply and where they don't. By suggesting creative strategies and guidelines for speaking to diverse audiences now and in the future, the Institute of Medicine seeks to take health communication into the 21st century. In an age where we are inundated by multiple messages every day, this book will be a critical tool for all who are interested in communicating with diverse communities about health issues.

Health and Behavior reviews our improved understanding of the complex interplay among biological, psychological, and social influences and explores findings suggested by recent research-including interventions at multiple levels that we can employ to improve human health. The book covers three main areas: * What do biological, behavioral, and social sciences contribute to our understanding of health-including cardiovascular, immune system and brain functioning, behaviors that influence health, the role of social networks and socioeconomic status, and more. * What can we learn from applied research on interventions to improve the health of individuals, families, communities, organizations, and larger populations? * How can we expeditiously translate research findings into application?