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Rationale: One of the most effective means to prevent youth and young adults from starting to smoke is countering the tobacco industry s pervasive marketing to youth and young adults generic levlen 0.15mg amex. Tobacco Strategy 5 By June 30 order levlen 0.15mg with amex, 2017 buy levlen 0.15 mg on-line, Increase the number of quit attempts by low- income Oregonians. Rationale: Oregonians with lower incomes are disproportionately affected by tobacco use. To achieve lower overall tobacco use prevalence, this disparity must be eliminated. Evidence shows that the more times people try to quit tobacco, the greater the likelihood is that they will be successful. Health Promotion and Chronic Disease Prevention 5 Year Plan 13 Decrease obesity Obesity is the No. Obesity is more prevalent among communities of color, those who have low incomes or are less educated, and rural populations. To achieve healthy communities, all people must have access to healthy foods, safe biking and walking routes, and active transportation and recreation options. Reducing the burden of obesity in Oregon through multiple, evidence-based strategies will achieve better population health and lower health care costs. Health Promotion and Chronic Disease Prevention 5 Year Plan 15 Obesity Strategy 1 By June 30, 2017, develop a comprehensive obesity prevention and education infrastructure to build state and community capacity for chronic disease prevention. Rationale: There is growing evidence that a comprehensive community approach can decrease the rate of obesity. To create healthy communities, it is critical to engage state and local public health partners with opportunities to promote informed decision making, policy development and funding that support access to healthy foods, active transportation and physical activity for all Oregonians. Rationale: Rising consumption of sugary drinks has been a major contributor to the obesity epidemic. Education and awareness messages, when combined with other obesity interventions, are an effective strategy to increase healthy eating and reduce the consumption of sugary beverages. Obesity Strategy 3 By June 30, 2017, increase the number of environments that have adopted and implemented standards for nutrition and physical activity. Rationale: Healthy eating and active living are supported when environments promote and provide safe and sustainable options to eat better, move more, and discourage the consumption of sugary beverages. Rationale: Transportation and land use planning inclusive of considerations fot the public s health provide opportunites for informed decision making, policy development and funding that support access to healthy foods, active transportation and physical activity options for all Oregonians. Obesity Strategy 5 By June 30, 2017, develop a sustainable delivery system for evidence-based chronic disease self-management programs. Rationale: Self-management programs can enhance self-efficacy and adoption of healthy behaviors, including healthy eating and physical activity. Developing a sustainable delivery system for self-management programs will increase access and referrals to evidence-based programs that can address risk factors for obesity. Rationale: Adherence to evidence-based recommendations for the prevention and management of obesity will improve quality of care for and prevention of obesity- related diseases. Health Promotion and Chronic Disease Prevention 5 Year Plan 17 Decrease heart disease and stroke During the past 20 years, Oregon has seen significant reductions in the rates of death due to heart disease and stroke. Still heart disease and stroke remain the leading causes of death in the state, accounting for 25 percent of all deaths each year. The burden of heart disease and stroke in Oregon can be reduced through the management of heart-related chronic conditions, such as high blood pressure and high cholesterol, and through the promotion of nutrition standards addressing trans fat and sodium intake. Additionally, modifiable risk factors for heart disease and stroke such as tobacco use and obesity can be addressed through proven prevention strategies. The 2010 baseline was 135 hospitalizations per 100,000 people under the age of 74 and the 2017 target is 119 hospitalizations per 100,000 people under the age of 74. Health Promotion and Chronic Disease Prevention 5 Year Plan 19 Heart Disease and Stroke Strategy 1 By June 30, 2017, increase the number of environments that have adopted and implemented standards for nutrition and physical activity. Rationale: High blood pressure and cholesterol may be prevented or controlled through a healthy diet and physical activity. Nutrition standards can help increase public awareness and acceptance of healthier food options, and influence the practices and products of food companies. Heart Disease and Stroke Strategy 2 By June 30, 2017, the five largest Oregon manufacturers will reduce sodium in bread products. Rationale: High amounts of dietary sodium have been linked to high blood pressure, which increases the risk of heart disease events. Heart Disease and Stroke Strategy 3 By June 30, 2017, eliminate trans fats from restaurants in Oregon. Rationale: Healthy eating and active living are supported when environments promote and provide safe and sustainable options to eat better, move more, and discourage the consumption of trans-fats. Rationale: Developing a sustainable delivery system for self-management and cessation tools will increase access to evidence-based programs that promote cessation and manage or lower heart disease risk factors. Heart Disease and Stroke Strategy 6 By June 30, 2017, increase the number of environments where tobacco use is prohibited. Rationale: Smokers are two to four times more likely to develop coronary heart disease than nonsmokers. Tobacco-free environments encourage quitting among tobacco users, protect people from secondhand smoke and reduce youth initiation of tobacco. Screening can actually prevent colorectal cancer when pre-cancerous cells are found and removed. Colorectal cancer screening services have an A Recommendation (the highest) from the U. Because screening rates are so low, more than half of all colorectal cancers are found at late stages.

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The insidiously toxic effects of high levels of circulating sugar threaten the health of Patient 2 s blood vessels buy 0.15mg levlen otc. Responses to drug treatments 0.15mg levlen overnight delivery, which have changed little for decades generic levlen 0.15mg with mastercard, are highly variable. Similarly, changes in exercise habits and diet help some patients more than others. There is a high likelihood that Patient 2 faces a future of escalating medical interventions, declining health, and increasing disability. The human, social, and economic costs associated with patients such as Patient 2 are daunting and 8 In 2010, approximately 1. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 64 distressingly typical of those seen for patients with chronic diseases throughout our aging population. The Committee s assigned task was to explore the feasibility and need, and develop a potential framework, for creating a New Taxonomy of human diseases based on molecular biology. Moreover, the Committee clearly recognized that developing and implementing a Knowledge Network of Disease has the unique potential to go far beyond classification of disease to act as a catalyst that would help to revolutionize the way research is done and patients are treated. Patient 1 has a high likelihood of overcoming her life-threatening disease and going on to live a long, healthy, and productive life. These prospects are a direct result of a new ability to recognize, based on molecular analyses, the precise type of breast cancer she has and to target a rational therapy to her disease. The Committee believes that the best prospects for creating a similarly bright future for Patient 2 lies in achieving a similarly precise understanding of his disease by creating a Knowledge Network of Disease and an associated New Taxonomy. Both these points suggested that we could best address our charge by framing the new-taxonomy challenge broadly. Many of the conclusions and recommendations could apply, as well, to other challenges in translational research such as evaluating and refining existing treatments and developing new ones. However, disease classification is inextricably linked to all progress in medicine, and the Committee took the view that an ambitious initiative to address this challenge and particularly to modernize the discovery model for the needed research is an excellent place to start. The Committee thinks that the key to success lies in building new relationships that must span the whole spectrum of research and patient-care activities that comprise American medicine. Our recommendations seek to empower stakeholder communities by providing them with informational resources the Information Commons, the Knowledge Network, and the New Taxonomy itself that would transform the way they work and make decisions. At the core of the Committee s optimism is a conviction that dramatic advances in biological knowledge can be coupled more effectively than they are now to the goal of improving the health outcomes of individual patients. Biology has flourished in the 50+ years since the discovery of the molecular basis of inheritance. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 65 Genome Project, genetics is in a golden age of discovery. Sequence similarity between genes studied in fruit flies and those studied in humans allows nearly instant recognition of the potential medical relevance of the most basic advances in biochemistry and cell biology. Increasingly, this process also works in reverse: unusual human patients call attention to molecules and biochemical pathways whose importance in basic biology had been overlooked or was otherwise inaccessible. Indeed, there are already many areas of basic biology in which human studies are leading the way to deep new insights into the way organisms work. For the simple reason that one can ask a research subject what she sees when looking at a pattern of light instead of having to develop a crude behavioral test to find out whether she sees anything at all we know far more about the molecular details of light reception in humans than we could ever have learned from studying mice. Particularly as biomedical research puts an increasing emphasis on unraveling the molecular underpinnings of behavior, the advantages of starting research studies with humans, rather than model organisms, are likely to grow. Experience tells us that translation of intensifying knowledge of basic biology into clinical advances is a daunting task. Furthermore, the Committee shares the sense that basic biology is at an inflection point in which there is every reason to expect increasing payoffs from the large investments in basic science that have brought us to this point. However, the grand challenge of coupling basic science more effectively to medicine will require a rethinking of current practices on a scale commensurate with the challenge. The Committee regards the initiative it proposes to develop the tripartite Information Commons, Knowledge Network, and New Taxonomy, as having the potential to rise to this level. Information technology is the key contributor to the technological convergence the Committee perceives. In medicine, information technology offers perhaps the best hope of increasing efficiency and improving our collective learning about what works and what does not. In a mere 20 years, people have made the transition from regarding most human knowledge as locked away in the dusty backrooms of research libraries to expecting it to be at their finger tips. Understandably, the public is losing patience with barriers to the sharing and dissemination of information. The social-networking phenomenon is a particularly dramatic illustration of changing attitudes toward information and associated blurring of the line between the public and private. The Committee recognizes that some aspects of the world we envision are more readily approachable than others. As emphasized throughout this report, there are many impediments to progress along the path we outline. That is the reason the Committee recommends pilot projects of increasing scope and scale as the vehicle for moving forward. Although we consider the creation of an improved classification of disease valuable in its own right, we do not recommend a crash program to pursue this goal in isolation from the broader reforms we emphasize. We regard smaller projects on the recommended path as preferable to larger, narrower initiatives that would distract attention and resources from these reforms.

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Person (in this report): Used as the primary descriptor of a donor (rather than terms such as individual or self) in order to highlight the fact that people do not act in isolation buy discount levlen 0.15mg. The notion of a person implies a social being in relationship(s) with other social beings and as such draws attention to the significance of personal buy generic levlen 0.15 mg line, kinship and economic connections in understanding transactions involving bodily material purchase 0.15mg levlen with mastercard. Pluripotent stem cells: Cells that have the potential to develop into many other different kinds of cell. Post mortem: Internal examination of the body after death, in order to investigate the cause of death and/or the factors contributing to death. The Human Fertilisation and Embryology Authority must agree that a particular condition is sufficiently serious before clinics are permitted to test for it. It is possible to hold some property rights in connection with bodily material (for example those that enable the right-holder to control the use of their bodily material once separated from their body) without necessarily holding others (such as a right to monetary gain from that material). Recompense (in this report): A general term for payment made to a person in recognition of losses they have incurred, material or otherwise. In this report, reimbursement of expenses and compensation are both types of recompense (see reimbursement and compensation). Reimbursement (in this report): Payment to a person to cover expenses actually incurred in the act of donation, such as travel expenses, meals and lost earnings. Reimbursement returns the person to the same financial position they would have occupied had they not donated, and does not enrich the donor in any way. Remuneration (in this report): Material advantage gained by a person as a result of donating bodily material (reward), where this is calculated as a wage or equivalent. Specific consent: Consent to the use of donated bodily material for a specified project. Stewardship model: A concept of the role of the state that includes a clear obligation on the part of states to enable people to lead healthy lives. Stranger donation: The donation of an organ by a living donor to an unknown recipient. Superovulation: The medical stimulation of the ovary with hormones to induce the production of multiple egg-containing follicles in a single menstrual cycle. Tiered consent: A form of generic consent for future use of donated bodily material, where the donor is invited to agree to the future use of their tissue in unknown projects, but given the option of specifying particular categories of research that they wish to exclude (see generic consent). Tissue bank: Repository for a range of bodily materials for treatment or research purposes (also known as biobanks or biorepositories). Totipotent stem cells: Stem cells with the potential to develop into any kind of cell. Transaction (in this report): An umbrella concept used to cover all kinds of dealings, here for therapeutic or research purposes, between persons and/or persons and agencies with respect to human bodily material. Transplant commercialism: Defined in the Declaration of Istanbul as a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain. Transplant tourism: Colloquial term used to refer to how those waiting for an organ transplant travel abroad to countries where organs are more readily available. It is typically applied to travel for transplantation involving thriving illegal markets where organs are bought and sold. Published in the United States by Pantheon Books, a division of Random House, Inc. Library of Congress Cataloging in Publication Data Illich, Ivan, 1926 Medical nemesis. The Medicalization of Life Political Transmission of Iatrogemc Disease Social latrogenesis Medical Monopoly Value-Free Cure? Political Countermeasures Consumer Protection for Addicts Equal Access to Torts Public Controls over the Professional Mafia The Scientific Organization of Life Engineering for a Plastic Womb 8. The Recovery of Health Industrialized Nemesis From Inherited Myth to Respectful Procedure The Right to Health Health as a Virtue 1 The Epidemics of Modern Medicine During the past three generations the diseases afflicting Western societies have undergone dramatic changes. Polio, diphtheria, and tuberculosis are vanishing;1 one shot of an antibiotic often cures pneumonia or syphilis; and so many mass killers have come under control that two-thirds of all deaths are now associated with the diseases of old age. Those who die young are more often than not victims of accidents, violence, or suicide. Although almost everyone believes that at least one of his friends would not be alive and well except for the skill of a doctor, there is in fact no evidence of any direct relationship between this mutation of sickness and the so-called progress of medicine. After a century of pursuit of medical Utopia,6 and contrary to current conventional wisdom,7 medical services have not been important in producing the changes in life expectancy that have occurred. A vast amount of contemporary clinical care is incidental to the curing of disease, but the damage done by medicine to the health of individuals and populations is very significant. They are not modified any more decisively by the rituals performed in medical clinics than by those customary at religious shrines. The infections that prevailed at the outset of the industrial age illustrate how medicine came by its reputation. By the time their etiology was understood and their therapy had become specific, these diseases had lost much of their virulence and hence their social importance. The combined death rate from scarlet fever, diphtheria, whooping cough, and measles among children up to fifteen shows that nearly 90 percent of the total decline in mortality between 1860 and 1965 had occurred before the introduction of antibiotics and widespread immunization. These in turn peaked and vanished, to be replaced by the diseases of early childhood and, somewhat later, by an increase in duodenal ulcers in young men. Despite intensive research, we have no complete explanation for the genesis of these changes. For more than a century, analysis of disease trends has shown that the environment is the primary determinant of the state of general health of any population. As the older causes of disease recede, a new kind of malnutrition is becoming the most rapidly expanding modern epidemic. In contrast to environmental improvements and modern nonprofessional health measures, the specifically medical treatment of people is never significantly related to a decline in the compound disease burden or to a rise in life expectancy. The new techniques for recognizing and treating such conditions as pernicious anemia and hypertension, or for correcting congenital malformations by surgical intervention, redefine but do not reduce morbidity.

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