Institute of Medicine's research while affiliated with University of Rochester and other places

Publications (114)

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From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2...
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For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine (IOM) has...
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Speech and language are central to the human experience; they are the vital means by which people convey and receive knowledge, thoughts, feelings, and other internal experiences. Acquisition of communication skills begins early in childhood and is foundational to the ability to gain access to culturally transmitted knowledge, organize and share th...
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Between 1963 and 1969, the U.S. military carried out a series of tests, termed Project SHAD (Shipboard Hazard and Defense), to evaluate the vulnerabilities of U.S. Navy ships to chemical and biological warfare agents. These tests involved use of active chemical and biological agents, stimulants, tracers, and decontaminants. Approximately 5,900 mili...
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward va...
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Interprofessional teamwork and collaborative practice are emerging as key elements of efficient and productive work in promoting health and treating patients. The vision for these collaborations is one where different health and/or social professionals share a team identity and work closely together to solve problems and improve delivery of care. A...
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The National Institutes of Health - and many other organizations and individuals worldwide - are interested in the state of the science on preventing Alzheimer's disease, mild cognitive impairment, and age-related cognitive decline. This letter report reviews the evidence on interventions to decrease the risk of developing clinical Alzheimer's-type...
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In January 2015, the Institute of Medicine conducted a study to determine the incidence and prevalence, as well as the risk of developing multiple sclerosis (MS) and other neurologic diseases as a result of service in the 1990-1991 Persian Gulf and post 9/11 Global Operations theaters. The other neurologic diseases to be considered include: Parkins...
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Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of childr...
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The U.S. National Climate Assessment identified a number of ways in which climate change is affecting, and is likely to affect, people, infrastructure, natural resources, and ecosystems. Those impacts, in turn, are increasingly having important current and potential future consequences for human health. There is a need to probe more deeply into how...
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The United States Social Security Administration (SSA) administers two disability programs: Social Security Disability Insurance (SSDI), for disabled individuals, and their dependent family members, who have worked and contributed to the Social Security trust funds, and Supplemental Security Income (SSSI), which is a means-tested program based on i...
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From 1972 to 1982, approximately 1,500-2,100 US Air Force Reserve personnel trained and worked on C-123 aircraft that had formerly been used to spray herbicides in Vietnam as part of Operation Ranch Hand. After becoming aware that some of the aircraft on which they had worked had previously served this purpose, some of these AF Reservists applied t...
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On October 17, 2014, spurred by incidents at U.S. government laboratories that raised serious biosafety concerns, the United States government launched a one-year deliberative process to address the continuing controversy surrounding so-called "gain-of-function" (GOF) research on respiratory pathogens with pandemic potential. The gain of function c...
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The Air Force Health Study (AFHS) is a longitudinal, prospective epidemiologic study of more than 2,700 men followed for approximately 20 years. This cohort participated in up to six intensive physical examinations with high rates of compliance. In addition to a complete record of clinical measurements and observations collected at these exams, ser...
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Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatmen...
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More than 1.2 billion people worldwide play video games (online, via console, mobile phone, and other wireless devices), and many may be unaware that programmers often incorporate neuroscience into game design. Given the high prevalence of gaming in today's society, the Institute of Medicine Forum on Neuroscience and Nervous System Disorders hosted...
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Determinants of health - like physical activity levels and living conditions - have traditionally been the concern of public health and have not been linked closely to clinical practice. However, if standardized social and behavioral data can be incorporated into patient electronic health records (EHRs), those data can provide crucial information a...
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The Postdoctoral Experience Revisited builds on the 2000 report Enhancing the Postdoctoral Experience for Scientists and Engineers. That ground-breaking report assessed the postdoctoral experience and provided principles, action points, and recommendations to enhance that experience. Since the publication of the 2000 report, the postdoctoral landsc...
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It is probably only a matter of time before we witness the next event in which large numbers of people are exposed to ionizing radiation. In the past, planning a response to such an occurrence would have likely focused on the management of casualties from high-dose exposure. However, more recently, a different threat has come to the fore: accidenta...
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Over the last three decades, researchers have made remarkable progress in creating and testing family-focused programs aimed at fostering the cognitive, affective, and behavioral health of children. These programs include universal interventions, such as those for expecting or new parents, and workshops for families whose children are entering adol...
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The National Children's Study (NCS) was authorized by the Children's Health Act of 2000 and is being implemented by a dedicated Program Office in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The NCS is planned to be a longitudinal observational birth cohort study to evaluate the effects of chronic and...
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The more than 200,000 men and women that make up the Department of Homeland Security (DHS) workforce have been entrusted with the ultimate responsibility - ensuring that the homeland is safe, secure, and resilient against terrorism and other hazards. Every day, these dedicated individuals take on the critical and often dangerous challenges of the D...
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Substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset and progression of disease has accumulated over the past few decades. Electronic health records (EHRs) provide crucial information to providers treating individual patients, to health systems, including public health officials, abo...
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Since its inception, the U.S. human spaceflight program has grown from launching a single man into orbit to an ongoing space presence involving numerous crewmembers. As the U.S. space program evolves, propelled in part by increasing international and commercial collaborations, long duration or exploration spaceflights - such as extended stays on th...
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More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pat...
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Each year, child protective services receive reports of child abuse and neglect involving six million children, and many more go unreported. The long-term human and fiscal consequences of child abuse and neglect are not relegated to the victims themselves -- they also impact their families, future relationships, and society. In 1993, the National R...
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From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2...
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The process for translating basic science discoveries into clinical applications has historically involved a linear and lengthy progression from initial discovery to preclinical testing, regulatory evaluation and approval, and, finally, use in clinical practice. The low rate of translation from basic science to clinical application has been a sourc...
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Sharing data generated through the conduct of clinical trials offers the promise of placing evidence about the safety and efficacy of therapies and clinical interventions on a firmer basis and enhancing the benefits of clinical trials. Ultimately, such data sharing - if carried out appropriately - could lead to improved clinical care and greater pu...
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Identifying and Addressing the Needs of Adolescents and Young Adults with Cancer is the summary of a workshop convened by the Institute of Medicine's National Cancer Policy Forum in July 2013 to facilitate discussion about gaps and challenges in caring for adolescent and young adult cancer patients and potential strategies and actions to improve th...
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Neurodegeneration: Exploring Commonalities Across Diseases is the summary of a workshop hosted by the Institute of Medicine's (IOM's) Forum on Neuroscience and Nervous System Disorders in Spring 2012 to explore commonalities across neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and...
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The responsibilities of the Department of Homeland Security (DHS) range from preventing foreign and domestic terrorist attacks; securing the nation's borders; safeguarding transportation systems; responding to natural disasters; nuclear detection; and more. Created in 2002 from a merger that rapidly incorporated parts of eight cabinet departments a...
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The primary federal program designed to ensure that all states are capable of participating the nation's research enterprise fall under the general rubric of the Experimental Program to Stimulate Competitive Research (EPSCOR). The National Science Foundation (NSF), Department of Energy, Department of Agriculture, and National Aeronautics and Space...
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The Institute of Medicine (IOM) Committee on Quality Measures for the Healthy People Leading Health Indicators was charged by the Office of the Assistant Secretary for Health to identify measures of quality for the 12 Leading Health Indicator (LHI) topics and 26 Leading Health Indicators in Healthy People 2020 (HP2020), the current version of the D...
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The U.S. government supports programs to combat global HIV/AIDS through an initiative that is known as the President's Emergency Plan for AIDS Relief (PEPFAR). This initiative was originally authorized in the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and focused on an emergency response to the HIV/AIDS pandemic to deli...
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Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advis...
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As of December 2012, Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of about 2.2 million troops; there have been 2,222 US fatalities in OEF and Operation New Dawn (OND)1 and 4,422 in OIF. The numbers of wounded US troops exceed 16,000 in Afghanistan and 32,000 in Iraq. In ad...
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The California Institute for Regenerative Medicine (CIRM) was created in 2005 by The California Stem Cell Research and Cures Act (Proposition 71) to distribute $3 billion in state funds for stem cell research. The passage of Proposition 71 by the voters of California occurred at a time when federal funding for research involving human embryonic ste...
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Health systems and assets are a large part of the critical infrastructure of any community and are vital not only for the safety and well-being of its citizens, but also for the economic vitality, quality of life, and livelihood of the entire community. As part of its ongoing mission to foster dialogue among stakeholders and to confront the challen...
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Breast cancer remains the most common invasive cancer among women. The primary patients of breast cancer are adult women who are approaching or have reached menopause; 90 percent of new cases in U.S. women in 2009 were diagnosed at age 45 or older. Growing knowledge of the complexity of breast cancer stimulated a transition in breast cancer researc...
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IOM's 1999 landmark study To Err is Human estimated that between 44,000 and 98,000 lives are lost every year due to medical errors. This call to action has led to a number of efforts to reduce errors and provide safe and effective health care. Information technology (IT) has been identified as a way to enhance the safety and effectiveness of care....
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Nearly 69 percent of U.S. adults and 32 percent of children are either overweight or obese, creating an annual medical cost burden that may reach $147 billion. Researchers and policy makers are eager to identify improved measures of environmental and policy factors that contribute to obesity prevention. The IOM formed the Committee on Accelerating...
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Because of continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Congress passed the Agent Orange Act of 1991. The legislation directed the Secretary of Veterans Affairs (VA) to request the Institite of Medicine to perform a comprehensive evaluation of scientific and medical information regarding t...
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Access to oral health care is essential to promoting and maintaining overall health and well-being, yet only half of the population visits a dentist each year. Poor and minority children are less likely to have access to oral health care than are their nonpoor and nonminority peers. Older adults, people who live in rural areas, and disabled individ...
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Though it is highly preventable, tooth decay is a common chronic disease both in the United States and worldwide. Evidence shows that decay and other oral diseases may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes. However, individuals and many health care professionals remain unaware of th...
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The Robert Wood Johnson Foundation asked the Institute of Medicine (IOM) to examine three topics in relation to public health: measurement, the law, and funding. IOM prepared a three book series-one book on each topic-that contain actionable recommendations for public health agencies and other stakeholders that have roles in the health of the U.S p...
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Medical devices that are deemed to have a moderate risk to patients generally cannot go on the market until they are cleared through the FDA 510(k) process. In recent years, individuals and organizations have expressed concern that the 510(k) process is neither making safe and effective devices available to patients nor promoting innovation in the...
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Chronic pain 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 Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for a...
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Increasing public investments in health care services for low-income and special needs children and adolescents in the United States have raised questions about whether these efforts improve their health outcomes. Yet it is difficult to assess the general health status and health care quality for younger populations, especially those at risk of poo...
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The indoor environment affects occupants' health and comfort. Poor environmental conditions and indoor contaminants are estimated to cost the U.S. economy tens of billions of dollars a year in exacerbation of illnesses like asthma, allergic symptoms, and subsequent lost productivity. Climate change has the potential to affect the indoor environment...
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Chronic diseases are common and costly, yet they are also among the most preventable health problems. Comprehensive and accurate disease surveillance systems are needed to implement successful efforts which will reduce the burden of chronic diseases on the U.S. population. A number of sources of surveillance data--including population surveys, coho...
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Health literacy is the degree to which one can understand and make decisions based on health information. Nearly 90 million adults in the United States have limited health literacy. While poor health literacy spans all demographics, rates of low health literacy are disproportionately higher among those with lower socioeconomic status, limited educa...
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Over 3 million U.S. military personnel were sent to Southeast Asia to fight in the Vietnam War. Since the end of the Vietnam War, veterans have reported numerous health effects. Herbicides used in Vietnam, in particular Agent Orange have been associated with a variety of cancers and other long term health problems from Parkinson's disease and type...
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In the United States, chronic diseases currently account for 70 percent of all deaths, and close to 48 million Americans report a disability related to a chronic condition. Today, about one in four Americans have multiple diseases and the prevalence and burden of chronic disease in the elderly and racial/ethnic minorities are notably disproportiona...
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With the responsibility to ensure the safety of food, drugs, and other products, the U.S. Food and Drug Administration (FDA) faces decisions that may have public-health consequences every day. Often the decisions must be made quickly and on the basis of incomplete information. FDA recognized that collecting and evaluating information on the risks p...
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At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for resea...
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The Child and Adult Care Food Program (CACFP) is a federally-funded program designed to provide healthy meals and snacks to children and adults while receiving day care at participating family day care homes, traditional child care centers, afterschool facilities, adult care facilities, and emergency shelters. CACFP has the broadest scope of any of...
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In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus, as well as questions regarding personal protective equipment (PPE) for healthcare personnel. In this book, the Institute of Medicine assesses the progress of PPE research and identifies future directions for PPE for...
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Increased HIV screening may help identify more people with the disease, but there may not be enough resources to provide them with the care they need. The Institute of Medicine's Committee on HIV Screening and Access to Care concludes that more practitioners must be trained in HIV/AIDS care and treatment and their hospitals, clinics, and health dep...
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Despite having the costliest medical care delivery system in the world, Americans are not particularly healthy. Recent international comparisons show that life expectancy in the U.S. ranks 49th among all nations, and infant mortality rates are higher in the U.S. than in many far less affluent nations. While these statistics are alarming, the bigger...
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With the widespread use of highly active anti-retroviral treatment (HAART), HIV has become a chronic, rather than a fatal, disease. But for their treatment to succeed, patients require uninterrupted care from a health care provider and uninterrupted access to anti-HIV medications. The IOM identifies federal, state, and private health insurance poli...
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HIV/AIDS is a catastrophe globally but nowhere more so than in sub-Saharan Africa, which in 2008 accounted for 67 percent of cases worldwide and 91 percent of new infections. The Institute of Medicine recommends that the United States and African nations move toward a strategy of shared responsibility such that these nations are empowered to take o...
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Nearly nine out of 10 adults have difficulty using everyday health information to make good health decisions. The Institute of Medicine (IOM) Roundtable on Health Literacy held a meeting on May 27, 2010, to explore areas for research in health literacy, the relationship between health literacy and health disparities, and ways to apply information t...
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Millions of people in sub-Saharan Africa suffer from mental, neurological, and substance use (MNS) disorders, and most do not have the resources to obtain treatment. The Uganda National Academy of Sciences and the Institute of Medicine hosted a workshop to discuss the state of care for MNS disorders in sub-Saharan Africa. © 2010 by the National Aca...
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The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus qualify for disability benefits. In this report, the Institute of Medicine (IOM) makes several recommendations for improving SSA's capacity for determining disabili...
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It is as yet uncertain how the Gulf of Mexico oil spill will affect the health of clean-up workers and volunteers, residents, and visitors in the Gulf. The IOM recommends that the U.S. Department of Health and Human Services focus on researching psychological and behavioral health, exposure information to oil and dispersants, seafood safety, commun...
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The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly a...
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Does a longer life mean a healthier life? The number of adults over 65 in the United States is growing, but many may not be aware that they are at greater risk from foodborne diseases and their nutritional needs change as they age. The IOM's Food Forum held a workshop October 29-30, 2009, to discuss food safety and nutrition concerns for older adul...
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Even though slightly over half of the U.S. population is female, medical research historically has neglected the health needs of women. However, over the past two decades, there have been major changes in government support of women's health research--in policies, regulations, and the organization of research efforts. To assess the impact of these...
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Reducing the intake of sodium is an important public health goal for Americans. Since the 1970s, an array of public health interventions and national dietary guidelines has sought to reduce sodium intake. However, the U.S. population still consumes more sodium than is recommended, placing individuals at risk for diseases related to elevated blood p...
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In the face of so many daunting near-term challenges, U.S. government and industry are letting the crucial strategic issues of U.S. competitiveness slip below the surface. Five years ago, the National Academies prepared Rising Above the Gathering Storm, a book that cautioned: "Without a renewed effort to bolster the foundations of our competitivene...
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Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive dru...
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Many people naturally assume that the claims made for foods and nutritional supplements have the same degree of scientific grounding as those for medication, but that is not always the case. The IOM recommends that the FDA adopt a consistent scientific framework for biomarker evaluation in order to achieve a rigorous and transparent process. © 2010...
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For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the IOM is conducting an ongoing re...
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In this book, the IOM makes recommendations for permitting independent practice for mental health counselors treating patients within TRICARE--the DOD's health care benefits program. This would change current policy, which requires all counselors to practice under a physician's supervision without regard to their education, training, licensure or e...
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The FDA requested that the IOM examine the ethical and informed consent issues that should be considered when conducting clinical trials to evaluate drug safety. This report outlines when and how the FDA should conduct clinical trials to protect the public's health and the health of trial participants. © 2010 by the National Academy of Sciences. Al...
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Vaccination is a fundamental component of preventive medicine and public health. The use of vaccines to prevent infectious diseases has resulted in dramatic decreases in disease, disability, and death in the United States and around the world. The current political, economic, and social environment presents both opportunities for and challenges to...
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Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how...
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Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular...
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From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of U.S. base camps and outlying fire-support bases. In response to concerns and continuing uncertaint...
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The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In i...
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Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavior...
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Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have...