Nicole Lurie's research while affiliated with Massachusetts General Hospital and other places

Publications (306)

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Use of telehealth,¹ or technologies to support and promote long-distance clinical care, education, and health administration, has increased dramatically in the past decade. Common modalities include live video teleconferencing, store-and-forward technology (eg, radiograph readings), remote patient monitoring (eg, telehealth coverage of intensive ca...
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Introduction National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall i...
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The global community needs to easily identify and respond to new and reemerging threats, such as H1N1, Ebola, and most recently Zika. Clinicians are often the first-line providers to recognize these threats, but yet have few opportunities to learn from each other in real time. In this concept article, we describe the ways clinical information is tr...
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In the setting of a natural disaster, patients with chronic conditions may have difficulty accessing their prescribed medications, because they are left behind in an evacuation or because a refill cannot be obtained from the pharmacy in the aftermath, which happened after hurricanes Sandy and Katrina.¹,2 Some natural disasters are forecasted severa...
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The scientific feasibility of developing a safe, effective Zika vaccine doesn't ensure successful development. An efficient development pathway must be delineated, including better ways to evaluate vaccine candidates for intended target populations.
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Science preparedness, or the ability to conduct scientific research early in a public health emergency (PHE), is essential to increase the likelihood that important research questions regarding pregnant women will be addressed during future PHEs while the window of opportunity for data collection is open. Science preparedness should include formula...
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The recent Ebola epidemic exposed critical knowledge gaps about the disease and its impact on different populations, particularly children, which hindered the public health and medical response. For instance, unanswered questions remain about the natural history of Ebola virus disease in young children and its transmissibility in breast milk. Other...
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Perspectives From the Assistant Secretary for Preparedness and Response - Volume 9 Issue 6 - Nicole Lurie
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PurposeLow health literacy is a hidden epidemic. Identifying individuals with low health literacy is a formidable barrier to eliminating disparities and improving health care quality and health outcomes. However, screening individual patients for low health literacy can be prohibitively expensive, time consuming, and inefficient. Focusing on commun...
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Recent public health emergencies including Hurricane Katrina (2005), the influenza H1N1 pandemic (2009), and the Ebola virus disease outbreak in West Africa (2014–2015) have demonstrated the importance of multiple-level emergency planning and response. An effective response requires integrating coordinated contributions from community-based health...
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Life-threatening emerging or reemerging infectious diseases increasingly inspire demands for access to novel, often untested therapies. Recent concern about transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in Asia underscores the need to rapidly evaluate investigational therapies during outbreaks, identify those that actu...
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Hemodialysis patients have historically experienced diminished access to care and increased adverse outcomes after natural disasters. Although "early dialysis" in advance of a storm is promoted as a best practice, evidence for its effectiveness as a protective measure is lacking. Building on prior work, we examined the relationship between the rece...
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Objectives: Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. Study design: A survey of health insurance plans....
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Whether a community is in the path of a natural disaster, the target of an act of terror, or simply striving to meet the demands of increasingly dense urban populations, a community resilience paradigm can help communities and individuals not just to mitigate damage and heal, but to thrive. This article discusses experiences from recent, large-scal...
Conference Paper
After 9/11, Hurricane Katrina, H1N1 flu epidemic, the Deep Water Horizon (DWH) Oil Spill, Hurricane Sandy and other disasters, the need to collect data and information rapidly following a disaster to explore both short term as well as longitudinal health concerns and effects has been increasingly raised by the CDC, NIH, ASPR and others. Unfortunate...
Conference Paper
A Visionary Science Preparedness System to Consider In this section the Assistant Secretary for Preparedness and Response will provide the opening key note on behalf of the HHS interagency regarding Science Preparedness, Response and Recovery. The Assistant Secretary for Preparedness and Response will set the tone for this informative and interac...
Conference Paper
Each disaster reveals new, critical scientific questions that merit a robust and efficient science response. As scientists try to tackle these new questions, and wade through challenges like asynchronous studies, differing quality reports, or inconclusive studies – how should public health authorities communicate this uncertain information to the p...
Conference Paper
Past disasters such as the terrorist attacks on September 11, the 2009 Influenza A (H1N1) pandemic, the Deepwater Horizon oil spill, and Hurricane Sandy illustrate a critical need for the rapid collection of data and information to inform emergency responders, leaders and our communities on health and medically related science preparedness, respons...
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Background: Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters. Study design: Retrospective cohort study with 2 comparison groups. Setting & participants: Using Centers for Medicare & Med...
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Emergency department (ED) information systems are designed to support efficient and safe emergency care. These same systems often play a critical role in disasters to facilitate real-time situation awareness, information management, and communication. In this article, we describe one ED's experiences with ED information systems during the April 201...
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Purpose Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. This article addresses the role of epidemiology in informing policies after a disaster to mitigate ongoing exposures, provide care and compensation, and improve preparedness for future disaster...
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During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we pi...
Conference Paper
The presentation will focus on challenges the United States faces in conducting scientific research as part of a comprehensive response to new and emerging pandemic outbreaks, using H1N1 and H7N9 as examples.
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The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life- and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care syst...
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In addition to the deaths, injuries, and damage to the physical and economic infrastructure caused by Hurricane Sandy, the storm wreaked havoc on scientific and biomedical research infrastructure. Facilities and specialized equipment were destroyed; thousands of animals, many of which were pains-
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Introduction On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of this study was to determine how the power outage impacted operati...
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The U.S. Department of Health and Human Services (HHS) announces a new review process for certain gain-of-function (GOF) experiments with the avian influenza A (H7N9) virus, some of which are proposed this week by influenza scientists. Specifically, before being undertaken using funds from the HHS, proposed studies that are reasonably anticipated t...
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There is emerging consensus among US policy leaders that community resilience is fundamental to disaster preparedness, response, and recovery. Building resilience is one of the two major focuses of the National Health Security Strategy of the US Department of Health and Human Services.(1) According to the National Health Security Strategy, resilien...
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Objectives: The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or "all-hazards," framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of consid...
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This paper uses the difference-in-difference estimation approach to explore the self-selection bias in estimating the effect of neighborhood economic environment on self-assessed health among older adults. The results indicate that there is evidence of downward bias in the conventional estimates of the effect of neighborhood economic disadvantage o...
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The authors review lessons learned from several recent public health emergencies and argue that we must conduct research during emergencies to improve our capacity to prevent illness and injury. They propose policies to facilitate timely research.
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Background: The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the vaccination programme, a project to monitor vaccine adverse events was undertaken, the most comprehensive safety surveillance agenda in the USA to date. The adverse e...
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Background: Understanding how hospitals functioned during the 2009 influenza A(H1N1)pdm09 pandemic may improve future public health emergency response, but information about its impact on US hospitals remains largely unknown. Research design: We matched hospital and emergency department (ED) discharge data from the Agency for Healthcare Research...
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Hurricanes and other disasters can have devastating effects on people who depend on home nursing, personal care attendants, or electric medical technologies. Some key policies can help to strengthen our infrastructure to increase community resilience during disasters.
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In response to the 2009 H1N1 pandemic and subsequent vaccination program, the Department of Health and Human Services and collaborators developed the Post-Licensure Rapid Immunization Safety Monitoring (PRISM) Program as a demonstration project to detect rare adverse events rapidly. The program monitored three million people who had received the H1...
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In a paper appearing in this issue, Adini, et al. describe a struggle familiar to many emergency planners---the challenge of planning for all scenarios. The authors contend that all-hazards, or capabilities-based planning, in which a set of core capabilities applicable to numerous types of events is developed, is a more efficient way to achieve gen...
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The Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services develops health and medical response plans for all hazards--natural and human caused. While a nuclear power plant (NPP) incident will take time to evolve, a terrorist incident will have 'no-notice' so that extensive preparation and pla...
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The opportunities for researchers to improve health and health care by contributing to the formulation and implementation of policy are almost unlimited. Indeed, the availability of these opportunities is a tribute to a generation of health services researchers questioning existing policies or studying essential “Why?” and “What if?” questions usin...
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Local health departments (LHDs) play an important role in ensuring essential public health services. Geographic information system (GIS) technology offers a promising means for LHDs to identify geographic gaps between areas of need and the reach of public health services. We examined how large LHDs could better inform planning and investments by us...
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Social media are changing the way people communicate both in their day-to-day lives and during disasters that threaten public health. Engaging with and using such media may help the emergency-management community to respond to disasters.
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To quantify contributions of individual sociodemographic factors, neighborhood socioeconomic status (NSES), and unmeasured factors to racial/ethnic differences in health behaviors for non-Hispanic (NH) whites, NH blacks, and Mexican Americans. We used linear regression and Oaxaca decomposition analyses. Although individual characteristics and NSES...
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The effort to vaccinate the US population against the 2009 H1N1 influenza virus hinged, in part, on public confidence in vaccine safety. Early in the vaccine program, >20% of parents reported that they would not vaccinate their children. Concerns about the safety of the vaccines were reported by many parents as a factor that contributed to their in...
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The VHA is the largest integrated US health system and is increasingly moving care into the communities where veterans reside. Veterans who utilize the VA for their care have worse health status than the general population. However, there is limited evidence about the association of neighborhood environment and health outcomes among veterans. The p...
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An estimated 36 percent of American adults have health literacy levels rated at "basic or below," indicating that they have difficulty obtaining, processing, and understanding basic health information and services. To help healthcare decisionmakers in Missouri identify neighborhood-level "hotspots" of suboptimal health or healthcare that may be due...
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Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations. Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in...
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Seasonal influenza and pneumococcal immunization rates are substantially lower for older Hispanics than for non-Hispanic whites. Beneficiary-reported past-year influenza and lifetime pneumococcal immunization for English- and Spanish-preferring Hispanic beneficiaries were compared with those for non-Hispanic whites in cross-sectional bilingual surv...
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Over the past 50 years, the practice of medicine in the United States has changed dramatically. Successful medical innovations have increased the complexity of delivering care while, at the same time, the U.S. population is aging and becoming increasingly diverse and the prevalence of chronic diseases is on the rise. In 2003, an Institute of Medici...
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This study presents a new, latent archetype approach for studying place in population health. Latent class analysis is used to show how the number, defining attributes, and change/stability of neighborhood archetypes can be characterized and tested for statistical significance. The approach is demonstrated using data on contextual determinants of h...
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The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric...
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As the Deepwater Horizon oil disaster enters its next phase, consensus is emerging that among its most profound immediate health effects are those on the emotional and psychosocial health of Gulf Coast communities. State mental health and substance-abuse agencies report an increase in emotional distress and demand for assistance. Calls to domestic-...
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We investigate an alternative conceptualization of neighborhood context and its association with health. Using an index that measures a continuum of concentrated advantage and disadvantage, we examine whether the relationship between neighborhood conditions and health varies by socio-economic status. Using NHANES III data geocoded to census tracts,...
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Objective: Studies of neighborhood influences on self-assessed health have consistently shown correlations between self-assessed health and the economic status of the surrounding neighborhood environment. For older adults, self-assessed health is not only an important measure of current health but is also a predictor of future health trajectories....
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The authors hypothesized that adherence to anti-inflammatory treatment could reduce overall cost of asthma care, as higher spending on drugs would be offset by reductions in hospital and emergency care. A retrospective observational study using 2 years of claims data for 41,234 commercially insured asthmatics on monotherapy with either leukotriene...
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INTRODUCTION Low health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is la...
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Vaccination against seasonal influenza is far from universal among groups specifically recommended for vaccine. There is little research to guide communication with patients about vaccination. To assess the utility of the self-reported intention to be vaccinated against seasonal influenza in predicting vaccine uptake, reasons for being unvaccinated...
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Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Maurer, Harris, and Lurie. Acquisition of data: Maurer, Harris, and Lurie. Analysis and interpretation of data: Maurer, Harris, and Lurie. Drafting o...
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To assess whether neighbourhood socioeconomic status (NSES) is independently associated with disparities in biological 'wear and tear' measured by allostatic load in a nationally representative sample of US adults. Cross-sectional study. Population-based US survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with...
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We analyze data on the intention of U.S. adults to receive novel H1N1 vaccine if available this fall, and studies the relationship between the intention to be vaccinated against novel H1N1 and the uptake of seasonal influenza vaccine last year. We surveyed a nationally representative sample of U.S. adults (n=2067) via the Internet between May 26th...
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Achieving an effective, efficient, and equitable health system has proven to be an elusive goal for health policy makers in the United States, but the field of health services research (HSR) has become increasingly central in charting the path toward this destination. HSR has evolved in tandem with the information needs of decision makers in govern...
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Single-year estimates of health disparities in small racial/ethnic groups are often insufficiently precise to guide policy, whereas estimates that are pooled over multiple years may not accurately describe current conditions. While collecting additional data is costly, innovative analytic approaches may improve the accuracy and utility of existing...
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Medicine and public health have been likened to trains on parallel tracks, with windows facing opposite directions, looking out on the same landscape. As described by Shalala,1 those individuals on the medical train see the individual trees—the subtle differences in size, color, age, and health; and those individuals aboard the public health train...
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On Sunday, 26 April 2009, the secretary of the U.S. Department of Health and Human Services declared a public health emergency in response to the outbreak of H1N1 influenza (known as swine flu) in the United States. Through an analysis of state and local health department Web sites, we determined whether departments were able to provide online info...
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We demonstrated the feasibility of collecting and disseminating mid-season estimates of influenza vaccine coverage. We surveyed a nationally representative sample of U.S. adults (n = 3972) via the Internet about use of influenza vaccination as of mid-November 2008. Findings were presented on 10 December 2008 to the media and the public health commu...
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To assess the extent to which the systems in place for prevention and control of routine annual influenza could provide the information and experience needed to manage a pandemic. The authors conducted a qualitative assessment based on key informant interviews and the review of relevant documents. Although there are a number of systems in place tha...
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Commercial health plans need member racial/ethnic information to address disparities, but often lack it. We incorporate the U.S. Census Bureau’s latest surname list into a previous Bayesian method that integrates surname and geocoded information to better impute self-reported race/ethnicity. We validate this approach with data from 1,921,133 enroll...
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Insomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia sym...
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Disease management (DM) has been promoted to improve health outcomes and lower costs for patients with chronic disease. Unfortunately, most of the studies that support claims of DM's success suffer from a number of biases, the most important of which is selection bias, or bias in the type of patients enrolling. To quantify the differences between t...
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We studied the feasibility of using an internet-based panel survey to obtain timely and accurate population-based data on influenza vaccination. We surveyed a nationally representative sample of US adults (n=3043) via the internet about use of influenza vaccination during the 2007-8 influenza vaccination season. We compared the internet-based rates...
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To examine race/ethnic-specific patterns of association between neighborhood socioeconomic status (NSES) and a cumulative biological risk index in a nationally representative population. The study sample included 13,199 white, black, and Mexican-American men and women, ages 20 and older, who attended the National Health and Examination Survey exami...
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We conducted a review of 164 relevant publications to consolidate the evidence on gaps in the quality of asthma care, the impact of those gaps, and the costs and benefits of closing those gaps. Researchers used a wide variety of definitions for measures of quality asthma care, clinical and utilization end points, and disease severity. Gaps in care...
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The Merck Childhood Asthma Network, Inc conference titled "State of Childhood Asthma and Future Directions: Strategies for Implementing Best Practices" was held December 13 to 14, 2006. Here we summarize the presentations and recommendations for systems approaches from that conference and discuss current asthma care.
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Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% qu...
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In 2007, Sanofi Pasteur asked RAND Health, a division of the RAND Corporation, to study the current climate for adolescent immunization in the United States, to recommend broad strategies for immunizing low-income adolescents (through age 18), and to identify promising "on the ground" practices consistent with the proposed strategic framework. To c...
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The lack of frequent real-world opportunities to study preparedness for large-scale public health emergencies has hindered the development of an evidence base to support best practices, performance measures, standards, and other tools needed to assess and improve the nation's multibillion dollar investment in public health preparedness. In this art...
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The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unabl...
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Coordination and communication among community partners-including health departments, emergency management agencies, and hospitals-are essential for effective pandemic influenza planning and response. As the nation's largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning. To...
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Most national health surveys do not permit precise measurement of the health of racial/ethnic subgroups that comprise <1 per cent of the U.S. population. We identify three potentially promising sample design strategies for increasing the accuracy of national health estimates for a small target subgroup when used to supplement a small probability sa...