A Population-based policy and systems change approach to prevent and control hypertension

"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 drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines. The book is an important resource for federal public health officials and organizations, especially the Center for Disease Control and Prevention, as well as medical professionals and community health workers."--resource home page.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 drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines.Public health importance of hypertension -- The role of the Division for Heart Disease and Stroke Prevention in the prevention and control of hypertension -- Interventions directed at the general population -- Interventions directed at individuals with hypertension -- Implementing a population-based policy and systems approach to the prevention and control of hypertension.Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, Board on Population Health and Public Health Practice, Institute of Medicine of the National Academies.Title from resource title page (National Academies Press, viewed July 15, 2010)"This report was made possible by the support of the Division of Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention." - p. xIncludes bibliographical references

Legal themes concerning obesity regulation in the United States: Theory and practice

Despite national health objectives to reduce the incidence of obesity to 15% of the population by 2010, public health data suggest that the incidence of obesity in the United States is actually increasing. The U.S. recognizes that it (like other industrialized countries) faces an epidemic of obesity and related health conditions. How can U.S. jurisdictions (federal, state, and local) and the private sector respond to this epidemic through laws and policies that are directly or indirectly designed to address obesity? This article analyzes the theoretical and practical roles of law as a tool to curb obesity in the U.S. It proffers ten major legal themes to address obesity among the U.S. population, including: (1) use of incentives to encourage healthier behaviors; (2) use of financial disincentives to discourage unhealthy behaviors; (3) requirements to improve food quality, diversity, or availability; (4) compensation for injured persons seeking recourse; (5) restriction of access to unhealthy foods; (6) regulations aimed at influencing consumer choices; (7) control of marketing and advertising; (8) creation of communities that support healthy lifestyles; (9) physical education/fitness requirements; and (10) insurance coverage mandates

EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on principles for deriving and applying Dietary Reference Values

This Opinion of the EFSA Panel on Dietetic products, Nutrition, and Allergies (NDA) deals with the general principles for development and application of Dietary Reference Values (DRVs). These quantitative reference values for nutrient intakes for healthy individuals and populations are based on health criteria. Derived from DRVs, nutrients goals and recommendations take into account other criteria such as food composition or dietary habits, and may be used for assessment and planning of diets. It is proposed to derive the following DRVs: 1) Population Reference Intakes (PRI), 2) Average Requirement (AR), 3) Lower Threshold Intake (LTI), 4) Adequate Intake (AI), 5) Reference Intake ranges for macronutrients (RI). Nutrient requirements differ with age, sex and physiological condition. The Panel proposes to define the age ranges used for each nutrient on a case-by-case basis depending on the available data. For the age group < 6 months requirements are considered to be equal to the supply from breast- milk, except in those cases where this does not apply. Separate reference values will be established for pregnant and lactating women. Interpolation or extrapolation between population groups will be used in instances where no data are available for defined age and sex groups

Children\u27s Consumption of Fruits and Vegetables: Do School Environment and Policies Affect Choices at School and Away from School?

School environment and policies may affect children\u27s ability to make healthy food choices both at and away from school. Using data from the third School Nutrition Dietary Assessment Study conducted in 2005 we estimate the effect of environment and policies on children\u27s fruit and vegetable intakes. We use an instrumental variable approach to control for the endogeneity of participation in the National School Lunch Program (NSLP). On an average school day, school lunch participants consume more fruits and vegetables, including relatively more at school and less away from school compared to nonparticipants. Meal policies had little effect on NSLP participation itself. Policies that restrict high fat milks or desserts and restrict the sale of competitive foods are associated with greater fruit and/or vegetable intake at school; some policies affected consumption at home as well

Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A: letter report

"At the request of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) the Institute of Medicine convened this committee to provide recommendations regarding the necessary respiratory protection for healthcare workers in their workplace against novel H1N1 influenza A (nH1N1). This report focuses on the scientific and empirical evidence regarding the efficacy of various types of personal respiratory protection technologies as one measure to protect healthcare workers against nH1N1. The committee concludes that an emphasis is needed on implementing a range of strategies across all levels of the hierarchy of controls to minimize risk and decrease the number of healthcare workers and other patients exposed to patients with suspected or confirmed nH1N1. The committee provides the following findings and recommendations and provides additional detail in the report that follows. " - p. 1-2Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, Board on Health Sciences Policy. ; Catharyn T. Liverman, Tracy A. Harris, M.E. Bonnie Rogers, and Kenneth I. Shine, editors.Outcome of the Workshop on Personal Protective Equipment for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A held August 12-13, 2009 in Washington, DCAvailable via World Wide Web in Open Book format or, though free registation, as an Acrobat .pdf file (524.3 KB, 69 p.).Includes bibliographical references (p. 30-36).IOM (Institute of Medicine). 2009. Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A: A letter report. Washington, DC: The National Academies Press

The Forest for the Trees: A Systems Approach to Human Health Research

We explore the relationship between current research directions in human health and environmental and public health policy. Specifically, we suggest there is a link between the continuing emphasis in biomedical research on individualized, therapeutic solutions to human disease and the increased reliance on individual choice in response to environmental and/or public health threats. We suggest that continued research emphasis on these traditional approaches to the exclusion of other approaches will impede the discovery of important breakthroughs in human health research necessary to understand the emerging diseases of today. We recommend redirecting research programs to interdisciplinary and population-focused research that would support a systems approach to fully identifying the environmental factors that contribute to disease burden. Such an approach would be able to address the interactions between the social, ecological, and physical aspects of our environment and explicitly include these in the evaluation and management of health risks from environmental exposures

Veterans Justice Programs: Assessing Population Risks for Suicide Deaths and Attempts

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156471/2/sltb12631_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156471/1/sltb12631.pd

Foreigners Traveling to the U.S. for Transplantation May Adversely Affect Organ Donation: A National Survey

The aims of this study were (1) to determine attitudes among the American public regarding foreigners coming to the United States for the purposes of transplantation, and (2) to investigate the impact this practice might have on the public's willingness to donate organs. A probability-based national sample of adults age ≥18 was asked whether people should be allowed to travel to the United States to receive a transplant, and whether this practice would discourage the respondents from becoming an organ donor. Among 1049 participants, 30% (95% CI 25–34%) felt that people should not be allowed to travel to the United States to receive a deceased donor transplant, whereas 28% felt this would be acceptable in some cases. Thirty-eight percent (95% CI 33–42%) indicated that this practice might prevent them from becoming an organ donor. In conclusion, deceased-donor transplantation of foreigners is opposed by many Americans. Media coverage of this practice has the potential to adversely affect organ donation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79295/1/j.1600-6143.2010.03111.x.pd

Fish Consumption and Mercury Exposure among Louisiana Recreational Anglers

Ba c k g r o u n d: Methylmercury (MeHg) exposure assessments among average fish consumers in the United States may underestimate exposures among U.S. subpopulations with high intakes of region-ally specific fish. obj e c t i v e s: We examined relationships among fish consumption, estimated mercury (Hg) intake, and measured Hg exposure within one such potentially highlyexposed group, recreational anglers in the state of Louisiana, USA. Me t h o d s: We surveyed 534 anglers in 2006 using interviews at boat launches and fishing tourna-ments combined with an Internet-based survey method. Hair samples from 402 of these anglers were collected and analyzed for total Hg. Questionnaires provided information on species-specific fish consumption during the 3 months before the survey. re s u l t s: Anglers’ median hairHg concentration was 0.81 μg/g (n = 398; range, 0.02–10.7 μg/g);40% of participants had levels >1 μg/g, which approximately corresponds to the U.S. Environmental Protection Agency’s reference dose. Fish consumption and Hg intake were significantly positively associated with hairHg. Participants reported consuming nearly 80 different fish types, many of which are specific to the region. Unlike the general U.S. population, which acquires most of its Hg from commercial seafood sources, approximately 64% of participants’ fish meals and 74% of their estimated Hg intake came from recreationally caught seafood. co n c l u s i o n s: Study participants had relatively elevated hairHg concentrations and reported con-sumption of a wide variety of fish, particularly locally caught fish. This group represents a highlyexposed subpopulation with an exposure profile that differs from fish consumers in other regions of the United States, suggesting a need for more regionallyspecific exposure estimates and public health advisories.ISSN:1552-9924ISSN:0091-676

A Preliminary Study of Elderly Emergency Service Clients in Chicago and Their Housing-Related Problems

Emergencies to which city agencies respond reveal a connection between homelessness and other housing hardships of the elderly. This study examines a random sample of 125 case records of elderly clients assisted by the Chicago Department of Human Services Emergency Services program between 1984 and 1987. The crises that lead to emergency services, the extent of clients' housing-related problems, and the needs that cluster around shelter placement and other housing related problems are analyzed An extraordinarily broad range of problems and service needs are identified The findings reveal the prevalence of housing problems for the elderly and the relationship between basic needs, patterns of services offered, and certain emergencies, includ ing homelessness. They have implications for improving client services and underscore the importance of ongoing rather than emergency assistance with the elderly. Very old persons without kin who experience crises are at great risk and pose growing dilemmas for urban public agencies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68265/2/10.1177_073346489201100102.pd