For the Public's Health Institute of Medicine; Board on Population Health and Public Health Practice; Committee on Public Health Strategies to Improve Health
12/2010
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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 problem is that we do not know how to reverse this trend. Our lack of knowledge is due in large part to significant inadequacies in the health system for gathering, analyzing, and communicating health information about the population.
To inform the public health community and all other sectors that contribute to population health, For the Public's Health: The Role of Measurement in Action and Accountability reviews current approaches for measuring the health of individuals and communities and creates a roadmap for future development. This book, the first of three in a series, focuses on data and measurement-not as ends in themselves, but rather tools to inform the myriad programs, policies, and processes developed or undertaken by governmental public health agencies and their many partners in the health system.
For the Public's Health seeks to reinstate the proper and evidence-based understanding of health as not merely the result of medical or clinical care but the result of the sum of what we do as a society to create the conditions in which people can be healthy. To achieve this goal, the book suggests changes in the processes, tools, and approaches used to gather information about health outcomes and their determinants. The book also recommends developing an integrated and coordinated system in which all parties-including governmental and private sector partners at all levels-have access to timely and meaningful data to help foster individual and community awareness and action.
Health literacy(HL) has recently been proposed as a potential mediator in the pathway through which socio-economic status(SES) affects health. However, empirical research investigating the ...contribution of HL in this relationship remains scarce. This study investigated whether functional HL mediates the association between SES and self-reported health(SRH) in an adult population-based sample.
The study adopted a cross-sectional design. Education level and financial status were used as measures of SES, while functional HL was assessed with the Newest Vital Sign. Moderated mediation analyses were conducted using SES variables as independent variables, SRH as dependent variable and functional HL as mediator variable. Furthermore, age, sex and chronic diseases were tested as moderators of the effect mediated by functional HL.
452 subjects completed the study (58,8% female; mean age 53,25±11,7). Results showed that functional HL mediates on average 18.5% of the association between education and SRH (p = 0.02) and 12.9% (p = 0.01) of the association between financial status and SRH. Furthermore, the proportion of effect mediated by functional HL was found to be higher in lower socio-economic classes for both SES variables considered. No significant moderation effects of age, sex or chronic diseases were observed for both SES variables.
Findings suggest that functional HL may serve as a pathway by which SES affects health status, especially in lower SES groups. HL may be a valuable and actionable intermediate target for addressing health inequalities. However, further studies are needed to better define the mediating role of HL across socio-economic classes.
Gastrointestinal (GI) dysfunction is frequent in the critically ill but can be overlooked as a result of the lack of standardization of the diagnostic and therapeutic approaches. We aimed to develop ...a research agenda for GI dysfunction for future research. We systematically reviewed the current knowledge on a broad range of subtopics from a specific viewpoint of GI dysfunction, highlighting the remaining areas of uncertainty and suggesting future studies.
This systematic scoping review and research agenda was conducted following successive steps: (1) identify clinically important subtopics within the field of GI function which warrant further research; (2) systematically review the literature for each subtopic using PubMed, CENTRAL and Cochrane Database of Systematic Reviews; (3) summarize evidence for each subtopic; (4) identify areas of uncertainty; (5) formulate and refine study proposals that address these subtopics; and (6) prioritize study proposals via sequential voting rounds.
Five major themes were identified: (1) monitoring, (2) associations between GI function and outcome, (3) GI function and nutrition, (4) management of GI dysfunction and (5) pathophysiological mechanisms. Searches on 17 subtopics were performed and evidence summarized. Several areas of uncertainty were identified, six of them needing consensus process. Study proposals ranked among the first ten included: prevention and management of diarrhoea; management of upper and lower feeding intolerance, including indications for post-pyloric feeding and opioid antagonists; acute gastrointestinal injury grading as a bedside tool; the role of intra-abdominal hypertension in the development and monitoring of GI dysfunction and in the development of non-occlusive mesenteric ischaemia; and the effect of proton pump inhibitors on the microbiome in critical illness.
Current evidence on GI dysfunction is scarce, partially due to the lack of precise definitions. The use of core sets of monitoring and outcomes are required to improve the consistency of future studies. We propose several areas for consensus process and outline future study projects.
Objective
This study was undertaken to validate the accuracy of the Epidemiology‐Based Mortality Score in Status Epilepticus (EMSE) in predicting the risk of death at 30 days in a large cohort of ...patients with status epilepticus (SE) using a machine learning system.
Methods
We included consecutive patients with SE admitted from 2013 to 2021 at Modena Academic Hospital. A decision tree analysis was performed using the 30‐day mortality as a dependent variable and the EMSE predictors as input variables. We evaluated the accuracy of EMSE in predicting 30‐day mortality using the area under the receiver operating characteristic curve (AUC ROC), with 95% confidence interval (CI). We performed a subgroup analysis on nonhypoxic SE.
Results
A total of 698 patients with SE were included, with a 30‐day mortality of 28.9% (202/698). The mean EMSE value in the entire population was 57.1 (SD = 36.3); it was lower in surviving compared to deceased patients (47.1, SD = 31.7 vs. 81.9, SD = 34.8; p < .001). The EMSE was accurate in predicting 30‐day mortality, with an AUC ROC of .782 (95% CI = .747–.816). Etiology was the most relevant predictor, followed by age, electroencephalogram (EEG), and EMSE comorbidity group B. The decision tree analysis using EMSE variables correctly predicted the risk of mortality in 77.9% of cases; the prediction was accurate in 85.7% of surviving and in 58.9% of deceased patients within 30 days after SE. In nonhypoxic SE, the most relevant predictor was age, followed by EEG, and EMSE comorbidity group B; the prediction was correct in 78.9% of all cases (89.6% in survivors and 46.1% in nonsurvivors).
Significance
This validation study using a machine learning analysis shows that the EMSE is a valuable prognostic tool, and appears particularly accurate and effective in identifying patients with 30‐day survival, whereas its performance in predicting 30‐day mortality is lower and needs to be further improved.
Leading Health Indicators 2030 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice ...
02/2020
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Beginning in 1979 and in each subsequent decades, the U.S. Department of Health and Human Services (HHS) has overseen the Healthy People initiative to set national goals and objectives for health ...promotion and disease prevention. At the request of HHS, this study presents a slate of Leading Health Indicators (LHIs) that will serve as options for the Healthy People Federal Interagency Workgroup to consider as they develop the final criteria and set of LHIs for Healthy People 2030.
Bioprospecting--the exchange of plants for corporate promises of royalties or community development assistance--has been lauded as a way to develop new medicines while offering southern nations and ...indigenous communities an incentive to preserve their rich biodiversity. But can pharmaceutical profits really advance conservation and indigenous rights? How much should companies pay and to whom? Who stands to gain and lose? The first anthropological study of the practices mobilized in the name and in the shadow of bioprospecting, this book takes us into the unexpected sites where Mexican scientists and American companies venture looking for medicinal plants and local knowledge. Cori Hayden tracks bioprospecting's contentious new promise--and the contradictory activities generated in its name. Focusing on a contract involving Mexico's National Autonomous University, Hayden examines the practices through which researchers, plant vendors, rural collectors, indigenous cooperatives, and other actors put prospecting to work. By paying unique attention to scientific research, she provides a key to understanding which people and plants are included in the promise of "selling biodiversity to save it"--and which are not. And she considers the consequences of linking scientific research and rural "enfranchisement" to the logics of intellectual property. Roving across UN protocols, botanical collecting histories, Mexican nationalist agendas, neoliberal property regimes, and North-South relations, When Nature Goes Public charts the myriad, emergent publics that drive and contest the global market in biodiversity and its futures.
Social Capital and Health Kawachi, Ichiro; Subramanian, S. V; Kim, Daniel
2007, 2008, 2007-11-15, 20080401
eBook
This text discusses social capital, a concept that originated in the social sciences, & its application to the field of public health. The editors take care to define the concept of social capital, ...describe its theoretical origins, & discuss the controversies & debates surrounding the use of the concept in public health research.
Europe has the most advanced regional protection regime in the world. The predicted impact of this body of norms, including the new Common European Asylum System, has been widely identified as one ...that will have a 'ripple effect' beyond the EU. However, very few studies have noted the fact that this regime has already influenced the law and practice of states around the world, for some time. The purpose of this book is to gather evidence that emulation is happening (if it is), to explore the extent and identify the processes through which it is happening, and to examine the implications of these findings. A review of seven case studies reveals all but one of these cases provides clear evidence of emulation at some point in time. The EU protection regime, which has been most influenced by the European Court of Human Rights, is 'naturally' evolving transnationally and spreading internationally.
Should a court order medical treatment for a severely disabled newborn in the face of the parents' refusal to authorize it? How does the law apply to a neighborhood that objects to a group home for ...developmentally disabled people? Does equality mean treating everyone the same, even if such treatment affects some people adversely? Does a state requirement of employee maternity leave serve or violate the commitment to gender equality?
Martha Minow takes a hard look at the way our legal system functions in dealing with people on the basis of race, gender, age, ethnicity, religion, and disability. Minow confronts a variety of dilemmas of difference resulting from contradictory legal strategies-strategies that attempt to correct inequalities by sometimes recognizing and sometimes ignoring differences. Exploring the historical sources of ideas about difference, she offers challenging alternative ways of conceiving of traits that legal and social institutions have come to regard as "different." She argues, in effect, for a constructed jurisprudence based on the ability to recognize and work with perceptible forms of difference.
Minow is passionately interested in the people-"different" people-whose lives are regularly (mis)shaped and (mis)directed by the legal system's ways of handling them. Drawing on literary and feminist theories and the insights of anthropology and social history, she identifies the unstated assumptions that tend to regenerate discrimination through the very reforms that are supposed to eliminate it. Education for handicapped children, conflicts between job and family responsibilities, bilingual education, Native American land claims-these are among the concrete problems she discusses from a fresh angle of vision.
Minow firmly rejects the prevailing conception of the self that she believes underlies legal doctrine-a self seen as either separate and autonomous, or else disabled and incompetent in some way. In contrast, she regards the self as being realized through connection, capable of shaping an identity only in relationship to other people. She shifts the focus for problem solving from the "different" person to the relationships that construct that difference, and she proposes an analysis that can turn "difference" from a basis of stigma and a rationale for unequal treatment into a point of human connection. "The meanings of many differences can change when people locate and revise their relationships to difference," she asserts. "The student in a wheelchair becomes less different when the building designed without him in mind is altered to permit his access." Her book evaluates contemporary legal theories and reformulates legal rights for women, children, persons with disabilities, and others historically identified as different.
Here is a powerful voice for change, speaking to issues that permeate our daily lives and form a central part of the work of law. By illuminating the many ways in which people differ from one another, this book shows how lawyers, political theorist, teachers, parents, students-every one of us-can make all the difference,
This book argues that the colonial confrontation was central to the formation of international law and, in particular, its founding concept, sovereignty. Traditional histories of the discipline ...present colonialism and non-European peoples as peripheral concerns. By contrast, Anghie argues that international law has always been animated by the 'civilizing mission' - the project of governing non-European peoples, and that the economic exploitation and cultural subordination that resulted were constitutively significant for the discipline. In developing these arguments, the book examines different phases of the colonial encounter, ranging from the sixteenth century to the League of Nations period and the current 'war on terror'. Anghie provides a new approach to the history of international law, illuminating the enduring imperial character of the discipline and its continuing importance for peoples of the Third World. This book will be of interest to students of international law and relations, history, post-colonial studies and development studies.
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