Friday, January 25, 2008

[EQ] IOM: Knowing what works in health care: A roadmap

Knowing what works in health care: A roadmapfor the nation.

 

US Institute of Medicine (IOM).January 2008.

Washington, DC: The National Academies Press

 

Available online at: http://www.nap.edu/catalog.php?record_id=12038

“…..Solutions to some of the nation’s most pressing health policy problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what clinical practice standards should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new Institute of Medicine report, Knowing What Works in Health Care: A Roadmap for the Nation, provides a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. The program would also develop and promote rigorous standards for creating clinical practice guidelines, which could help minimize use of questionable services and target services to the patients most likely to benefit. …”

Content:

 

Summary

1 Introduction

2 An Imperative for Change

3 Setting Priorities for Evidence Assessment

4 Systematic Reviews: The Central Link Between Evidence and Clinical Decision Making

5 Developing Trusted Clinical Practice Guidelines

6 Building a Foundation for Knowing What Works in Health Care

Appendix A Acronyms and Abbreviations

Appendix B Workshop Agendas and Questions to Panelists

Appendix C Template for Submissions of Topics to the Agency for Healthcare Research and Quality

Appendix D Standards for Reporting Meta-Analyses of Clinical Trials and Observational Studies: QUOROM and MOOSE

Appendix E Examples of ECRI Institute and Hayes, Inc. Quick Turnaround Reports

Appendix F Guideline Standards: The AGREE Instrument and COGS Checklist

Appendix G Committee Biographies

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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[EQ] Maternal and child undernutrition: consequences for adult health and human capital

The Lancet Series: Maternal and child undernutrition

 

Maternal and child undernutrition: consequences for adult health and human capital


Cesar G Victora, Linda Adair, Caroline Fall, Pedro C Hallal,  Reynaldo Martorell, Linda Richter, Harshpal Singh Sachdev
Maternal and Child Undernutrition Study Group

The Lancet, Volume 371, Number 9609, 26 January 2008

 

Available online at; http://www.thelancet.com/journals/lancet/article/PIIS0140673607616924/fulltext

 

 

“……In this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure).

 

We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and—for women—lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain—especially after infancy—is linked to these conditions.

 

The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy….”

 

Maternal and child undernutrition: global and regional exposures and health consequences

 

Robert E Black, Lindsay H Allen,  Zulfiqar A Bhutta, Laura E Caulfield, Mercedes de Onis, Majid Ezzati, Colin Mathers, Juan Rivera
Maternal and Child Undernutrition Study Group

The Lancet,  Volume 371, Number 9608, 19 January 2008

 

Available online at: http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext

 

 

 

 *      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Pathways of influence on equity in health

Pathways of influence on equity in health

 

Barbara Starfield

Johns Hopkins School of Hygiene and Public Health, Baltimore, USA

Social Science & Medicine 64 (2007) 1355–1362

 

URL:
http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6VBF-4MS9K51-2-5&_cdi=5925&_user=75682&_orig=browse&_coverDate=04%2F30%2F2007&_sk=999359992&view=c&wchp=dGLzVzz-zSkWz&_valck=1&md5=3272b1a44e7557279ad2164055ea8462&ie=/sdarticle.pdf

 

“…..The article proposes pathways, with bidirectional arrows, pursuant to theories and analytical
frameworks for social and societal influences on health
….”


“….An increasing number of studies are documenting the existence of inequities, and attention is now turning to exploring

pathways through which they are generated and might be attacked. This appears to be an opportune time to consider what

has been learned and what future directions might be taken by researchers to fill gaps in knowledge and make research

more useful for policy interventions.

 

This commentary briefly reviews some of the main contributions of past research that have possible relevance to

pathways, considers what those pathways might include, and concludes with implications for future research. It makes the

case for a conceptualization of influences on equity that explicitly includes distribution of health as an outcome as well as

characteristics of the society as influences….”

 

 

 

 

 

 *      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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PAHO/WHO Website: http://www.paho.org/

EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.