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As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women.Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.

Common diseases cost the developing world an enormous amount in terms of human life, health, and productivity, as well as lost economic potential. New and effective vaccines could not only improve the quality of life for millions of residents in developing countries, they could also contribute substantially to further economic development. Using data from the World Health Organization and other international agencies, this book analyzes disease burdens, pathogen descriptions, geographic distribution of diseases, probable vaccine target populations, alternative control measures and treatments, and future prospects for vaccine development. New Vaccine Development provides valuable insight into immunological and international health policy priorities.

Third in the series, this book addresses the social implications of architectural and interpersonal environments for older people. It suggests how society and its structures can enhance the productivity of, and preserve the quality of life for, older residents in a community. The study investigates new approaches to the problem, including new housing alternatives and new strategies for reflecting the needs of the elderly in housing construction.

The Department of Veterans Affairs--the VA--operates the nation's largest and most diverse health care system. How many physicians does it need to carry out its principal mission-related responsibilities of patient care, education, and research? This book presents and demonstrates by concrete example a methodology to answer this basic, but extraordinarily complex, question. The heart of the methodology is a decision-making process in which both statistical and expert judgment approaches can be used separately or in concert to calculate the number of physicians required, by specialty, for any facility in the VA system. Although the analyses here focus entirely on the VA, the methodology could be used to determine physician staffing for a wide range of public and private sector health care organizations.

This book surveys the entire field of body composition as it relates to performance. It includes a clear definition of terminology and a discussion of the various methods for measuring body composition.The authored papers represent a state-of-the-art review of this controversial field and address questions such as: What is a better measure of body composition—body fat or lean body mass? Does being overweight for one's height really affect performance?The book also addresses the issue of physical appearance as it relates to body fatness and performance. It includes an in-depth discussion of many of the topics of interest to those involved in sports medicine and exercise physiology.

Authorities agree that nutritional care for pregnant, about-to-be pregnant, and nursing women can prevent health problems that are costly in terms of both dollars and quality of life. Yet many women still receive little guidance regarding maternal nutrition. Now, health care professionals can turn to a handy, practical guide for help in smoothly integrating maternal nutritional care into their practices. Nutrition During Pregnancy and Lactation provides physicians, nurses, primary care providers, and midwives with a ready-made, step-by-step program for helping new mothers. The guide--based on the two most authoritative volumes available on the topic, both from the Institute of Medicine--Nutrition During Pregnancy (1990) and Nutrition During Lactation (1991)--makes the findings and recommendations detailed in these books readily accessible for daily use. In keeping with recommendations by the U.S. Surgeon General, the guide promotes breastfeeding and includes practical information for mothers on how to breastfeed. Providing background details, resource lists, and a "toolbox" of materials, this implementation guide makes nutritional care simple and straightforward.Part I walks the health care professional through the process of providing nutritional advice for new mothers--from the prepregnancy questionnaire to the final postpartum visit. It includes helpful tools such as weight charts and checklists to follow during each patient visit. It also offers suggestions on encouraging nutritional eating habits and helping patients with problems such as nausea and nursing twins. Part II offers a wide range of practical information and guidelines on important topics, such as serving culturally diverse populations, making dietary assessments throughout pregnancy and lactation, and providing dietary advice in understandable, day-to-day terms. The guide explains how to determine if patients need vitamin-mineral supplements and what regimens to recommend. And, it includes information on referring patients to federal food and nutrition programs. The guide is tabbed for quick reference and each page is designed for the reader to find information easily.

The physiological or psychological stresses that employees bring to their workplace affect not only their own performance but that of their co-workers and others. These stresses are often compounded by those of the job itself. Medical personnel, firefighters, police, and military personnel in combat settings--among others--experience highly unpredictable timing and types of stressors. This book reviews and comments on the performance-enhancing potential of specific food components. It reflects the views of military and non-military scientists from such fields as neuroscience, nutrition, physiology, various medical specialties, and performance psychology on the most up-to-date research available on physical and mental performance enhancement in stressful conditions. Although placed within the context of military tasks, the volume will have wide-reaching implications for individuals in any job setting.

Breakthroughs in biomedicine often lead to new life-giving treatments but may also raise troubling, even life-and-death, quandaries. Society's Choices discusses ways for people to handle today's bioethics issues in the context of America's unique history and culture--and from the perspectives of various interest groups. The book explores how Americans have grappled with specific aspects of bioethics through commission deliberations, programs by organizations, and other mechanisms and identifies criteria for evaluating the outcomes of these efforts. The committee offers recommendations on the role of government and professional societies, the function of commissions and institutional review boards, and bioethics in health professional education and research. The volume includes a series of 12 superb background papers on public moral discourse, mechanisms for handling social and ethical dilemmas, and other specific areas of controversy by well-known experts Ronald Bayer, Martin Benjamin, Dan W. Brock, Baruch A. Brody, H. Alta Charo, Lawrence Gostin, Bradford H. Gray, Kathi E. Hanna, Elizabeth Heitman, Thomas Nagel, Steven Shapin, and Charles M. Swezey.

For many reasons, this decade is a time of rethinking many things. There is the impending turn of the millenium, an event packed with meaning. There is recent political history, which has changed the global structure of power in ways few could foresee, and there is an economic fluidity worldwide that makes every day unpredictable and the future uncertain. There are movements of people and surges of violence that seem unparalleled, and well may be. We are awash in change, and people everywhere are trying to understand that and read its implications. It is a time that provokes soul-searching: backward, into the lessons and achievements of the past, and forward, into ways for the future to be better. The fields of health and social development are no exception. More specifically, events and conditions in the health sector point to the need to rethink some large issues. Nations everywhere are grappling with the economic and ethical dilemmas of achieving and maintaining healthy populations, since these are both cause and consequence of true development.Increasingly, the thinking is global, because there are comparisons to be learned from, connections that have implications, obligations to fulfill, and costs that are somehow shared. As part of this dynamic, there has been an explosion of analytic documents, published since the start of this decade, that deal mainly, though not exclusively, with health in developing countries. The purpose of Global Health in Transition is to distill the essential elements from those efforts, discuss the major ideas they share and the thoughts they prompt, ask what those might mean for a next agenda in global health, and comment on the shifting context in which our current concepts of the ideal will proveor not provetheir adequacy for the future.

On November 6, 1995, the Institute of Medicine's Vaccine Safety Forum convened a workshop on detecting and responding to adverse events following vaccination. Workshop speakers and participants discussed the difficulties in detecting adverse events, current adverse events detection and response methods and procedures, suggestions for improving the means of detecting and responding to adverse events following vaccination, and future areas of research. This document represents a summary of that workshop.

Thousands of HIV-positive women give birth every year. Further, because many pregnant women are not tested for HIV and therefore do not receive treatment, the number of children born with HIV is still unacceptably high. What can we do to eliminate this tragic and costly inheritance? In response to a congressional request, this book evaluates the extent to which state efforts have been effective in reducing the perinatal transmission of HIV. The committee recommends that testing HIV be a routine part of prenatal care, and that health care providers notify women that HIV testing is part of the usual array of prenatal tests and that they have an opportunity to refuse the HIV test. This approach could help both reduce the number of pediatric AIDS cases and improve treatment for mothers with AIDS. Reducing the Odds will be of special interest to federal, state, and local health policymakers, prenatal care providers, maternal and child health specialists, public health practitioners, and advocates for HIV/AIDS patients. January

It is a commonly held belief that athletes, particularly body builders, have greater requirements for dietary protein than sedentary individuals. However, the evidence in support of this contention is controversial. This book is the latest in a series of publications designed to inform both civilian and military scientists and personnel about issues related to nutrition and military service. Among the many other stressors they experience, soldiers face unique nutritional demands during combat. Of particular concern is the role that dietary protein might play in controlling muscle mass and strength, response to injury and infection, and cognitive performance. The first part of the book contains the committee's summary of the workshop, responses to the Army's questions, conclusions, and recommendations.The remainder of the book contains papers contributed by speakers at the workshop on such topics as, the effects of aging and hormones on regulation of muscle mass and function, alterations in protein metabolism due to the stress of injury or infection, the role of individual amino acids, the components of proteins, as neurotransmitters, hormones, and modulators of various physiological processes, and the efficacy and safety considerations associated with dietary supplements aimed at enhancing performance.

The model for risk assessment of nutrients used to develop tolerable upper intake levels (ULs) is one of the key elements of the developing framework for Dietary Reference Intakes (DRIs). DRIs are dietary reference values for the intake of nutrients and food components by Americans and Canadians. The U.S. National Academy of Sciences recently released two reports in the series (IOM, 1997, 1998). The overall project is a comprehensive effort undertaken by the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (DRI Committee) of the Food and Nutrition Board (FNB), Institute of Medicine, National Academy of Sciences in the United States, with active involvement of Health Canada. The DRI project is the result of significant discussion from 1991 to 1996 by the FNB regarding how to approach the growing concern that one set of quantitative estimates of recommended intakes, the Recommended Dietary Allowances (RDAs), was scientifically inappropriate to be used as the basis for many of the uses to which it had come to be applied.

This guide offers helpful advice on how teachers, administrators, and career advisers in science and engineering can become better mentors to their students. It starts with the premise that a successful mentor guides students in a variety of ways: by helping them get the most from their educational experience, by introducing them to and making them comfortable with a specific disciplinary culture, and by offering assistance with the search for suitable employment. Other topics covered in the guide include career planning, time management, writing development, and responsible scientific conduct. Also included is a valuable list of bibliographical and Internet resources on mentoring and related topics.

During Spring 1998, the U.S. Department of Health and Human Services (DHHS) contracted with the National Academy of Sciences (NAS), Institute of Medicine (IOM) to conduct a multi phase project resulting in the development of sets of leading health indicators that would provide a 'face' for Healthy People 2010. Of equal or greater importance was the development of indicator sets that would attract and sustain public attention and motivation to engage in healthy behaviors. Development of such leading health indicators sets is intended to move the United States toward achievement of more positive health outcomes for the general population and for select population groups defined by race, ethnicity, gender, age, socio-economic status, level of education, and disability. This second interim report presents a summary of the efforts of the IOM Committee on Leading Health Indicators for Healthy People 2010 to develop sample sets of leading health indicators that would meet the requisite functions of attracting and sustaining attention and motivating engagement in healthier behaviors by the public.Reactions to this report and more specifically, to the potential leading health indicator sets and suggested measures, will be solicited from the public health community as well as representatives of diverse consumer audiences through electronic communication, regional public meetings convened by DHHS, focus group discussions with target populations, and other information-gathering techniques. Review of information from these various sources will be summarized in a third and final report for DHHS to be published in April 1999. The third report will also include the committee's final recommendations regarding the functions to be fulfilled by leading health indicators, will define specific criteria underlying the selection of leading health indicators, and will identify specific sets of leading health indicators to be promoted and monitored during the decade 2000 to 2010.

Since 1941, Recommended Dietary Allowances (RDAs) has been recognized as the most authoritative source of information on nutrient levels for healthy people. Since publication of the 10th edition in 1989, there has been rising awareness of the impact of nutrition on chronic disease. In light of new research findings and a growing public focus on nutrition and health, the expert panel responsible for formulation RDAs reviewed and expanded its approach--the result: Dietary Reference Intakes. This new series of references greatly extends the scope and application of previous nutrient guidelines. For each nutrient the book presents what is known about how the nutrient functions in the human body, what the best method is to determine its requirements, which factors (caffeine or exercise, for example) may affect how it works, and how the nutrient may be related to chronic disease. The first volume of Dietary Reference Intakes includes calcium, phosphorus, magnesium, vitamin D, and fluoride. The second book in the series presents information about thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.Based on analysis of nutrient metabolism in humans and data on intakes in the U.S. population, the committee recommends intakes for each age group--from the first days of life through childhood, sexual maturity, midlife, and the later years. Recommendations for pregnancy and lactation also are made, and the book identifies when intake of a nutrient may be too much. Representing a new paradigm for the nutrition community, Dietary Reference Intakes encompasses: * Estimated Average Requirements (EARs). These are used to set Recommended Dietary Allowances. * Recommended Dietary Allowances (RDAs). Intakes that meet the RDA are likely to meet the nutrient requirement of nearly all individuals in a life-stage and gender group. * Adequate Intakes (AIs). These are used instead of RDAs when an EAR cannot be calculated. Both the RDA and the AI may be used as goals for individual intake. * Tolerable Upper Intake Levels (ULs). Intakes below the UL are unlikely to pose risks of adverse health effects in healthy people. This new framework encompasses both essential nutrients and other food components thought to pay a role in health, such as dietary fiber.It incorporates functional endpoints and examines the relationship between dose and response in determining adequacy and the hazards of excess intake for each nutrient.

Historically, 20% of all injured combatants die on the battlefield before they can be evacuated to a field hospital. Blood loss--hemorrhage--is the single major cause of death among those killed in action whose lives might otherwise be saved. Fluid resuscitation and the treatment of hypovolemia (the abnormally decreased volume of circulating fluid in the body) offer the greatest opportunity for reducing mortality and morbidity associated with battlefield casualties. In Fluid Resuscitation, a committee of experts assess current resuscitation fluids and protocols for the treatment of combat casualties and make recommendations for future research. Chapters focus on the pathophysiology of acute hemorrhagic shock, experience with and complications of fluid resuscitation, novel approaches to the treatment of shock, protocols of care at the site of injury, and future directions for research. The committee explicitly describes the similarities and differences between acute medical care during combat and civilian emergency trauma care.Fluid Resuscitation should help energize and focus research in both civilian and military emergency care and help save the lives of citizens and soldiers alike.

Healthy People is the nation's agenda for health promotion and disease prevention. The concept, first established in 1979 in a report prepared by the Office of the Surgeon General, has since been revised on a regular basis, and the fourth iteration, known as Healthy People 2010, will take the nation into the 21st century. Leading Health Indicators for Healthy People 2010: Final Report contains a number of recommendations and suggestions for the Department of Health and Human Services that address issues relevant to the composition of leading health indicator sets, data collection, data analysis, effective dissemination strategies, health disparities, and application of the indicators across multiple jurisdictional levels.

Since 1941, Recommended Dietary Allowances (RDAs) has been recognized as the most authoritative source of information on nutrient levels for healthy people. Since publication of the 10th edition in 1989, there has been rising awareness of the impact of nutrition on chronic disease. In light of new research findings and a growing public focus on nutrition and health, the expert panel responsible for formulation RDAs reviewed and expanded its approach--the result: Dietary Reference Intakes. This new series of references greatly extends the scope and application of previous nutrient guidelines. For each nutrient the book presents what is known about how the nutrient functions in the human body, what the best method is to determine its requirements, which factors (caffeine or exercise, for example) may affect how it works, and how the nutrient may be related to chronic disease. This volume of the series presents information about thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Based on analysis of nutrient metabolism in humans and data on intakes in the U.S. population, the committee recommends intakes for each age group--from the first days of life through childhood, sexual maturity, midlife, and the later years.Recommendations for pregnancy and lactation also are made, and the book identifies when intake of a nutrient may be too much. Representing a new paradigm for the nutrition community, Dietary Reference Intakes encompasses: * Estimated Average Requirements (EARs). These are used to set Recommended Dietary Allowances. * Recommended Dietary Allowances (RDAs). Intakes that meet the RDA are likely to meet the nutrient requirement of nearly all individuals in a life-stage and gender group. * Adequate Intakes (AIs). These are used instead of RDAs when an EAR cannot be calculated. Both the RDA and the AI may be used as goals for individual intake. * Tolerable Upper Intake Levels (ULs). Intakes below the UL are unlikely to pose risks of adverse health effects in healthy people. This new framework encompasses both essential nutrients and other food components thought to pay a role in health, such as dietary fiber. It incorporates functional endpoints and examines the relationship between dose and response in determining adequacy and the hazards of excess intake for each nutrient.

In an effort to increase knowledge and understanding of the process of assuring data quality and validity in clinical trials, the IOM hosted a workshop to open a dialogue on the process to identify and discuss issues of mutual concern among industry, regulators, payers, and consumers. The presenters and panelists together developed strategies that could be used to address the issues that were identified. This IOM report of the workshop summarizes the present status and highlights possible strategies for making improvements to the education of interested and affected parties as well as facilitating future planning.

Malnutrition and obesity are both common among Americans over age 65. There are also a host of other medical conditions from which older people and other Medicare beneficiaries suffer that could be improved with appropriate nutritional intervention. Despite that, access to a nutrition professional is very limited. * Do nutrition services benefit older people in terms of morbidity, mortality, or quality of life? * Which health professionals are best qualified to provide such services? * What would be the cost to Medicare of such services? Would the cost be offset by reduced illness in this population? This book addresses these questions, provides recommendations for nutrition services for the elderly, and considers how the coverage policy should be approached and practiced. The book discusses the role of nutrition therapy in the management of a number of diseases. It also examines what the elderly receive in the way of nutrition services along the continuum of care settings and addresses the areas of expertise needed by health professionals to provide appropriate nutrition services and therapy.

This volume is the newest release in the authoritative series of quantitative estimates of nutrient intakes to be used for planning and assessing diets for healthy people. Dietary Reference Intakes (DRIs) is the newest framework for an expanded approach developed by U.S. and Canadian scientists. This book discusses in detail the role of vitamin C, vitamin E, selenium, and the carotenoids in human physiology and health. For each nutrient the committee presents what is known about how it functions in the human body, which factors may affect how it works, and how the nutrient may be related to chronic disease. Dietary Reference Intakes provides reference intakes, such as Recommended Dietary Allowances (RDAs), for use in planning nutritionally adequate diets for different groups based on age and gender, along with a new reference intake, the Tolerable Upper Intake Level (UL), designed to assist an individual in knowing how much is "too much" of a nutrient.

On June 24-25, 1999, the Committee on Integrating the Science of Early Childhood Development of the Board on Children, Youth, and Families of the National Research Council/National Academy of Sciences and the Institute of Medicine convened a workshop for researchers and practitioners to examine the underlying knowledge base that informs current best practices in early childhood services, from the prenatal period to school entry. Early Childhood Intervention discusses the diversity of working assumptions, theories of change, and views about child development and early intervention that currently shape a wide variety of social policies and service delivery systems for young children and their families.