Institute of Medicine – författare

"The book is well organized, well detailed, and well referenced; it is an invaluable sourcebook for researchers and clinicians working in the area of bereavement. For those with limited knowledge about bereavement, this volume provides an excellent introduction to the field and should be of use to students as well as to professionals," states Contemporary Psychology. The Lancet comments that this book "makes good and compelling reading...It was mandated to address three questions: what is known about the health consequences of bereavement; what further research would be important and promising; and whether there are preventive interventions that should either be widely adopted or further tested to evaluate their efficacy. The writers have fulfilled this mandate well."

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.

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.

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.

Interdisciplinary research is a cooperative effort by a team of investigators, each an expert in the use of different methods and concepts, who have joined in an organized program to attack a challenging problem. Each investigator is responsible for the research in their area of discipline that applies to the problem, but together the investigators are responsible for the final product. The need for interdisciplinary training activities has been detailed over the last 25 years in both public and private reports. The history of science and technology has even shown the important advances that arose from interdisciplinary research, including plate tectonics which brought together geologists, oceanographers, paleomagnetists, seismologists, and geophysicists to advance the ability to forecast earthquakes and volcanic eruptions.In recognition of this, the need to train scientists who can address the highly complex problems that challenge us today and fully use new knowledge and technology, and the fact that cooperative efforts have proved difficult, the National Institute of Mental Health (NIMH), the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR), the National Institute on Nursing Research (NINR), and the National Institute on Aging (NIA) requested that an Institute of Medicine (IOM) Committee be created to complete several tasks including: examining the needs and strategies for interdisciplinary training in the brain, behavioral, social, and clinical sciences, defining necessary components of true interdisciplinary training in these areas, and reviewing current educational and training programs to identify elements of model programs that best facilitate interdisciplinary training. Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences provides the conclusions and recommendations of this committee.Due to evaluations of the success of interdisciplinary training programs are scarce, the committee could not specify the "necessary components" or identify the elements that "best facilitate" interdisciplinary training. However, after reviewing existing programs and consulting with experts, the committee identified approaches likely to be successful in providing direction for interdisciplinary endeavors at various career stages. This report also includes interviews, training programs, and workshop agendas used.

At the dawn of the twenty-first century, Americans enjoyed better overall health than at any other time in the nationa (TM)s history. Rapid advancements in medical technologies, breakthroughs in understanding the genetic underpinnings of health and ill health, improvements in the effectiveness and variety of pharmaceuticals, and other developments in biomedical research have helped develop cures for many illnesses and improve the lives of those with chronic diseases. By itself, however, biomedical research cannot address the most significant challenges to improving public health. Approximately half of all causes of mortality in the United States are linked to social and behavioral factors such as smoking, diet, alcohol use, sedentary lifestyle, and accidents. Yet less than five percent of the money spent annually on U.S. health care is devoted to reducing the risks of these preventable conditions. Behavioral and social interventions offer great promise, but as yet their potential has been relatively poorly tapped. Promoting Health identifies those promising areas of social science and behavioral research that may address public health needs.It includes 12 papersa "commissioned from some of the nationa (TM)s leading expertsa "that review these issues in detail, and serves to assess whether the knowledge base of social and behavioral interventions has been useful, or could be useful, in the development of broader public health interventions.

Since 1994 the Institute of Medicine's Food and Nutrition Board has been involved in developing an expanded approach to developing dietary reference standards. This approach, the Dietary Reference Intakes (DRIs), provides a set of four nutrient-based reference values designed to replace the Recommended Dietary Allowances (RDAs) in the United States and the Recommended Nutrient Intakes (RNIs) in Canada. These reference values include Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). To date, several volumes in this series have been published. This new book, Applications in Dietary Assessment, provides guidance to nutrition and health research professionals on the application of the new DRIs. It represents both a "how to" manual and a "why" manual. Specific examples of both appropriate and inappropriate uses of the DRIs in assessing nutrient adequacy of groups and of individuals are provided, along with detailed statistical approaches for the methods described. In addition, a clear distinction is made between assessing individuals and assessing groups as the approaches used are quite different.Applications in Dietary Assessment will be an essential companion to any-or all-of the DRI volumes.

The need for quality improvement and for cost saving are driving both individual choices and health system dynamics. The health services research that we need to support informed choices depends on access to data, but at the same time, individual privacy and patient-health care provider confidentiality must be protected.

Brain disordersa "neurological, psychiatric, and developmentala "now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect. Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke. The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.