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Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment

July 16, 2012 Comments off

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment

Source: Institute of Medicine

Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event – including combat – which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating.

As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments’ PTSD treatment programs and services. This first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment

July 14, 2012 Comments off

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment
Source: Institute of Medicine

Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event – including combat – which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating.

As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments’ PTSD treatment programs and services. This first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.

The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?

July 11, 2012 Comments off

The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?

Source: Institute of Medicine

From press release:

Millions of baby boomers will likely face difficulties getting diagnoses and treatment for mental health conditions and substance abuse problems unless there is a major effort to significantly boost the number of health professionals and other service providers able to supply this care as the population ages, says a new report from the Institute of Medicine. The magnitude of the problem is so great that no single approach or isolated changes in a few federal agencies or programs will address it, said the committee that wrote the report.

The report calls for a redesign of Medicare and Medicaid payment rules to guarantee coverage of counseling, care management, and other types of services crucial for treating mental health conditions and substance use problems so that clinicians are willing to provide this care. Organizations that accredit health and social service professional schools and license providers should ensure that all who see older patients — including primary care physicians, nurses, physicians’ assistants, and social workers — are able to recognize signs and symptoms of geriatric mental health conditions, neglect, and substance misuse and abuse and provide at least basic care, the committee said.

Top leaders of the U.S. Department of Health and Human Services need to promote national attention to building a work force of sufficient size that is trained in geriatric mental health and substance abuse care. They should ensure that all the department’s relevant agencies are devoting sufficient attention and resources to these conditions.

Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation

May 9, 2012 Comments off

Accelerating Progress in Obesity Prevention: Solving the Weight of the NationSource: Institute of Medicine

Two-thirds of adults and one-third of children are overweight or obese. Left unchecked, obesity’s effects on health, health care costs, and our productivity as a nation could become catastrophic.

The staggering human toll of obesity-related chronic disease and disability, and an annual cost of $190.2 billion for treating obesity-related illness, underscore the urgent need to strengthen prevention efforts in the United States. The Robert Wood Johnson Foundation asked the IOM to identify catalysts that could speed progress in obesity prevention.

The IOM evaluated prior obesity prevention strategies and identified recommendations to meet the following goals and accelerate progress

  • Integrate physical activity every day in every way
  • Market what matters for a healthy life
  • Make healthy foods and beverages available everywhere
  • Activate employers and health care professionals
  • Strengthen schools as the heart of health

On their own, accomplishing any one of these might help speed up progress in preventing obesity, but together, their effects will be reinforced, amplified, and maximized.

Ethical and Scientific Issues in Studying the Safety of Approved Drugs

May 5, 2012 Comments off
Source:  Institute of Medicine
In any given month, an estimated 48 percent of Americans take at least one prescription drug. Prescription drugs are crucial for preventing and treating diseases and improving the public’s health, but they can also have unintended harmful effects. Often, their benefits and risks cannot be fully identified until after a drug has been used by a large, diverse group of patients over time, mainly because clinical trials conducted before approval may be too small or too short to detect all possible risks. The passage of the Food and Drug Administration Act in 2007 provides the Food and Drug Administration (FDA) with additional postmarketing regulatory tools to better protect the health of the public, including the authority to require manufacturers to continue studying drugs that are being marketed.
To help determine when it is appropriate to require a postmarketing study, which types of studies to require, how to best protect the rights and interests of patients who participate in research, and how to use research in making regulatory decisions, the FDA asked the IOM to evaluate the scientific and ethical aspects of conducting safety studies for approved drugs. The IOM concludes that the FDA’s current approach to drug oversight in the postmarket setting is not sufficiently systematic and does not ensure that it assesses the benefits and risks of drugs consistently over the drug’s life cycle. Adopting a regulatory framework that is standardized across all drugs, yet flexible enough to adapt to regulatory decisions of differing complexity, could help make the agency’s decision-making process more predictable, transparent, and proactive. These changes could allow the FDA to better anticipate post-approval research needs and improve drug safety for all Americans.

For the Public’s Health: Investing in a Healthier Future

April 11, 2012 Comments off

For the Public’s Health: Investing in a Healthier Future
Source: Institute of Medicine

The poor performance of the United States in life expectancy and other major health outcomes, as compared with its global peers reflects what the nation prioritizes in its health investments. It spends extravagantly on clinical care but meagerly on other types of population-based actions that influence health more profoundly than medical services. The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.

In 2009, the IOM formed a committee to consider three topics related to population health: data and measurement, law and policy, and funding. In this final report, the IOM assesses both the sources and adequacy of current government public health funding and identifies approaches to building a sustainable and sufficient public health presence going forward, while recognizing the importance of the other actors in the health system, including clinical care, governmental public health, and others. In order for health outcomes to improve in the U.S., we will need to transform the way the nation invests in health to pay more attention to population-based prevention efforts; remedy the dysfunctional manner in which public health funding is allocated, structured and used; and ensure stable funding for public health departments.

IOM Report Identifies Public Health Actions for Improving the Lives of Those With Epilepsy

April 6, 2012 Comments off

IOM Report Identifies Public Health Actions for Improving the Lives of Those With Epilepsy
Source: Institute of Medicine

An estimated 2.2 million people in the United States live with epilepsy, a complex brain disorder characterized by sudden and often unpredictable seizures. The highest rate of onset occurs in children and older adults, and it affects people of all ethnicities and socio-economic backgrounds, yet this common disorder is widely misunderstood. Epilepsy refers to a spectrum of disorders with seizures that vary in type, cause, severity, and frequency. Many people do not know the causes of epilepsy or what measures to take if they witness a seizure. A new report from the Institute of Medicine highlights numerous gaps in the knowledge and management of epilepsy and recommends actions for improving the lives of those with epilepsy and their families and promoting better understanding of the disorder.

Effective treatments for epilepsy are available but access to treatment and timely referrals to specialized care are often lacking, the report’s expert committee found. Reaching rural and underserved populations, as well as providing state-of-the art care for people with persistent seizures, is particularly crucial. The report’s recommendations for expanding access to patient-centered health care include early identification and treatment of epilepsy and associated health conditions, implementing measures that assess quality of care, and establishing accreditation criteria and processes for specialized epilepsy centers. In addition, the wide variety of health professionals who care for those with epilepsy need improved knowledge and skills to provide the highest quality health care.

Some causes of epilepsy, such as traumatic brain injury, infection, and stroke, are preventable. Prevention efforts should continue for these established risk factors, as well as for recurring seizures in people with epilepsy and depression, and for epilepsy-related causes of death, the report says.

+ Epilepsy Across the Spectrum: Promoting Health and Understanding

Social and Economic Costs of Violence: Workshop Summary

March 28, 2012 Comments off

Social and Economic Costs of Violence: Workshop Summary
Source: Institute of Medicine

Measuring the social and economic costs of violence can be difficult, and most estimates only consider direct economic effects, such as productivity loss or the use of health care services. Communities and societies feel the effects of violence through loss of social cohesion, financial divestment, and the increased burden on the healthcare and justice systems. Initial estimates show that early violence prevention intervention has economic benefits. The IOM Forum on Global Violence Prevention held a workshop to examine the successes and challenges of calculating direct and indirect costs of violence, as well as the potential cost-effectiveness of intervention.

Chimpanzees in Biomedical and Behavioral Research: Assessing the Necessity

December 16, 2011 Comments off

Chimpanzees in Biomedical and Behavioral Research: Assessing the NecessitySource: Institute of Medicine
From press release:

Given that chimpanzees are so closely related to humans and share similar behavioral traits, the National Institutes of Health should allow their use as subjects in biomedical research only under stringent conditions, including the absence of any other suitable model and inability to ethically perform the research on people, says a new report from the Institute of Medicine and National Research Council. In addition, use of these animals should be permissible only if forgoing their use will prevent or significantly hinder advances necessary to prevent or treat life-threatening or debilitating conditions, said the committee that wrote the report. Based on these criteria, chimpanzees are not necessary for most biomedical research.

NIH also should limit the use of chimpanzees in behavioral research to studies that provide otherwise unattainable insights into normal and abnormal behavior, mental health, emotion, or cognition, the report says. NIH should require these studies to be performed only on acquiescent animals using techniques that are minimally invasive and are applied in a manner that minimizes pain and distress. Animals used in either biomedical or behavioral studies must be maintained in appropriate physical and social environments or in natural habitats, the report adds.

Breast Cancer and the Environment: A Life Course Approach

December 11, 2011 Comments off

Breast Cancer and the Environment: A Life Course Approach
Source: Institute of Medicine

With more than 230,000 new cases of breast cancer expected to be diagnosed in the United States in 2011, many wonder about the role that environmental exposures may be playing. Susan G. Komen for the Cure® asked the IOM to review the current evidence on breast cancer and the environment, consider gene–environment interactions, review the research challenges, explore evidence-based actions that women might take to reduce their risk, and recommend directions for future research. Overall, the IOM finds that major advances have been made in understanding breast cancer and its risk factors, but more needs to be learned about its causes and how to prevent it. The report urges a life-course approach to studying breast cancer because new information suggests that women and girls might be more susceptible to some risk factors during certain life stages.

The committee defined “environment” broadly, and reviewed evidence on a range of factors women encounter in their daily lives. Of the environmental factors reviewed, those with the most consistent evidence of a link with increased breast cancer risk included ionizing radiation, combination estrogen-progestin hormone therapy, and greater postmenopausal weight. More physical activity was linked to reduced risk. But for many other factors, the evidence from human studies is more limited, contradictory, or absent.

The IOM concludes that women may have some opportunities to reduce their risk of breast cancer through personal actions, such as avoiding unnecessary medical radiation throughout life, avoiding use of estrogen –progestin hormone therapy, avoiding smoking, limiting alcohol consumption, increasing physical activity, and, for postmenopausal breast cancer, minimizing weight gain. In addition to applying a life-course approach to studies of breast cancer, research recommendations include developing improved tools for epidemiologic research and testing of chemicals and other substances, developing effective preventive interventions, developing better approaches to modeling breast cancer risks, and improving communication about breast cancer risks. Questions about the topics addressed in the report are explored in the Questions and Answers booklet (PDF).

Health IT and Patient Safety: Building Safer Systems for Better Care

December 2, 2011 Comments off

Health IT and Patient Safety: Building Safer Systems for Better CareSource: Institute of Medicine

If implemented appropriately, health IT can help improve health care providers’ performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans. Health IT is designed to help improve the performance of health professionals, reduce costs, and enhance patient safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. However, poorly designed health IT can create new hazards in the already complex delivery of care.

In the wake of more widespread use of health IT, the Department of Health and Human Services asked the IOM to evaluate health IT safety concerns and to recommend ways that both government and the private sector can make patient care safer using health IT. The IOM finds that safe use of health IT relies on several factors, clinicians and patients among them. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system. Vendors, users, government, and the private sector all have roles to play. The IOM’s recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products.

Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan

November 1, 2011 Comments off

Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan
Source: Institute of Medicine
From press release:

Insufficient data on service members’ exposures to emissions from open-air burn pits for trash on military bases in Iraq and Afghanistan is one of the reasons why it is not possible to say whether these emissions could cause long-term health effects, says a new report from the Institute of Medicine. High background levels of ambient pollution from other sources and lack of information on the quantities and composition of wastes burned in the pits also complicate interpretation of the data.

During deployment to a war zone, military personnel can be exposed to a variety of environmental hazards, many of which have been associated with long-term adverse health outcomes such as cancer and respiratory disease. Many veterans returning from Iraq and Afghanistan have health problems that they worry are related to their exposure to burn pits on military bases. Special attention has been focused on the burn pit at Joint Base Balad (JBB), one of the largest U.S. military bases in Iraq and a central logistics hub.

Based on its analysis of raw data from air monitoring efforts at JBB conducted by the U.S. Department of Defense, the committee that wrote the report concluded that levels of most pollutants of concern at the base were not higher than levels measured at other polluted sites worldwide. Moreover, research on other populations exposed to complex mixtures of pollutants, primarily firefighters and workers at municipal waste incineration plants, has not indicated increased risk for long-term health consequences such as cancer, heart disease, and most respiratory illnesses among these groups.

Even so, the committee pointed out shortcomings in research and gaps in evidence that prevented them from drawing firm conclusions, and it recommended a path to overcome some of these limitations. Lack of information on the specific quantities and types of wastes burned and on other sources of background pollution when air samples were being collected meant it was difficult to correlate pit emissions, including smoke events, with potential health outcomes. Different types of wastes produce different combinations of chemical emissions with the possibility of different health outcomes in those exposed. Moreover, it is hard to determine whether surrogate populations such as firefighters experience exposures to pollutants and durations of exposures similar to those of service members stationed at JBB.

Documents in the News — Adverse Effects of Vaccines: Evidence and Causality

August 25, 2011 Comments off

Adverse Effects of Vaccines: Evidence and Causality
Source: Institute of Medicine

Immunizations are a cornerstone of the nation’s efforts to protect people from a host of infectious diseases. Though generally very rare or minor, there are side effects, or “adverse effects,” associated with some vaccines. Importantly, some adverse events following a vaccine may be due to coincidence and are not caused by the vaccine. To make this distinction, researchers use evidence to determine if adverse events following vaccination are causally linked to a specific vaccine; if so, these events are referred to as adverse effects. The Health Resources and Services Administration asked the IOM to review a list of adverse events associated with eight vaccines—varicella zoster, influenza (except 2009 H1N1), hepatitis B, HPV, MMR, hepatitis A, meningococcal, and those that contain tetanus—and evaluate the scientific evidence about the event–vaccine relationship. The IOM committee appointed to this task was not asked to assess the benefits or effectiveness of vaccines but only the risk of specific adverse events.

Using epidemiologic and mechanistic evidence, the committee developed 158 causality conclusions and assigned each relationship between a vaccine and an adverse health problem to one of four categories of causation:

  • Evidence convincingly supports a causal relationship
  • Evidence favors acceptance of a causal relationship
  • Evidence favors rejection of a causal relationship
  • Evidence is inadequate to accept or reject a causal relationship

The committee finds that evidence convincingly supports a causal relationship between some vaccines and some adverse events—such as MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus-containing vaccines linked to anaphylaxis. Additionally, evidence favors rejection of five vaccine-adverse event relationships, including MMR vaccine and autism and inactivated influenza vaccine and asthma episodes. However, for the majority of cases (135 vaccine-adverse event pairs), the evidence was inadequate to accept or reject a causal relationship. Overall, the committee concludes that few health problems are caused by or clearly associated with vaccines.

Improving Access to Oral Health Care for Vulnerable and Underserved Populations

August 24, 2011 Comments off

Improving Access to Oral Health Care for Vulnerable and Underserved Populations
Source: Institute of Medicine

Good health requires good oral health, yet millions of Americans lack access to basic oral health care. Various factors create barriers, preventing access to care for vulnerable and underserved populations, such as children and Medicaid beneficiaries. The Health Resources and Services Administration and the California HealthCare Foundation asked the IOM and the National Research Council to assess the current oral health care system, to develop a vision for how to improve oral health care for these populations, and to recommend ways to achieve this vision.

Access to oral health care across the life cycle is critical to overall health, and it will take flexibility and ingenuity among multiple stakeholders—including government leaders, oral health professionals, and others—to make this access available. To improve provider participation in public programs, states should increase Medicaid and Children’s Health Insurance Program reimbursement rates. With proper training, nondental health care professionals can acquire the skills to perform oral disease screenings and provide other preventive services. Dental schools should expand opportunities for dental students to care for patients with complex oral health care needs in community-based settings in order to improve the students’ comfort levels in caring for vulnerable and underserved populations. Finally, states should examine and amend state practice laws to allow healthcare professionals to practice to their highest level of competence. The IOM’s recommendations provide a roadmap for the important and necessary next steps to improve access to oral health care, reduce oral health disparities, and improve the oral health of the nation’s vulnerable and underserved populations.

Medical Devices and the Public’s Health: The FDA 510(k) Clearance Process at 35 Years

August 1, 2011 Comments off

Medical Devices and the Public’s Health: The FDA 510(k) Clearance Process at 35 Years
Source: Institute of Medicine

Medical devices play a critical role in the health care of Americans. They can range from simple tools, such as tongue depressors and bandages, to complex or life-saving equipment, such as pacemakers, magnetic resonance imaging machines, and heart–lung machines. The Federal Food, Drug, and Cosmetic Act (FFDCA) requires a “reasonable assurance of safety and effectiveness” before a device can be marketed, and the U.S. Food and Drug Administration (FDA) is responsible for enforcing this requirement. Devices that are deemed to have a moderate risk to patients generally cannot go on the market until they are cleared through the 510(k) process, named for Section 510(k) of the FFDCA. Some policymakers and patients have expressed concern about the ability of the 510(k) process to ensure that medical devices on the market are safe and effective. Other policymakers and patients, as well as the medical-device industry, have asserted that the process has become too burdensome and time-consuming and that it is delaying important new medical devices from entering the market.

The FDA turned to the IOM to review the 510(k) process and answer two questions:

  • Does the current 510(k) process protect patients optimally and promote innovation in support of public health?
  • If not, what legislative, regulatory, or administrative changes are recommended to achieve the goals of the 510(k) process optimally

The IOM finds that the current 510(k) process is flawed based on its legislative foundation. Rather than continuing to modify the 35-year-old 510(k) process, the IOM concludes that the FDA’s finite resources would be better invested in developing an integrated premarket and postmarket regulatory framework that provides a reasonable assurance of safety and effectiveness throughout the device life cycle. The IOM outlines its criteria for this framework in the report.

Clinical Preventive Services for Women: Closing the Gaps

July 21, 2011 Comments off

Clinical Preventive Services for Women: Closing the Gaps
Source: Institute of Medicine
From press release:

A new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA requires plans to cover the services listed in the U.S. Department of Health and Human Services’ (HHS) comprehensive list of preventive services. At the agency’s request, an IOM committee identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions. The report suggests the following additional services:

  • screening for gestational diabetes
  • human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
  • counseling on sexually transmitted infections
  • counseling and screening for HIV
  • contraceptive methods and counseling to prevent unintended pregnancies
  • lactation counseling and equipment to promote breast-feeding
  • screening and counseling to detect and prevent interpersonal and domestic violence
  • yearly well-woman preventive care visits to obtain recommended preventive services

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

July 11, 2011 Comments off

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research
Source: Institute of Medicine

Chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem.

In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges

June 29, 2011 Comments off

For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges
Source: Institute of Medicine
From press release:

Because strong evidence indicates that policies beyond the health sector have substantial effects on people’s health, all levels of U.S. government should adopt a structured approach to considering the health effects of any major legislation or regulation, says a new report by the IOM. In addition, federal and state policymakers should review and revise public health laws so that they adequately address current health challenges.

”The law has been an essential factor for improving the public’s health through policies such as decreasing tobacco use, increasing road safety, and ensuring the greater healthfulness of our food and water,” said Marthe Gold, chair of the committee that wrote the report and Arthur C. Logan Professor and Chair of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York City. “Our report recommends several actions that will ensure that federal, state, and local public health agencies make full use of a broad array of proven legal tools that can improve population health.”

Climate Change, the Indoor Environment, and Health

June 7, 2011 Comments off

Climate Change, the Indoor Environment, and Health
Source: Institute of Medicine

Amid the considerable research on how climate change may affect public health, one subject has received relatively little attention—the impact of climate change on indoor environments. As the world’s climate changes, buildings that were designed to operate under the “old” climatic conditions may not function well under the “new”—affecting the health of those who live, work, study, or play in them. Against this backdrop, the U.S. Environmental Protection Agency (EPA) asked the IOM to summarize the current state of scientific understanding of the effects of climate change on indoor air and public health, and to offer priorities for action.
The IOM concludes that climate change influences indoor environmental quality, warranting attention and action. This conclusion is based on three key findings:

  1. Poor indoor environmental quality is creating health problems today and impairs the ability of occupants to work and learn.
  2. Climate change may worsen existing indoor environmental problems and introduce new problems.
  3. There are opportunities to improve public health while mitigating or adapting to alterations in indoor environmental quality induced by climate change.

In this report, the IOM outlines the major climate-induced indoor environmental problems and recommends ways to reduce the health effects these problems cause. The IOM also recommends a number of specific actions for the EPA to take, in cooperation with other government organizations and the private sector.

Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel

June 4, 2011 Comments off

Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel
Source: Institute of Medicine

Military personnel, especially those in combat zones, face a distinct risk of traumatic brain injury (TBI). The injuries can range from mild to severe, and their effects can appear within minutes or hours—or sometimes weeks or even years later. Although estimates of incidence and prevalence are elusive, some estimates suggest that TBI has accounted for up to one-third of combat-related injuries. TBI also is a major problem among civilians, especially those who engage in certain sports, with an estimated 1.6 to 3.8 million sports-related TBIs occurring annually. Despite such health tolls, the mechanisms and damaging effects of TBI on the brain are not fully understood. While some research has explained these mechanisms of injury, new information suggests that nutritional interventions could help in treating or even providing resilience against TBI.

In this light, the Department of Defense (DoD) asked the IOM to review the potential role of nutrition in the treatment of and resilience against TBI. Given the complexity of TBI and the current gaps in scientific knowledge, the IOM could identify only one action that can immediately improve treatment efforts: early feeding to patients with severe TBI. Research has shown that feeding the severely injured soon after an injury is known to help in decreasing mortality. In addition, new information suggests that nutritional interventions could help in treating or even providing resilience against TBI. The IOM identified a number of other possible benefits for specific nutritional interventions and recommends that the DoD and other collaborates conduct more research.

+ Report Brief (PDF)

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