Centers for Disease Control and Prevention
Research Agenda Development
Public Comment Report
  Total
Respondents
Code Topic
1 89 C Community Preparedness and Response
2 133 E Environmental and Occupational Health and Injury Prevention
3 63 G Global Health
4 75 S Health Information Services
5 115 H Health Promotion
6 83 I Infectious Diseases
7 91 X Cross-Cutting Research
8 94 D General Discussion
Total 743  
Unique 394  
Date Time Type ID Group Comment
04/20/2005 09:53 PU 473 C INOCULATIONS: THE TRUE WEAPONS OF MASS DESTRUCTION CAUSING VIDS (VACCINE INDUCED DISEASES) (AN EPIDEMIC OF GENOCIDE) by Rebecca Carley, M.D. Court Qualified Expert in VIDS and Legal Abuse Syndrome January 2005 “One basic truth can be used as a foundation for a mountain of lies, and if we dig down deep enough in the mountain of lies, and bring out that truth, to set it on top of the mountain of lies; the entire mountain of lies will crumble under the weight of that one truth. And there is nothing more devastating to a structure of lies than the revelation of the truth upon which the structure of lies was built, because the shock waves of the revelation of the truth reverberate, and continue to reverberate throughout the Earth for generations to follow, awakening even those people who had no desire to be awakened to the truth.” (by Delamar Duvaris as written in the preface of “Behold the Pale Horse” by William Cooper). The basic truth that served as the foundation for the mountain of lies known as vaccinations was the observation that mammals which recover from infection with microorganisms acquire natural immunity from further infections. Whenever cytotoxic T cells (the little Pac man cells which devour and neutralize viruses, bacteria, and cancer cells, thus conferring cellular immunity and are also responsible for allograft rejection) and B cells (antibody producing cells which confer humoral immunity by circulating in the body’s fluids or “humors”, primarily serum or lymph) are activated by various substances foreign to the body called antigens, some of the T and B cells become memory cells. Thus, the next time the individual meets up with that same antigen, the immune system can be quickly triggered to demolish it. This is the process known as natural immunity. This truth gave birth to a beLIEf that if a foreign antigen was injected into an individual, that individual would then become immune to a future infection. This beLIEf, (you see the lie in the middle), was given the name, “vaccinations”. What the promoters of vaccination failed to realize is that secretory IgA (an antibody found predominately in saliva and secretions of the gastrointestinal and respiratory tract mucosa) is the initial normal antibody response to all airborne and ingested pathogens. IgA helps protect against viral infection, agglutinate bacteria, neutralize microbial toxins, and decrease attachment of pathogens to mucosal surfaces. What this author has realized is that bypassing this mucosal aspect of the immune system by directly injecting organisms into the body leads to a corruption in the immune system itself whereby IgA is transmuted into IgE, and/or the B cells are hyperactivated to produce pathologic amounts of self-attacking antibody as well as suppression of cytotoxic T cells (as explained shortly). As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they cause chronic disease and thus further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment. This is especially true with viruses grouped under the term “stealth adapted”, which are viruses formed when vaccine viruses combine with viruses from tissues used to culture them, leading to a lack of some critical antigens normally recognized by the cellular immune system. One example is stealth adapted (mutated) cytomegaloviruses which arose from African green monkey (simian) kidney cells when they were used to culture polio virus for live polio virus vaccines. Thus, not only was the vaccinee inoculated with polio, but with the cytomegalovirus as well. The mechanism by which the immune system is corrupted can best be realized when you understand that the two poles of the immune system (the cellular and humoral mechanisms) have a reciprocal relationship in that when the activity of one pole is increased, the other must decrease. Thus, when one is stimulated, the other is inhibited. Since vaccines activate the B cells to secrete antibody, the cytotoxic (killer) T cells are subsequently suppressed. (In fact, progressive vaccinia (following vaccination with smallpox) occurs in the presence of high titers of circulating antibody to the virus[1] combined with suppressed cytotoxic T cells, leading to spreading of lesions all over the body). This suppression of the cell mediated response is thus a key factor in the development of cancer and life threatening infections. In fact, the “prevention” of a disease via vaccination is, in reality, an inability to expel organisms due to the suppression of the cell-mediated response. Thus, rather than preventing disease, the disease is actually prevented from ever being resolved. The organisms continue circulating through the body, adapting to the hostile environment by transforming into other organisms depending on acidity, toxicity and other changes to the internal terrain of the body as demonstrated by the works of Professor Antoine Béchamp. He established this prior to the development of the “germ theory” of disease by Louis Pasteur. Pasteur’s “germ theory” was a plagiarist’s attempt to reshape the truth from Béchamp into his own “original” premise – the beLIEf that germs are out to “attack” us, thereby causing dis-ease. Thus, treatment of infection with antibiotics as well as “prevention” of disease with vaccines are both just corrupted attempts at cutting off the branches of dis-ease, when the root of the cause is a toxic internal environment combined with nutritional deficiency. However, since Pasteur’s germ theory was conducive to the profits of the burgeoning pharmaceutical cartels that only manage dis-ease, no mention of the work of Professor Béchamp is made in medical school curricula. To make matters worse than the suppression of cellular immunity which occurs when vaccines are injected, adjuvants (which are substances added to vaccines to enhance the antibody response) can actually lead to serious side effects themselves. Adjuvants include oil emulsions, mineral compounds (which may contain the toxic metal aluminum), bacterial products, liposomes (which allow delayed release of substances), and squalene. The side effects of adjuvants themselves include hyperactivity of B cells leading to pathologic[2] levels of antibody production, as well as allergic reaction to the adjuvants themselves (as demonstrated in Gulf War I soldiers injected with vaccines containing the adjuvant squalene, to which antibodies were found in many soldiers). Note that the pathologically elevated hyperactivity of antibody production caused by adjuvants also results in a distraction from the other antigens that the immune system encounters “naturally”, which must be addressed to maintain health. In addition to the transmutation of IgA into IgE leading to allergic reactions described shortly, the overall hyperactivity of the humoral (antibody producing) pole of the immune system is, in this author’s opinion, the sole cause of all autoimmune diseases. The only thing which determines which autoimmune disease you develop is which tissues in your body are attacked by auto-antibodies[3]. If the inside lining of the gastrointestinal tract (the mucosa) is attacked by auto-antibodies you develop leaky gut syndrome (which leads to food allergies when partially digested food particles are released into the bloodstream, are recognized as antigens foreign to the body, and elicit an antibody response against those food particles that becomes heightened every time that same food is eaten and released into the bloodstream partially digested again). Crohn’s disease and colitis are also caused by auto-antibody attack on the mucosa of the GI tract itself. If the islet (insulin producing) cells of the pancreas are attacked by auto-antibodies, you develop insulin dependent (juvenile) diabetes. If the respiratory mucosa is attacked by auto-antibodies, you develop “leaky lung” syndrome where, just as with leaky gut, antigens recognized as foreign to the body which are inhaled are able to traverse the lining of the respiratory tract, causing the creation of antibodies against those antigens (usually dust, mold, pet or pollen antigens). When these substances are inhaled again, IgE (the pathologic form of IgA created after corruption of the immune system due to inoculation rather than inhalation of disease) acts as a reagin[4] and sensitizes mast and basophil cells, causing release of their histamine and slow reacting substance granules on contact with the allergen to produce constriction of the bronchioles leading to asthma. This process is also responsible for the immediate hypersensitivity reaction known as anaphylaxis, which is a potential side effect noted in the Physician’s Desk Reference for every vaccine; as well as the wheal and flare reaction of the skin known as hives. If the components of the articular surface of the joints are attacked by auto-antibodies, you develop rheumatoid (or juvenile) arthritis. If the skin is compromised on a chronic basis, you develop “leaky skin” syndrome, where contact antigens which could not otherwise traverse the skin lead to skin allergies to contact antigens (a delayed hypersensitivity reaction where inflammation occurs due to release of soluble factors). Additionally, depending on which level of the skin is attacked by auto-antibodies, (i.e., the epidermis or dermis), you develop eczema, psoriasis or scleroderma. If the kidney tissue is attacked by auto-antibodies, you develop one of the many types of nephritis, depending on which component of renal tissue is attacked (for example, with glomerulonephritis, the basement membrane of the glomerular apparatus within the kidney (which filters blood to form urine) is attacked by auto-antibodies, thus allowing protein to escape from the serum into the urine). If you develop auto-antibodies against thyroid gland tissue, you develop Grave’s disease. If you develop auto-antibodies against the tissue of the thymus gland (which is crucial in T cell production and function), you develop myasthenia gravis. If you develop auto-antibodies against the very DNA in the nucleus of all cells, you develop systemic Lupus (thus, the autoimmune potential of DNA vaccines being developed now is self evident; worse yet, DNA components from these vaccines can be incorporated into your DNA, leading to actual genetic changes which could cause extinction of all (vaccinated) life on the Earth, as will be discussed shortly). And on, and on, and on. The brain and spinal cord can also be attacked with auto-antibodies (which this author refers to as vaccine induced encephalitis), leading to a variety of neurological diseases. The most severe of these, leading to death, are sudden infant death syndrome (SIDS) and most cases of “shaken baby syndrome”. If components of the myelin sheath (the insulating covering of nerve fibers which allows proper nerve conduction) or the actual neurofilaments themselves are attacked by auto-antibodies, the resultant condition is determined solely by the location of the damage done. Such neurological conditions include but are not limited to minimal brain dysfunction, ADD/ADHD, learning disabilities, mental retardation, criminal behavior, the spectrum of pervasive developmental disorders (including autism), multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, Guillen Barre’, seizure disorders, etc., etc. etc. (Please note that other factors are also sometimes involved, such as: the organism which causes Lymes disease, aspartame and mercury in cases of MS; aspartame in seizures; or pesticides in cases of Parkinson’s). Thus, when detoxing to reverse these diseases, these other substances must also be removed to obtain a full recovery. However, the corruption of the immune system caused by the injection of vaccines is a key component in these disease states leading to immune malfunction, and is the reason why an autistic child may also have leaky gut or eczema, etc. Note that myelin production, for the most part, does not begin until after birth. Most myelin is apparently laid down by age 5 years and usually completed by age 10 years, judging by the level of success at various ages in reversing autistic and other neurological VIDS symptoms that this author has observed in hundreds of children by detoxing the viruses with homeopathic nosodes[5], and repairing the immune corruption by simultaneous administration of bovine colostrum (i.e., after 10 years of age, the ability to stop and repair auto-antibody induced damage in the myelin sheath and neurofilaments themselves is dramatically decreased). In summary, the hyperactivity of the humoral arm of the immune system in autoimmune disease is caused by adjuvants added just for that purpose. However, the damage caused by the autoimmunity itself (i.e., antibody against self) has several mechanisms, including the following: 1. The antigens present in the culture media itself cannot be completely filtered and separated from the organisms cultured thereon. Thus, any antibodies formed against antigens from the culture cells themselves (for example myelin basic protein from chick embryos or the 13 vaccines which now contain aborted human fetal cells) can cross-react to form an autoimmune reaction against the myelin basic protein in your myelin sheath, etc. 2. Molecular mimicry is due to similarity of proteins contained in organisms and mammals. (For example, the measles virus is made up of proteins similar to myelin basic protein; thus, antibodies formed against the measles virus antigens subsequently also cause an auto-antibody attack against myelin basic protein in the myelin sheath due to cross reactivity of these antibodies). 3. Formation of immune complexes occur as antigens and antibodies interlock into clusters which can then become trapped in various tissues, especially the kidneys, lung, skin, joints, or blood vessels. Once trapped, these complexes then set off an inflammatory reaction which lead to further tissue damage. 4. Intentional inclusion of antigens in vaccines to cause formation of antibodies that attack specific hormones or races (for example, experiments done on women of childbearing age in the Philippines and probably other locations where HCG (human chorionic gonadotropin)[6] placed into vaccines given these women resulted in antibodies against the HCG hormone, and subsequent spontaneous abortion thus occurred when the women became pregnant. It is also this author’s hypothesis that the epidemic of vitiligo in people of color (hypo pigmentation of skin caused by auto-antibody attack on melanocytes[7]) is also occurring due to intentional inclusion of melanin in vaccines given to people of color. Another heinous (and obviously genocidal) creation of the Anti-Hippocratics is the DNA vaccines now being developed. These vaccines contain plasmids, which are closed rings of recombinant DNA that make their way into the nucleus of a cell and instruct the cell to synthesize encoded antigenic proteins[8]. Thus, the very genetic makeup of the individual, plant or animal will be altered to produce a never ending supply of antigens to distract the immune system. These genetic changes will remain as cell division occurs, and will be transmissible to offspring. This is the TRUE “mark of the beast” , and could lead to extinction and/or modification (including behavioral) of any group inoculated. In addition to the above phenomena which lead to simultaneous depression of cellular immune function and hyperactivity of humoral immune function, vaccines also contain other toxic substances which can cause serious side effects themselves. The following ingredients are actually listed on the CDC website with this introductory statement: “Many things in today’s world, including food and medicines, have chemicals added to them to prevent the growth of germs and reduce spoilage.” Translation: you’re already toxic, so what’s the big deal with adding more poison? This author’s answer to that question is that any immunotoxin can end up being the “straw that breaks the immune system’s back” in that individual, leading to dis-ease. This is where genetics is key; i.e., not that what disease you develop is actually caused by some “gene” in most cases; but rather that your genes determine the strength of your immune system (i.e., how many assaults your immune system can take before it reaches critical mass, and you develop a dis-ease). Some additional ingredients in vaccines (as listed by the CDC on their website) include antibiotics, aluminum gels, formaldehyde, monosodium glutamate (MSG), egg protein, and sulfites. Thus, we have antibiotics (which you could be allergic to); aluminum (which when combined with silicon deficiency, results in the neurofibrillary tangles seen in Alzheimer’s disease); formaldehyde (a toxic carcinogenic substance used to preserve dead people); MSG ( a potent excitotoxin[9] which, like aspartame, can cause seizures, brain tumors, etc.); egg protein (to which you could have a life threatening anaphylactic reaction); and sulfites (another toxin which we are advised not to consume much of orally, but in vaccines, it is injected directly into the body). Is this not a veritable witch’s brew of chemicals, organisms, and animal parts? What the CDC does NOT list is that 13 vaccines at present (and more are in the works) are actually cultured on aborted human fetal tissues (go to www.cogforlife.org for more info). THIS IS CANNIBALISM. Note in this list that they also fail to mention the ethyl-mercury containing preservative thimerosol, which has been the only dangerous substance in vaccines to receive mainstream media attention (albeit most of that being disinformation) after the explosion in the rate of occurrence of autism in the last generation became self-evident proof that vaccines are the causative factor. For, although the scientists working for the medical mafia continue to use statistics to twist and spin their data to make us beLIEve that vaccines are not the cause, too many thousands of parents have watched their children enter the downward spiral into autism after their children received the vaccine which was the straw that broke the back of their child’s immune system. No matter what the “white coats” tell these parents, they know the truth! Mercury (also in dental amalgam fillings) is a highly toxic heavy metal, has been documented to cause cancer, and can be absorbed through the digestive track, skin, and respiratory track. Mercury is 1,000 times more toxic than lead, and is second only to uranium as the most toxic metal. If children receive all recommended vaccines, they will receive many times the “allowable safe limit” for mercury in the first two years of life (as if there is such a thing as a “safe” amount of a toxic poison). Yet, even after Congressional hearings instigated by Congressman Dan Burton (whose own grandchild became autistic after receiving vaccines) resulted in the FDA requesting (not ordering) vaccine manufacturers to remove this toxic heavy metal from their products, mercury is still present in many vaccines. Although the symptoms of mercury poisoning have been described as identical to the symptoms of autism, it should be noted that most children who descend into the hellish state known as autism do so after the MMR vaccine. The MMR vaccine is one of the few vaccines that do not contain mercury. Thus, it is self-evident that the removal of mercury will not make vaccines “safe”. (This is why the mercury is the only thing being addressed at all; because when the people reading this paper realize that the very mechanism by which vaccines corrupt the immune system means that NO vaccine is safe and effective; there will be an evolution of consciousness where the structure of lies telling us vaccines are safe and effective disintegrates.) The good news is that these VIDS can be reversed using natural remedies (especially homeopathy) contained in the Hippocrates Protocol (www.drcarley.com). This “surgical strike” detoxification approach which has the potential to reverse ALL of the aforementioned conditions under the VIDS umbrella as long as detoxification is started early enough will be the one truth put on top of the mountain of lies (that vaccines are safe and effective) that will cause the entire mountain of vaccine lies to crumble. Thus, the vaccine-induced holocaust (where instead of people being put in concentration camps, the concentration camps are being put into the people) will finally be put to an end. In this author’s opinion, it will be the reversal of VIDS (especially autism) in children and reversal of Gulf War Syndrome in the vaccine damaged soldiers and vets of the American Gulf War Veterans Association (www.agwva.org) led by Peter Kawaja which will stop this holocaust on humanity caused by vaccines, since the reversal of dis-ease subsequent to detoxification of the vaccines makes it self-evident that the vaccines caused the problem. Unfortunately, we can no longer pretend that this epidemic of VIDS is merely a “mistake” made by well intentioned, albeit misguided mad scientists. Because it’s even worse than the above, folks…we are talking TREASON and CRIMES AGAINST HUMANITY, PETS, and even PLANTS, (which are also being genetically modified to create vaccines). The evidence for this is as follows: As concern for population growth started to grow and the final plans to bring in the New World Order were put in place, this lie called vaccines was transformed into pure evil, as it was realized that such delivery systems could be used to intentionally cause disease, which is now being done under the US Code, Title 50, Chapter 32, § 1520 and 1524. You can read it for yourself at your local library. This law has been in place since the 1960's, and it was last modified in April of 2000. The only stipulation made for experimentation on human subjects is that local civilian officials be notified 30 days before the experiment is started. Section 1524 adds that the Secretary of Defense may enter into agreements with the Secretary of Health and Human Services to provide support for vaccination programs through use of excess peacetime biological weapons (i.e., weapons of mass destruction). In April 2000, § 1520 (a) was passed to put alleged restrictions on the use of human subjects for testing of chemical or biological agents after a caller on C Span mentioned this law in 1999, which revealed this treasonous law to a huge audience of listeners (including this author, who has been including it in lectures and written materials since that call came into “Washington Journal”). However, the exceptions written to Title 50, chapter 32 under § 1520 subsection (b) in the 2000 law passed by our aiders and abettors of treason in Congress not only loophole back in a test carried out for "any peaceful purpose that is related to a medical, therapeutic, pharmaceutical, agricultural, industrial, or research activity"; but add that such biological and chemical warfare agents can now be also used for any law enforcement purpose, including "any purpose related to riot control” (just in case those C Span listeners should actually get off the couch at the horror of what the traitors in Washington, D.C. are doing to God’s people). Subsection (c) of this law now mandates that “informed consent” be required. In reality, not a single vaccine has ever been tested for its long term side effects (including carcinogenic potential). Additionally, the intentional introduction into vaccines of stealth viruses, (including man-made viruses that cause cancer, mycoplasma and the HIV virus), antigens which target certain races, and silicon and/or DNA chips in the future makes it self evident that informed consent is impossible, as it would initiate impeachment proceedings and war crimes trials against every “public servant” involved in perpetrating these crimes against the American people, in violation of the Nuremberg Code (which was written after the end of WW II to prevent the barbaric experiments that occurred in the Nazi concentration camps) . What most people don’t know is that the top level mad scientists from Nazi Germany were actually brought to the United States after the war through “Operation Paperclip”, and have been continuing their work to this day in places like Brookhaven labs, Cold Spring Harbor and Plum Island in this author’s backyard on Long Island. In 1969 the U.S. military/CIA and Rockefeller directed National Academy of Sciences-National Research Council (NAS-NRC) announced that a research program to explore the feasibility of "creating a new infective microorganism..[HIV]..which would be refractory to the immunological and therapeutic processes upon which we depend to maintain our relative freedom from infectious disease" could be completed at a total cost of $10 million. Yes, this is what your tax dollars are going towards, folks. But hang on to your hat, because it only gets worse. Dr. James R. Shannon, former director of the National Institute of Health reported in December, 2003 that “the only safe vaccine is one that is never used”. However, the reverberating truth, “the shot heard round the world” which will lead to the evolution of consciousness necessary to stop the holocaust against humanity known as vaccinations, will be that not only are vaccinations not safe or effective, but that they are actually weapons of mass destruction being perpetrated upon humanity in the name of health, for the purpose of genocide and to bring in the New World Order. Part 2 of the genocidal plan could drop anytime with activation of the Model State Health Emergency Powers Act whenever the next fabricated terrorist attack using biological agents occurs. Worse yet, the Congressional traitors in Washington posing as public “servants” are doing all they can to pass “Codex” legislation which will make the natural remedies and supplements used in the Hippocrates Protocol developed by this author to reverse all dis-eases only available by prescription. So, you didn’t hear about that on your local news station either? Please go to the site of John Hamill of the International Alliance for Health Freedom (who reversed his schizophrenia symptoms with these natural supplements and has dedicated his life to stopping Codex from passing) at www.iahf.com . The most heinous, bone chilling and evil piece of this puzzle has been revealed to the world by an American hero named Habib Peter Kawaja, who worked in the late 1980’s as a security and counter terrorism expert for the United States government (a service for which he has been rewarded with the murder of his wife, torching of his home, issuance of a War Powers Act search warrant to (they thought) confiscate all his evidence, illegal IRS liens on all subsequent income, and multiple attempts on his own life, all funded by YOUR tax dollars). Please go to www.agwva.org/mission.htm and read some of the 34 counts that Mr. Kawaja brought against the domestic traitors to America (in both their individual and governmental capacities) in a federal lawsuit in which the perpetrators, again, used your tax dollars to hire themselves attorneys from the Department of “Justice” whose defense of their war criminal clients was that they are “immune, under color of law[10]”. (You can listen to Mr. Kawaja on one of his multiple internet radio shows, including “What’s Ailing America?” which he co-hosts with this author at www.againstthegrain.info every Monday and Friday at 11 PM, EST). Wake up, America-it's getting very late….it is time for the mountain of lies to crumble. Please spread the world to everyone you know….we will make it happen! The time to stop chopping at branches and get to the root of this evil is now ! Refer everyone you know to www.againstthegrain.info, where in the spring of 2005, Habib Peter Kawaja, as prosecutor for the people, and this author will commence trials on the internet against the traitors of America for their crimes against humanity. These traitors include William Atkinson, MD, MPH of the National Immunization Program at the CDC. On December 9, 2004, Dr. Atkinson informed a NYS Department of Health minion that a child to whom this author had given a medical exemption from further inoculation “should be vaccinated unless he has an anaphylactic allergy to hepatitis B vaccine” as there is “no such syndrome [as VIDS]”. Yet, in a document published by the CDC on May 4, 2000 (# 99-6194) entitled “Vaccine Information Statements; What You Need to Know”, on page 9 the following is printed under the heading “The Law (Recording Patient Information and Reporting Adverse Events): 42 U.S.C. § 300aa-25. Recording and Reporting of Information, (b) Reporting (2) “A report under paragraph (1) respecting a vaccine shall include the time periods after the administration of such vaccine within which vaccine-related illnesses, disabilities, injuries, or conditions the symptoms and manifestations of such illnesses, disabilities, injuries, or conditions, or DEATHS occur, and the manufacturer and lot number of the vaccine.” Thus, while Dr. Atkinson informed this author on January 8, 2005 that “having a judge in the Bronx Family Court “qualify” you as an “expert witness” neither makes you an expert, nor proves the existence of so called “vaccine induced disease syndrome”; the CDC’s own documents refer to the federal mandate for such to be reported to the secretary. Dr. Atkinson, who received a copy of the draft of this paper on 12/30/04, has not offered a single rebuttal to the mechanism whereby the mechanism of VIDS is explained in this paper. Ergo, this author hereby formally charges Dr. Atkinson and his co-conspirators in the CDC with the following counts, including but not limited to: 01.) False statements within a Government Agency, Title 18 USC § 35.1001. 02.) WAR CRIMES - crimes when death occurs, Title 18 USC § 34. 03.) Concealment, removal - Title 18 USC § 2071. 04.) Aiding and Abetting, Title 18 USC § 3. 05.) Obstruction of Justice, Title 18 USC § 1505 / USC § 2 (26). 06.) Defrauding America, Title 18, USC § 1101 (25). These charges also surround covert counter-terrorism activities in a lawsuit (go to www.agwva.org/mission.htm) brought by Peter Kawaja and the International Security Group, Inc., (1994) as Plaintiffs v. various [named] Agents (agencies/US attorneys etc) of the U.S. Government and 100 John Does (Bush Administration), and will also be submitted to the People of the United States and the World in the aforementioned internet trial to be conducted in the Spring of 2005. The charges laid in Kawaja's suit have never been refuted by the accused. Instead, the United States Government made a determination to appoint the US Attorney's Office to represent the Defendants, thereby admitting to the criminalities (and guilt). This decision to appoint "government" attorneys and the U.S. Attorney's Office to represent the Defendants was made after an initial response to the Plaintiff (Kawaja) filing Suit, and places these individuals, sworn to uphold the Constitution of the United States and defend against terrorists (whether foreign or domestic) into the defendant’s box as well. If the People lead, the “leaders” will follow…and we have found a true leader in Habib Peter Kawaja. SILENCE IS CONSENT. If you do nothing, before long highly trained Special Operations commandos with state of the art weaponry will be used in the U.S. to “execute quarantine and certain health laws”, including the Model State Health Emergency Powers Act passed in all states where, following another domestically perpetrated biological scare (such as the anthrax mailings to the Congress), a solution in the form of a vaccine will be offered only to those who will accept the national ID chip being injected into them. All others will be considered a danger and threat to society, hunted down, and imprisoned in concentration camps already built or be killed. Americans will welcome this solution, and turn in their neighbors or friends in order to survive themselves. This was all predicted by Peter Kawaja in 1994 when he wrote “The Saddest Chapter of America’s History”. If you are not part of the solution, therefore, you are part of the problem. Please do all you can (including telling others about the internet trial and donating whatever you can at www.agwva.org) to make this happen. It is now in your hands, People of the United States of America. Respectfully submitted by Rebecca Carley, MD www.drcarley.com (The author wishes to thank Mr. Chris Barr, a fellow radio host on www.highway2health.net and www.againstthegrain.info for his invaluable additions and editorial assistance in the writing of this document; and Meryl Dorey of the Australian Vaccination Network, Inc., whose additions for the publication of this paper in their magazine “Informed Choice” in Australia have also been included in this February, 2005 updated edition of this document.) -------------------------------------------------------------------------------- [1] “IMMUNOLOGY” by Ronald D. Guttman, MD, Professor of Medicine, McGill University, et. al., (ISBN # 0-89501-009-7), 1983. [2] Pathologic = pertaining to or caused by disease [3] Auto antibodies = antibodies produced by the body that attacks its own tissues. [4] Reagin = antibody of a specialized immunoglobulin class (IgE) which attaches to tissue cells of the same species from which it is derived, and which interacts with its antigen to induce the release of histamine and other vasoactive amines. [5] A nosode is a homeopathically prepared remedy, made from a disease or a pathological product. Nosodes are used in the same way as vaccines; they sensitize the body, prompting the immune system to react (and detox, or eliminate, the offending agent). However, as they are extremely dilute and oral in application, they do not lead to the corruption of the immune system caused by inoculation with disease. [6] Human chorionic gonadotropin = the hormone produced when women first become pregnant [7] Melanocytes = melanin producing cells in skin [8] “GENETIC VACCINES”, Scientific American, July 1999, pgs 50-57 @ p. 52. [9] Excitotoxins are usually amino acids, such as glutamate and aspartate. These special amino acids cause particular brain cells to become excessively excited, to the point they will quickly die. Excitotoxins can also cause a loss of brain synapses and connecting fibers. Food-borne excitoxins include such additives as MSG and aspartame, both toxic substances approved for use in humans by the FDA (Fraudulent Drug Administration). [10] “color of law” = the appearance or semblance, without the substance, of legal right. Misuse of power, possessed by virtue of state law and made possible only because wrongdoer is clothed with authority of state, is action taken under “color of state law”. Atkins v. Lanning, D.C.Okl., 415 F.Supp. 186, 188. Action taken by private individuals may be “under color of state law” for purposes of 42 U.S.C.A. § 1983 governing deprivation of civil rights when significant state involvement attaches to action. Wagner v. Metropolitan Nashville Airport Authority, C.A.Tenn., 772 F.2d 227, 229. Acts “under color of any law” of a State include not only acts done by State officials within the bounds or limits of their lawful authority, but also acts done without and beyond the bounds of their lawful authority; provided that, in order for unlawful acts of an official to be done “under color of any law”, the unlawful acts must be done while such official is purporting or pretending to act in the performance of his official duties; that is to say, the unlawful acts must consist in an abuse or misuse of power which is possessed by the official only because he is an official; and the unlawful acts must be of such a nature or character, and be committed under such circumstances, that they would not have occurred but for the fact that the person committing them was an official then and there exercising his official powers outside the bounds of lawful authority. 42 U.S.C.A. § 1983. (The above definitions are from Black’s law dictionary, 6th edition, pgs. 265-266)
04/19/2005 17:26 PU 463 C Regarding cagefory C8, Risk Perception & Protective Behaviors, the impact of the mentioned social factors on the development, acceptance, and implementation of preparation and planning activities, that occur *before* a disaster, should also be assessed.
04/19/2005 16:32 PU 459 C C2: Rapid clinical diagnosis could also include rapid questionnaire-based assessments (e.g. for mental health diagnoses), and rapid creation of new, psychometrically validatable assessment instruments. This ties in with C10 too, but with a focus on speed of development and deployment of existing best practice and newly developed instruments
04/19/2005 16:13 PU 457 C Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:31 PU 452 C Much of this does not appear to be research. For example, examining the organizational structure ...... This seems more like CDC priorities than research priorities. Or perhaps "things it would be good to know" for our programs.
04/19/2005 14:33 PU 448 C Should have an objective to do process and outcome evaluations of the funds which have been distributed to states to prepare for disasters.
04/19/2005 13:27 PU 440 C Research into effective interventions to promote community resilience.
04/19/2005 12:03 PU 434 C Since much of our preparedness relates well to issues that occur often in our communities such as disease outbreak and vaccine shortages, some research should include studies regarding identify the needs and implementation strategies of families in these situations i.e. childcare during an emergency, transportation in an urgent situation and food and water safety.
04/19/2005 10:29 PU 425 C Suggest inclusion of rural and frontier areas, especially as those touch international borders, and in particular regard to vector-borne diseases.
04/19/2005 10:23 PU 423 C I recommend that the research activities for C.13 also include: Identify sources, modes, and routes of communication and messages about risk and protection to prepare the public to responde safely and to cooperate with authorities in the event of an emergency. [The findings from this activity will support C.11]
04/19/2005 07:45 PU 419 C There needs to be coordination between programs (i.e. immunization and communicable disease) when developing software for BT or disease outbreak response.
04/18/2005 14:02 PU 403 C Insure mass fatality preparedness and response issues are adequately addressed throughout this area.
04/18/2005 13:47 PU 402 C Many of the Research themes appear to be overlapping - Community actions, Local and Regional Operations Strategies, Community and Regional Response. These might be better merged to reflect their relatedness, and therefore would be stronger.
04/18/2005 13:42 PU 401 C Suggest including information about the communication level of the directions, announcements,.materials to be developed and the modifications needed for individuals with communication disabilities (e.g., cognitive-communication difficulties due to traumatic brain injury, mental retardation, developmental disabilities, dementia; aphasia and other receptive or expressive language disabilities) before, during, and after a disaster.
04/18/2005 11:15 PU 389 C It is important to understand that disabilities are also important chronic conditions that affect people's health. Ensuring that we have surveillance and prevention strategies in place for disabilities should be a priority.
04/18/2005 08:26 PU 381 C c1 should include a component for the development and implementation of methods for the detection of infectious diseases in travelers (foreign and domestic). An example would be the early detection of Legionnaires' disease outbreaks by centralized real-time analysis of travel-associated cases of the disease.
04/18/2005 07:29 PU 377 C Several bulleted C3 "Environmental Detection and Decontamination" items under the Starter list including 1) • Quantify risks associated with mold exposure in the home work environments; 2) Outline risks associated with exposure to chemicals; and 3) Describe risk associated with injury events, should instead be under C4 "Risk Assessment and Management Strategy. "Health and Injury" should be added to the C4 titled. For the research on better tracking and surveillance for early detection, the systems should be phased, prioritized, and separated sufficiently to cover the broad areas of response and preparedness activities to safeguarding human life including: a) possible threats from space, 2) human-induced global changes, 3) international conflicts and war, 4) utility disruptions and blackouts/brownouts, 5) geological and meteorological events (volcanoe eruptions, earthquakes, mudslides, flooding, shore erosion from storms, tornadoes, hurricances/typoons, lightning), 6) naturally occurring disease outbreaks, 7) terrorism and intentionally caused disease outbreaks and disasters, 8) unintentional health outcomes from daily lifestyle choices (where work, where live, what drink, what eat, how travel, etc.). 9) spills and unintentional releases of hazardous and toxic substances (waste sites, pipe and container spills, production facilities and emissions, etc.), and 10) recreational activities (where, what, exposures to environmental media, etc.)
04/18/2005 07:27 PU 376 C Bullying in school and other kinds of school or community exposure to emotional abuse and violence should be a prominent component of this agenda.
04/15/2005 15:30 PU 365 C Will there be any items on state/local agency collaboration with local communities, and private organizations in dealing with preparedness.
04/15/2005 14:13 PU 361 C The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 13:24 PU 359 C C1, I think CDC has explored quite a few non-tranditional systems, and they often approved to be not effective. The resources should be spent on how to make tranditional systems work better instead of developing some fancy, good for IT only, nontranditional systems.
04/15/2005 09:54 PU 352 C Need to educate the public and encourage then to do the things necessay to have all things in place
04/15/2005 09:54 PU 351 C Need to educate the public and encourage then to do the things necessay to have all things in place
04/15/2005 09:06 PU 348 C True preparedness requires a strong public health infrastructure. Research is needed to define what structure provides the greatest positive impact on population health.
04/15/2005 08:00 PU 347 C I would rather see this labeled community health and prevention. None of the other topics appear to address the basic issue of the local community or considers the local culture, economy, geography, education, and general health and belief systems. The whole issue of terrorism preparedness has become a political boondoggle, wasting millions of taxpayer dollars. My comments do not necessarily reflect the opinions of my department or school.
04/14/2005 15:48 PU 339 C Important - but so many other agencies are addressing this.
04/14/2005 14:18 PU 337 C Although this is an important area for CDC's participation, it is not uniquely CDC's niche and I don't think it should be listed number #1.
04/14/2005 13:26 PU 332 C Behavioral science seems to get short shrift on this list.
04/14/2005 13:22 PU 331 C Like strategies for assesssing readiness of state systems for response activities.
04/14/2005 13:13 PU 330 C I think terrorism is not a serious public health priority. There are far more people ill, injured and dead from dozens of other threats.
04/14/2005 12:14 PU 324 C for example, where on the list does this suggestions appear? test only
04/14/2005 12:13 PU 322 C While this is an important area, I don't recommend it be placed at number one. I think that most of our current health problems are directly related to the lack of more intensive long term intervention studies to identify program strategies for sustaining health behaviors.
04/14/2005 12:07 PU 321 C I suggest we do a study of whether there is an spike in injuries or other adverse effects right after the time changes to or from daylight savings time.
04/14/2005 11:54 PU 320 C Develop a Central Resource person as the POC for Responders in need of psychological de-briefing and follow-up, and for families of Responders in cases of adverse outcomes.
04/14/2005 11:49 PU 319 C Develop effective psycho-social screening tools to screen responder applicants beyond just their academic credentials.
04/14/2005 11:33 PU 316 C C1 - I don't see a research component here. This is a program activity but I don't see what the research questions are related to this activity. There are other examples in this section that appear more program oriented than research oriented.
04/14/2005 11:05 PU 315 C Include research on susceptibility to disease and pathogens (natural and terrorist released) to help decide who to treat first. Also consider research on metabolism of antibiotics or other preventive measures that might be given to improve effectiveness.
04/14/2005 10:31 PU 308 C The research agenda assumes certain levels of readiness are in place. Are they? There are more fundamental research questions that need to be addressed to insure that we are abel to detect and respond to an even in a timely way?: What are the predictors of a rapid response? What determines which outbreaks of unknown origin get full rapid response attention at the local level? What are the average response times for outbreak response for critical agents, possible chemical attacks, and what are the determinants of those times? Who reports outbreaks and why? What are the incentives/disincentives for reporting? What can we do to increase reporting and early reporting? What is "community" public health? or Who are we to communicate with in the absence of county or city health departments in preparedness and assessing preparedness of public health?
04/14/2005 10:18 PU 305 C CDC is fortunate to have workers who are fluent in Non-English languages. In the event of an emergency it will be improtant to know who can assist with understanding, reading, writing, and developing emergency messages in other languages. How can we create a rapidly accessable database of volunteers listing their comfort level with other languages and cultures.
04/14/2005 10:10 PU 303 C I am getting a 'file error' when i 'click here for Starter list' on all of these items 1 through 7.
04/13/2005 16:22 PU 289 C C2 - Expand Rapid Clinical Diagnostic Capabilities through research activties targeting development of rapid tests capable of detecting very early exposures and that are robust -capable of holding up under very broad and varied testing environments with minimal skills required for perfoming the test ( CLIA waived)
04/13/2005 15:18 PU 282 C C8 include people with various disabilities (mobility, hearing, vision, cognitive, communication) among vulnerable populations example of research - assess the extent to which federal, state, and local emergency preparedness plans and response history has included people with disabilities C10 - include effectiveness of risk communications for people with various disabilities example - what are effective communication strategies for communicating risk to people with cognitive impairments?
04/13/2005 11:57 PU 275 C To my knowledge, neither CDC nor CMS has a comprehensive and current database of nationwide medical laboratory testing services, which includes all human testing laboratories--clinical and anatomic--with all tests offered. Such a comprehensive resource database, if updated annually, would benefit bioterror preparedness efforts, public health resource management, screening test capacity (toxicology and cancer screening), and laboratory workforce assessment; it would benefit CMS in their CLIA regulatory work.
04/13/2005 09:55 PU 270 C Currently, there is infrastructure in place to track the distribution of childhood vaccines through the Vaccines for Children (VFC) network but there is no similar infrastructure or informational network for adults. A Vaccines for Adults (VFA) program that incorporated influenza and pneumococcal vaccines would provide the basic infrastructure needed to distribute vaccines in the case of a pandemic and would make vaccines available to undervaccinated segments of the adult population. Some of this infrastructure was activated during the recent flu vaccine shortages. In addition, it would be possible to incorporate community organizations such as Fire Departments to administer vaccines to adults. With a VFA, manufacturers would keep distribution records in the same manner that they keep VFC records currently. This information and infrastructure would be invaluable in the face of a pandemic, or terrorist act.
04/12/2005 14:51 PU 264 C • Community Preparedness and Response: the 18 themes for this initiative cover quite well the types of research needed to address bioterrorism and other public health threats. The AADR suggests that, within research activities such as integrating traditional and nontraditional data systems to improve threat identification, assessing optimal roles for practitioners, preparing key personnel and identifying shortages in the workforce, the CDC consider the use of the dental office team. Suggestions in this regard have been made by the ADA and by a consensus workshop held in 2003 and sponsored by CDC, NIH, AADR, ADA, ADEA,ASTDD, et al. Dental offices are distributed across the community and can serve as an excellent surveillance resource, by observing and reporting characteristic lesions and /or unexplained patterns of employee absences or patients’ missed appointments. Dental offices may be also used as “mini-hospitals” if local hospitals are overwhelmed or when it is desirable to avoid concentrating patients in a single location. Dentists may also be used to provide treatment for cranial and facial injuries, take medical histories, administer CPR, and perform a host of other medical augmentation procedures. Saliva-based diagnostics are available or under development that are capable of rapidly identifying anthrax, lead, and other toxins.
04/12/2005 10:30 PU 261 C Embeded and highlighted within this research topic there has to be a focus on community based participatory research (CBPR) and partnership with grassroots organizations.
04/11/2005 09:59 OH 251 C see general discussion comment below
04/08/2005 13:56 PU 233 C Please indicate how we can submit our comments now available in Word file of the Stater list, relying on track changes. Thanks, Kenneth G. Castro, M.D. kcastro@cdc.gov
04/07/2005 19:03 PU 227 C As long as all disasters are included this is certainly a valid field. I think that research should be directed to evaluating levels of preparedness, and strengthening the public health infrastructure to deal with disaster preparedness. If public health surveillace was sufficient, it would be possible to identify public health disiasters in real time.
04/07/2005 15:59 PU 224 C C.8 - Include the assessment of service utilization by discrete populations. C.11 - Identify the appropriate mechanisms for the diffusion of messages in various communities specific to the appropriate health disparities
04/07/2005 10:09 PU 209 C Consider adding research related to the increasing use of contractors in the federal public health workforce and the impact on emergency response capabilitites. Contractors are not allowed to be trained as back up to the FTE's who are the initial responders; what impact does this have on emergency preparedness?
04/07/2005 09:19 PU 201 C We should asess our communities impact on others and perception by others which may lead to hostilities. This would be much more effective than providing protection from myriad of possible and devastating fronts. We should also assess danger brought to the public due to military interventions.
04/07/2005 07:53 PU 192 C C-2 & C-7 -- don't these fall more under NIH's pervue? In general, this topic seems to reflect CDC's new interest, but since chronic diseases kill 70% of Americans (and an increasing number world-wide), it seems to me to be more appropriate to put it further down the list.
04/07/2005 06:45 PU 190 C This is important, but money spent on personnel or equipment for some specific individual radionuclide analytical methods that are highly unlikely for radiological terrorist implementation would not be cost efficient. Alpha counting banks, for example, are very sample preparation intensive and typically very low throughput. These should be scrutinized for justification. First responder and local health provider response preparedness would be cost efficient.
04/06/2005 08:33 PU 177 C The draft list of priorities is comprehensive, thoughtful and timely. I can not think of additional, crucial, areas of concentration, but suggest the following two areas of emphasis: physical injuries and mental health consequences of disasters and terrorist incidents. While the US has undertaken massive (and appropriate) investments in preparedness activities to address possible chemical, biological and radiological disasters, the fact remains that the vast majority of terrorist-related morbidity and mortality to date has been traumatic in nature. A key question is how terrorist-related injuries differ from domestic injury patterns and what preparations are necessary to respond to these differences? To answer this question, in addition to the descriptive epidemiology, additional comparative analytic studies are necessary. Variables that are associated with severe injury and fatality must be identified. These variables should be amenable to rapid ascertainment by responding personnel. They should contribute in a meaningful manner to a model for prediction of survival in trauma patients. Additional questions include: What are the types, prevalence and incidence of fatal and non-fatal injuries? What are the demographic characteristics, including race, ethnicity and socio-economic status, of the affected? How are victims transported. What were the treatments? What were the outcomes? This kind of information is crucial for medical and public health professionals and community planners and policy makers to prepare for the possibility of terrorist incidents and disasters. Second, recognizing that the aim of terrorism is to terrorize, epidemiologic data on the behavioral consequences of disasters is essential to help guide relief and recovery efforts. Such information has implications for medical and public health response to surge capacity needs. It has been noted that the effort “required to collect the information necessary to provide apt and well-directed aid is more than justified by the improved results” . Yet, there are no uniform definitions among the multiple sources of health information , and collecting data is difficult. Data on mental health care needs and service requirements after disasters even more difficult to define and obtain. Thanks for this opportunity to comment. C. DiMaggio
04/05/2005 23:13 PU 175 C this is important when the focus includes infectious diseases such as TB
04/05/2005 19:50 PU 174 C There needs to be a focus on the role of Trauma Centers in disaster preparedness. Although not to minimize bioterrorism, most disasters include physical injuries. Not every hospital is adequately prepared to handle these injuries
04/05/2005 18:11 PU 172 C Please include research and support for the nation's TRAUMA SYSTEMS and TRAUMA CENTERS. The EMS and Hospital systems that daily support the emergency health care needs of the nation have a great many system, communication, preparedness, and response needs which are not being addressed. These systems are not currently organized for wide-spread disaster response. Thank you. Raelene Jarvis, RN
04/05/2005 15:12 PU 171 C recommend you strongly consider including TRAUMA CENTERS in your funding for disaster prepardness/terrorism activities.
04/05/2005 14:32 PU 167 C Support of Trauma Centers would be appropriate.
04/05/2005 14:21 PU 166 C Please consider including TRAUMA CENTERS and emergency departments as they provide a vital function in the event of a disaster or terrorism event.
04/05/2005 13:36 PU 163 C Please consider supporting Trauma Centers in funding for Disasters. Trauma Centers are having difficulty staying afloat financially. Should a disaster of any magnitude strike anywhere, the public will be heading to the closest trauma center whether they need to be there or not. Trauma Centers are faced with budget cuts annually. Help for the centers is needed. I am not talking about disaster equipment - hazmat tents and the like, but actual financial support just to stay in business. Monies should be set aside from taxes placed on cigarettes, alcohol. and the sales of large SUVs - these are at the root of many traumatic incidents occuring daily that is largely ignored by the government. A portion of the taxes placed on the above items should go directly to the states to be distributed to each verified trauma center within the state. A simple idea that could make a world of difference in readiness! Thank you
04/05/2005 13:15 PU 162 C Trauma Centers need to be include in funding grants for prevention and preparedness to respond to all kinds of events both natural and man made from disease outbreaks to terrorism. Trauma centers are the lead organizations in communites that have the organized structures in place that need enhancement we should not be duplicating process for just one type of event it should be seamless not matter what type of event and we should build on each strenght. I would encourage funding for trauma centers.
04/05/2005 13:14 PU 161 C Include Trauma Centers in your funding priorties. They will be responding to all terrorist and environmental challenges and the resources for Trauma Centers currently is overtaxed in the Unitied States and needs support.
04/05/2005 12:38 PU 160 C This money should be spent on trauma related issues and not bioterrorism. There has been a lot of money spent thus far on bioterrorism yet most terrorist activities and disaster situations are trauma related (ie bombs etc). Additionally, I ask you to strongly consider targeting trauma centers as they are the leaders in the community in trauma and have also been exlcuded in prior funding.
04/04/2005 13:30 PU 156 C While the topics are important. Aren't there enough federal agencies already involved (e.g., FEMA, etc.). Adding this to the NCIPC agenda depletes funds and attention to other relevant topics/problems.
04/04/2005 11:51 PU 153 C Please consider addressing pediatric populations, particularly in the critical settings of schools, communities, and medical centers. In the threat of a disaster, pediatric populations are often lost in the shuffle and not considered in preparedness efforts. However, in an actual disaster, pediatric populations are often the most drastically impacted. Pediatric populatins also tax our preparedness efforts - think for example of mothers with their children flooding the Emergency Departments following threats of air-borne pathogens and overwhelming the medical system. Schools are often targeted as sites of relief in a disaster (such as being a Red Cross site or a place to dispense food and water), but are rarely included in preparedness efforts focusing on how to best help children. Crisis plans in pediatric settings can also be iatrogenic for children - such as complete lockdowns in school crisis situations, which worsens the impact for children who then experience prolonged parental separation. With all community preparedness and response research, I hope the CDC can be a leader and consider pediatric populations not as an afterthought but as a primary focus.
04/04/2005 11:34 PU 151 C Less time and money should go into this focus area.
04/04/2005 11:05 PU 147 C Please focus less on terrorism than natural disasters (in places that have them regularly) and natural disease outbreaks. Foucusing research dollars on terrorism seems to just add to the hype.
04/03/2005 21:43 PU 144 C while it is very important for CDC to plan, develop and evaluate responses to ever emerging and unknown threats, i hope CDC will also look at threats that are much more likely to occur and are occuring daily all across the USA and that is the meth lab, the chemicals used in them and the high proobability of explosions... it is a human made disaster that is quickly reaching epidemic proportions.
04/01/2005 08:20 DC 142 C Review smallpox preparedness guidelines. Do hospitals need to be able to vaccinate all their staff and families in a 24 hour period? The CDC response to TV shows indicates that people will not get infected unless there is prolonged exposure. The messages appear to be in conflict. Is it time to mandate influenza vaccine for all health care workers?
03/30/2005 10:37 DC 131 C Would appreciate mre information on what rural communities need to focus on for preparedness. With limited resources, personnel and access to supplies, how can a small community become well prepared.
03/29/2005 15:48 DC 119 C Most leaders in tha area of emergency preparedness are not willing to focus much effort in the area of disease outbreaks. There seems to be a feeling or thought that there isn't much we can do to save lives in this area. Healthcare is very much more prepared for a mass casualty or CBERN event.
03/29/2005 10:57 DC 114 C It appears that the area wide preparation for natural disasters as well as chemical type exposures has been well addressed. The concern I have is that I feel we are poorly prepared for bioterrorism and pandemics. It appears in our area that all the federal funds have gone to fire department and other first responders and has been used to prepare for chemical incidents. Infection control was not even invited to participate within the committee that worked on this issue. When infection control expressed our concerns the response appeared to be that by the time we identify a bioterrorism incident there will be so many exposures that we will not be able to cope. I am employed in a 134 bed facility and we do not have the ability to shut off air handlers and close off areas of the facility. If it is pandemic influenza, we would probably be overwhelmed and full but could provide safe quality care to the patients. If we are hit with bioterrorism, I feel that we will not be able to respond safely. I do not know what the answer is as this is a very difficult situation, however, I think it is important to express the concerns regarding how we would handle this type of situation. If it is a terrorist attack that would require special air handling issues, we would be in serious trouble. This could even be said for such diseases as SARS.
03/29/2005 10:57 DC 111 C I believe it is critically important not to let fear mongers divert dollars to terrorism when disease outbreaks and natural disasters are known problems that affect many people. The infrastructure required to deal with those things will assist in the unlikely event of a terrorist attack, but the planning should be done with common things in mind first.
03/28/2005 13:29 DC 102 C Community Preparedness remains a priority issue for many of us in healthcare. We recommend further research on transmission risk related to specific diseases to support prudent use of limited resources. Disease specific references will continue to be needed to guide planning in our city.
03/28/2005 12:43 DC 92 C having the ability to quantify syndromes in clinical areas
03/28/2005 12:40 DC 90 C More funding needed for training, to increase ICU capacity, create more negative pressure rooms and to stockpile supplies. Few hosptals have more than 48hrs of supplies on hand at any one time. Cities need a plan to hold and triage mass casualties in non-hospital venues to keep hospital access clear or hold patients for quarrantine.
03/28/2005 11:48 DC 82 C Methods (including disaster drills) to examine how well a community is prepared to respond need to be examined. Disaster drills should be required of communities to be performed on a regular basis. The variety of disciplines among community-based public health workers and hospital-based healthcare workers are not used to networking or working together. Any disaster preparedness exercises performed as well as real disaster situations should be evaluated using a standard set of criteria in much the same way investigations are performed by the FAA for airplane accidents.
03/28/2005 11:33 DC 78 C Hospitals should be prepared to have single use space for infectious patients. Alcohol handwash should be readily available in hallways for care givers. Provide community wide opportunities for hand sanitizers in areas where people congregate such as in movie theaters, grocery stores, a major sporting events.
03/28/2005 11:05 DC 75 C I would like to see a database with medical as well as patient educational material that healthcare entities can download and adopt. This would lead to standardized healthcare educational information being handed out to patients. This would also lead to nurses and other key caregivers being educated to the same information which as been researched by CDC, rather than to individualized interpretation.
03/28/2005 10:14 DC 69 C Need to make the flu vaccine mandatory for health care providers. This will be the biggest tool to help prevent a pandemic. Need more vendors for the vaccine.
03/27/2005 16:24 DC 55 C The annual Flu and Flu-like illness are infact a model for a bioterrorist attack. There is much the CDC could do today to improve the coordination and dissemination of the data. I would be happy to supply CDC with some recommendations Will Sawyer MD 513-769-4951 or dr.will@henrythehand.com
03/25/2005 13:08 DC 51 C CDC needs to take the lead in better vaccine development--not just leaving it to the drug companies who are only out to make money.
03/25/2005 11:30 DC 49 C I have been fortunate to be asked to attend regional emergency prepardness meets with county EMS, Hospitals, etc. Though everyone is attempting to train to the best of their ability, there is not enough structure. Funding is being given to help with training and preparation but unfortunately most of this will be wasted as there is a lack of understanding and control of all the involved entities. I recently sat in on one of these meeting where a gentleman from an EMS talked 45 minutes as to why he didn't have time to activate the FRED system to notify hospitals and other entities of emergencies. A debate ensured as to whom would notify the hospitals. This should not be up for discussion. There should be specific direction from the federal level as to how this is to work. I realize that the CDC is not responsible for this aspect of emergency response terrorism however, if no one knows that an emergency occurred or how to deal with the emergency, the rest will not matter.
03/15/2005 00:18 WA 25 C Research needs to be done on areas of vaccine distribution and also control of infectious diseases as a global problem such as the possibility of bird flu passing from human to human and into the US through our airports, etc.
03/13/2005 17:18 OH 21 C Mollie, this is a test to see if I can submit comments anonymously without registering. I want to tell Public Meeting participants to submit extra comments at this website after the meeting if they like. Please confirm you got this message. Thanks. Robin
03/11/2005 07:02 GA 18 C Transparency of resource allocation with goals
03/04/2005 08:23 DC 10 C 1. Develop research agenda around emergency preparedness for people with disabilities. Looking to learn more about best practices, program evaluation and outcomes.
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Date Time Type ID Group Comment
04/19/2005 18:17 DC 466 E 1. Prioritize research on the relative role and effectiveness of respiratory protection and need for fit-testing in the control of transmission of various infectious agents, including Mycobacterium tuberculosis. 2. Outcome research (transmission studies) to define the relative importance of the hierarchy of controls in preventing healthcare associated transmission of Mycobacterium tuberculosis and other infectious agents potentially transmitted via the airborne route: administrative, environmental and personal protective equipment. 3. Health outcome and cost-benefit studies on the use of personal protective equipment: types of respiratory protection, frequency and utility of fit-testing. 4. The relative role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission
04/19/2005 17:26 PU 463 E There needs to also be research addressing the impact of government and corporate policies and activities on the various areas addressed here, such as the built environment, the organization of work, environmental risk factors, etc.
04/19/2005 16:59 PU 462 E As a NIOSH epidemiologist and Co-chair of NIOSH's National Occupational Research Agenda's (NORA) Reproductive team, I'm stunned and discouraged to see this list. Perhaps eight of the 21 NORA areas which were considered important by NIOSH over the last ten years are considered. And injury is considered, and considered, and considered! Injury is important, and it's a lot easier for PART purposes to demonstrate impact with fewer injuries, but there are entire occupational areas which have conversely been left behind. There is no mention of chronic conditions including reproductive health. Granted, aspects of reproductive health are covered in health promotion research, but nowhere in that document is any reference made to occupational exposures. These exposures will impact not only the affected workers, but in many cases, their children. As many as 55% of children are born to working mothers, and 65% of working men and women are of reproductive age. Most workers spend roughly a third of their lives at work. There is a good deal of cynicism among many here that any comments forwarded regarding occupational health will be filed in the "circular file". Can you truly afford to do this when ignoring occupational exposures may distort research findings? [comment from Barb Grajewski, NIOSH]
04/19/2005 16:57 PU 461 E Theme ID# E11-E12: I think it would be very helpful to list specific examples of priority risk and protective factors for adolescent injury prevention that would be the focus of future research. For example, current and binge drinking among adolescents is a key risk behavior for unintentional injuries and violence among youth. However, further research is needed to assess the impact of specific intervention strategies (e.g., reducing alcohol marketing to youth) on alcohol consumption and injury outcomes in this population. It would also be very helpful to conduct translation research aimed at assessing effective approaches to helping communities implement effective strategies to prevent youth drinking. In addition, it would be helpful to assess the impact of home policies restricting youth access to alcohol. Theme ID# E13: I would specifically highlight research on how to implement screening and brief intervention for alcohol problems in trauma centers as an important example of Trauma Systems Research.
04/19/2005 16:57 PU 460 E reproductive hazards in the workplace for both men and women like lead, eliminate asbestos exposure both in workplace and built environment mixed exposures, rather than just chemical mixtures. For example, effect of joint or successive exposure to chemicals and radiation, viruses and fibers, etc. Methods developmnent for workplace exposure assessment -- should we be concerned with particle size; mixed exposures; intensity, cumulative, or timing of exposure; fiber size, dimensions, or biopersistence; etc. Develop an overall workplace disease screening/intervention strategy--i.e., develop disease screening protocols for specific agents, guidelines for evaluation of group data, and identify cutpoints that define when workplace intervention is needed to reduce exposure.
04/19/2005 16:13 PU 457 E Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:31 PU 452 E Why is injury prevention research included here and in the Health Promotion Research area? They both deal with prevention. Is the research for environmental and occupational health also prevention research?
04/19/2005 14:33 PU 448 E E15 is very important area of research, and should include work on the biological effects of violence on a developing child (e.g., neural pathway development). E16, occupational injuries, should include as one major category, exposure to secondhand smoke to settle once and for all in the minds of those would have has us believe that there is any uncertainty the negative health effects (especially in hospitality, restaurant and bar workers) of short-term and long-term secondhand smoke exposure at work.
04/19/2005 14:20 PU 446 E E5 – Examples for studying the impact of design on communities should include liquor store density in relation to crime rates and types of crimes (violent vs property). E8 – Examine the reduction of injuries and violence by examining measures to reduce environmental alcohol exposure through zoning laws for liquor store density, banning alcohol at community events, etc. E9 – Research into lowering legal blood alcohol limit in relation to motor-vehicle crashes – use studies from other countries showing the effect of lower limits E10 – In addition to ethnic and racial disparities in violence, also consider the differences in risk behaviors among these groups especially with regards to binge drinking and heavy alcohol consumption. E11 – Risk factors such as binge drinking must be included to develop interventions for unintentional adolescent injuries. Evaluation of current laws and the enforcement of underage drinking laws should be included in this arena. E12-E16 Studying the impact of binge drinking and heavy alcohol use in relation to prevention of injuries in these age groups and categories is important and can better help focus interventions.
04/19/2005 13:27 PU 440 E Research into ways to promote positive human interpersonal interactions through appropriate environmental design.
04/19/2005 12:36 PU 438 E 1) Emerging contaminants such as endocrine disruptors, aquatic toxins, pharmaceuticals should at least be mentioned in the research agenda 2) Starter list is very long and detailed on the injury and violence side, but very short and general on the environmental health side. I would like to see some topics that relate to the practice of environmental health, such as onsite sewage treatment and drinking water quality
04/19/2005 10:59 PU 428 E some priority given to high risk, vunerable populations (children, young girls, pregnant women and the elderly)
04/19/2005 10:29 PU 425 E Suggest inclusion of farm safety issues, particularly in regard to exposure of children and non-English speaking workers to insecticides, herbicides, and fungicides. Suggest effort to make available in Spanish (and in visual graphics) MSDS (Material Safety and Data Sheet) information.
04/19/2005 10:23 PU 423 E Themes E.8 and E.9 are essential to prevention and translated research findings into public health practice. I recommend that the research activities for E.10 also include: Investigate how injury-related health disparities cross-cut disease-related health disparities (e.g., interpersonal violence as barrier to condom use) to develop interventions that can be integrated into other CDC prevention programs.
04/19/2005 02:23 PU 416 E An additional activity to list for E3-- Use the occurrence of disease (eg, cancer) clusters as an opportunity to recruit willing cases for inclusion in etiologic studies. On a related theme, I would ask that CDC partner with NCI and the state cancer registries to develop a complementary strategy for advancing understanding of the etiology of childhood leukemia.
04/18/2005 15:33 PU 410 E Violence prevention seems to take a back seat to imjury. Violence has widespread effects on the health of the community. It also has implication for community preparedness- as in school killings, terrorism from our own citizens, people who are willing to die as they kill others. Please keep violence prevention alive.
04/18/2005 13:47 PU 402 E These research priorities appear to be individual projects, with little cohesiveness and a limited common foundation. Some way to categorize risk areas - work, travel, home, etc. might make this more logical.
04/18/2005 11:15 PU 389 E Given that approximately 17% of children have a developmental disability, it should be seen as a very important priority to determine the causes of disabilities and to invest in the early identificaiton and prevention, whenever possible. It is also important that we understand more about cumulative and combined environmental exposures in relation to genetic and biological predispositions of individuals. Looking for the single exposure that directly causes a disease or disorder is too simplistic.
04/18/2005 10:12 PU 387 E I think research need to be performed on how the environment and the food we eat affects children. There has been a surge in unknown development delays and respiratory issues among our young children within the past 10 years and no one seem to be concerned. I understand their is a higher agenda to make money, therefore the problem is patched up with medicines that really only benefit the drug companies. Are the children really our future? If so. Why don't we get to the root of the problem and fix it.
04/18/2005 08:26 PU 381 E Legionnaires' disease should be included on the list of occupational respiratory diseases
04/18/2005 07:29 PU 377 E Much more work needs to be done on residential construction, space environs, and the quality of the breathing zones during daytime and nighttime activities. When I was at Johns Hopkins working on my doctorate, a professor from China shared with us a study that he did on the impacts of lowering ceiling heights and crowdedness and how the quality of the breathing zone was adversely affected by lowering the polluted air zone so that respiratory illnesses and allergic reactivity increased dramatically. Much more attention needs to be given to the built development areas including dams and reservoirs, highways, airports, mass transportation, and other major construction projects that impact human health in so many ways through vectors, flooding, water quality, injury prevention, etc. Much more can be done to design in safeguards to better protect public health and prevent adverse health outcomes from both natural and human-caused events, including terrorism. CDC does little (minor token work) to work with the other Federal and State agencies to safeguard human health in the long term on projects affecting millions of people. Is it acceptable that we should stand by and watch 60,000 or more die each year in vehicular accidents with half of the deaths attributed to some sort of alchohol involvement. Why is not more being done to prevent fire deaths? Why are we not doing more to prevent obesity and the diseases attributable to overeating? And so on... Bob Kay
04/17/2005 18:16 PU 373 E I suggest a well designed longitudinal study of the association between environment and health outcomes. For example, asthma, autism, brain tumors, etc. seem to be on the increase. We need a study to identif the causes and how we can prevent these conditions and deaths.
04/17/2005 12:20 PU 369 E E1, E4 and E7 would seem to apply equally well to all parts of our environment, including the workplace. If that is the intent, it should be made clearer. If it is not the intent to include the workplace, then they should be modified to clearly include the work environment. E3 specifically mentions "environmental and work settings" which is very clear and appropriate. E2, E5, E6, and E8-E15 can easily be read to include both at work and outside work issues, and that is the appropriate message. If there is any chance others will not realize both are included, then the language should be modified to make it clear. Most of the examples provided in E16-E21 could be included in one of the previous items to make it very clear that work and outside work issues are both of interest and are conceptually integrated in this agenda. However, none of the examples provided in E16-E21 should be lost from the document in such a process.
04/17/2005 11:36 PU 368 E The E9 Research Theme and Description is worded incorrectly, I believe. Insert "and" before "suicidal;" delete the comma after "suicidal" and insert "for" before "care" to avoid saying the theme is the prevention of care for the acutely injured. Alternately, move "care for the acutely injured" before the "prevention of" list.
04/16/2005 22:05 PU 367 E Efforts to identify the factors which contribute to successful trauma systems in terms of secondary injury prevention in the acutely injured patient should be of high priority. Recommendations for trauma system components are largely based upon anecdotal information. Determining the factors which make a true difference should be paramount.
04/15/2005 14:13 PU 361 E The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 13:23 PU 358 E Seems skewed toward injury (10/21 topics)--is that because injuries, and reductions in injuries, are easier to count than diseases? Nothing on the chronic diseases (cancer, cardiovascular disease) that are the two major causes of death in the US, nor on reproductive disorders resulting from occupational exposures Nothing on the role of gene-environment interactions in the development of environmental and occupational disease These two oversights are MAJOR gaps in the plan
04/15/2005 12:28 PU 355 E The Emergency Medicine Network (EMNet, www.emnet-usa.org) at Massachusetts General Hospital strongly supports the CDC’s Theme E 17 (Occupational Respiratory Disease). EMNet has conducted extensive research on emergency department (ED) visits for respiratory illnesses including asthma and COPD. We encourage research aimed at reducing the incidence of respiratory illness, but not just the relatively small subset due to occupational exposures. The CDC research agenda might more directly address the goals in Healthy People 2010: asthma (24-1 to 24-8) and COPD (24-9 to 24-10).
04/15/2005 12:11 PU 353 E E1: The starter list fails to recognize the distinction between indoor environmental hazards and ambient exposures. The relative risks of indoor vs. outdoor exposures need to be examined and resources should be redirected accordingly. Monitoring tools need to be developed to detect health hazards in housing -- and high risk housing units need to be assessed for hazards before health is harmed. E2 The term "susceptible populations" seems to suggest biological vulnerability. The term "at risk populations" recognizes the reality that low-income families are much more likely to suffer adverse health effects from substandard housing and other environmental exposures. E5 The "built environment," while a convenient umbrella term, is overly vague. It tends to put people to sleep and camouflages the signficant health hazards posed by substandard housing. Indoor environmental health hazards related to substandard housing deserve special emphasis and separate consideration. Substandard housing imposes disproportionate risk on low-income families -- and stands as a compelling environmental justice issue. Building DESIGN is only one aspect of the problem; building MAINTENANCE deserves explicit mention. E6 "Health promotion activities" is too vague a category. CDC and other federal agencies agree that lead-based paint and dust hazards in housing are the overwhelming cause of childhood lead exposure. Be more specific about validating tools and strategies for screening high risk housing for hazards (as well as screening children's blood for elevated lead levels), policy interventions to protect children in highest risk housing, confronting the "repeat offender" problem (houses that poison multiple children), and building capacity for lead-safe work practices and clearance testing.
04/15/2005 09:54 PU 352 E built environment and exposures form the past are important
04/15/2005 09:54 PU 351 E built environment and exposures form the past are important
04/15/2005 06:50 PU 344 E I would like to submit a strong recommendation to focus research on the sexual violence on peole with disabilities. The prevention of sexual violence is a critical issue that needs ongoing support and research, because the statistics are staggering. It certainly is a major public health problem, that is silent. The estimated statistics of the victimization of people with disabilities at least double those of their peers without disabilities.
04/14/2005 19:00 PU 342 E These are very important topics, though I am not sure why they are lumped this way. Injury prevention seems to have its own life; in fact, when I have tried to apply for "injury" grants to study occupational injuries, I have been told that only NIOSH funds stuff related to occupation. Will this change?
04/14/2005 15:48 PU 339 E Would like to see emphasis on environmental health disparites and inequity in environmental exposures.
04/14/2005 14:42 PU 338 E E5 - Built Environment and Health This area is not currently given any consideration in our state health department's environmental health group, though these issues may prove to be as important to community and worker health as more traditional environmental and occupational health issues. The potential impacts of the built environment and land use decisions on health endpoints in the general community and on health and productivity endpoints in the workforce merit further investigation and adequate resources to promote such research. By promoting this type of research priority as part of the CDC Research Agenda, state health departments and research institutions will have greater success in encouraging increased emphasis on these issues, in relation to the more traditional environmental and occupational health issues. This also may help generate more funding opportunities in this area of research. It would be advisable to expand this category of research to also include research on the impacts of open or green space on community health endpoints and workplace health and productivity endpoints.
04/14/2005 14:18 PU 337 E Again, this should be further down on the list!
04/14/2005 14:18 PU 336 E With anticipation of an older workforce it is important to explore unique injury risks of the aged, relationships between co-morbidity and recovery from injury, the influence of psychosocial factors on injury and rehabilitation, and susceptability of older workers to various environmental exposures.
04/14/2005 13:57 PU 335 E My comments are directed towards injury research. 1) CDC needs to abandon its tendency to lump age groups into 5-year intervals. More developmentally appropriate intervals that might be considered would be separately categories for <1, 1-2, 3-4, 5-9, 10-12, 13-15, 16-17, 18-21. 2) CDC-funded research on childhood injury needs to go beyond categorization of injuries as intentional or unintentional injury in order to address child abuse issues. Recurrent injuries in abusive families often include a combination of violence and neglect. Moreover, both violence and neglect may lead to fatal injuries or longstanding physical and mental problems in non-fatal injuries. Therefore, classifying injuries as abusive (injuries due to violence and neglect) and non-abusive should be utilized in CDC-sponsored research when approaching child abuse rather than the frequently unrealistic dichotomy between intentional ( or violent) vs. unintentional injuries. 3) CDC needs to promote methodologies that look at families as the unit of interest rather than individuals. This is especially true for children and adolescents less than 16 years old. Otherwise, injury research on children and adolescents loses potentially valuable insights into recurrent injuries among family members (such as the link between child abuse and intimate partner violence and the association of injuries due to violence and those due to lack of caregiver vigilance). Given that the focus of any intervention would inevitably be the family, it makes little sense to focus on the individual. 4) Recognize that automobile safety is the paramount issue for teenagers. This is true not only for teenage drivers but their passengers. (Most fatalities among adolescent passengers occur in cars driven by other teens.) CDC needs to fund studies that explore behavioral and cognitive contributions in adolescent drivers. It will be important to use methods that determine what teen drivers do, not what they say they do. (Don’t waste taxpayer dollars using surveys such as BRFSS or post-crash interviews for adolescent driving research, but fund research that provides objective, realistic data on adolescent driving.)
04/14/2005 13:53 PU 334 E I advocate for research priority for people with disabilities who fall victim to domestic and sexual abuse. Thank you.
04/14/2005 13:13 PU 330 E Should include a focus on environmental justice. Today the biggest environmental risks are often from things like poor quality housing or living on a heavy transportation route, things that are tied to poverty and to minority communities.
04/14/2005 12:36 PU 327 E Please investigate on substance abuse combining with injury prevention since many emergency room visits (70%)- are tied to the use of a mind altering substance.
04/14/2005 12:07 PU 321 E I suggest we do a study of whether there is an spike in injuries or other adverse effects right after the time changes to or from daylight savings time.
04/14/2005 11:04 PU 314 E Regarding E-16 "Occupational Injuries" research priority area: Examples of research activities are provided, but FAIL TO INCLUDE occupational safety and health training as a viable research intervention area. It would be pertinent to mention such training as a viable research area. In my own opinion, training can be sometimes overlooked, so including it here may help to ensure that its importance is maintained. While training, in a more general sense, could be included in the "Cross Cutting Research" in sub-areas X-7(health educ, communicat, marketing), X-10 (translation and dissemination of effective interventions), and X-11 (workforce training and development), NONE of these sub-areas specifically address OCCUPATIONAL SAFETY AND HEALTH TRAINING.
04/14/2005 10:31 PU 308 E Related to community preparedness, there are still high rates of injury among responsders to chemical emergency events (about 3,000 events per year). What are the rates? What are the rates among different groups? What are the predictors of the rates? and what should our recommendations be to reduce those rates?
04/14/2005 09:45 PU 300 E Eye safety in the workplace and in sports, especially for children.
04/13/2005 18:52 PU 293 E The reaction of the general public, medical professionals, and disability-related service providers to information about violence against women with disabilities is often one of shock and disbelief, as if they believe that disability is somehow a protective factor against this epidemic social problem. Advocates and researchers in the field of disability, on the other hand, are bringing to light case studies and statistics that point to disability as a risk factor for intimate partner violence (IPV) and sexual assault. Research out of Baylor College of Medicine's Center for Research on Women with Disabilities in Houston and other institutions indicate that intimate partners are the most likely perpetrators against women with physical disabilities. There is general agreement that disability introduces additional vulnerability for violence into women's lives. Yet the CDC center on injury prevention research has not identified this population as a priority. With the exception of the Office on Disability & Health, little to no attention has been paid to violence against people with disabilities.
04/13/2005 17:56 PU 292 E I recommend that CDC seriously consider including a focus on primary prevention of abuse against individuals with disabilities. The limited available research documents that individuals with disabilities (especially those with cognitive or other developmental disabilities) face a high risk of abuse. There are few victim assistance programs in the country that are addressing the problem of violence against persons with disabilities; however, interest by disability advocacy, domestic violence, and sexual assault programs in this area is increasing. In 2003, SafePlace in Austin, Texas, conducted a national survey on accessibility of domestic and sexual violence programs. The results indicated that few people with cognitive, physical, sensory or other developmental disabilities are accessing violence intervention services. Relatively little research has been conducted in the US on the issue on violence against persons with a wide range of disabilities or the efficacy of primary prevention efforts for this population. Most of the research on this topic is from Canada. If I can be a resource in any way to CDC on this topic, please feel free to contact me, Wendie Abramson Director of Disability Services SafePlace P. O. Box 19454 Austin, Texas 78760 (512) 356-1599 wabramson@austin-safeplace.org
04/13/2005 16:37 PU 291 E Risk and Protective Factors for Children with Developmental Disabilities. For children with developmental disabilities, identify the risk and protective factors and effective interventions associated with the leading cause of child maltreatment/abuse/victimizations. 1) Identify pathways to violence and identify risk factors associated with such behavior 2) Identify protective factors believed to buffer risk, such as fully integration in schools and community (not isolated) and education about abuse and how to stay safe.
04/13/2005 16:22 PU 289 E Is there any intention of looking at the Innovative pilot projects that EPA/OSWER is or has developed in this area and community preparedness?
04/13/2005 16:06 PU 288 E The Environmental Research Themes are all focused on exposure metrics; however, there are many health outcomes with possible environmental etiologies. Special emphasis should be placed on obtaining nationally representative prevalence or incidence of these diseases (e.g. neurologic, reproductive, environmental disruption, respiratory). The Injury Research Themes are overrepresented, repetitive, and not efficiently identified. E11, E12, E14, E15 could all be combined into one theme about injury prevention for communities, families, parents, children, and adolescents. Comes across as self-serving and protective of CIO research agendas within NCIPC divisions. This is not the purpose of the CDC Health Protection Research Guide, 2006-2015. I would leave this type of theme development at the CIO level. The Occupational Research Themes likewise could be collapsed. E16 and E18 both address interventions for occupational and musculoskeletal injuries and can be combined.
04/13/2005 15:49 PU 286 E Another inclusion, which may be considered, in research priorities in the Environmental Health Intervention section is the standardization of health indicators in environmental justice areas. I propose the following to be studied for inclusion as a standard: Rates of Age adjusted non-cancer mortality rate-rate per 100,000; Age adjusted cancer mortality rate-rate per 100,000; Infant mortality rate-rate per 100,000; Low birth weight-rate per 100,000; Mortality rate per 100,00 of disease of contamination and disease incidence rate per 100,000 per year, (Prevalence rate may be calculated for years of contamination).
04/13/2005 07:49 PU 266 E Research Priority Areas: National Vision Program/ CDC/ Division of Diabetes Translation CDC/DDT/NVP E 1 Environmental Risk Factors • Increase the understanding of the interaction between health and the environment. 1. CDC/ NVP may examine the role that chronic lead exposure has on the development of cataracts and age-related macular degeneration. 2. CDC/ NVP may look at other chronic environmental exposures, multiple stressors and their possible relationship to the maintenance of ocular health. E 7 Environmental Data and Information Systems • Develop methods and tools to link available environmental hazards and health outcome databases. 1. CDC/DDT/NVP plans to use epidemiologic, statistical and programmatic methods and tools to link available information across databases and data sources involving lead exposure and the presence of cataracts and or age-related macular degeneration. E 11 Risk and Protective Factors of Adolescent Unintentional Injury • For adolescents, identify the risk and protective factors and effective interventions associated with the leading causes of non-fatal injuries. 1. CDC/DDT/NVP will be working toward identifying and reducing risk taking behaviors related to eye injuries and youth. 2. CDC/DDT/NVP efforts targeted at HP 2010 focus area 28.8 and 28.9. E 16 Occupational Injuries • Identify the multiple factors and risks that contribute to occupational injuries and develop and evaluate effective interventions for reducing such injuries. 1. CDC/DDT/NVP will be working toward identifying and reducing risk taking behaviors related to occupational eye injuries.
04/12/2005 14:51 PU 264 E • Environment and Occupational Health and Injury Prevention: Consider the role of saliva-based diagnostics under E3 and E6 and the role of the dental staff in detecting and reporting domestic violence. Consider expanding environmental toxin exposure detection through salivary diagnostics and oral lesions.
04/12/2005 11:56 PU 263 E The group should be commended for its work putting these together. The Injury Research Center at the Medical College of Wisconsin believes that the workgroup has touched on many of the broad issues in the field of injury control and prevention research. One recommendation to strengthen the list is to consider broadening Theme #E11 to identify the risk and protective factors of unintentional injury across the age span. There are many unknown factors that cause injury to be the leading cause of death for people 1-44 years old. While this includes adolescents, it also includes children and adults, and these risk factors are very different than for adolescents. Also injuries are a primary cause of illness and death for the elderly as well, with injuries falls, motor vehicle crashes, and suicide being the leading cause of injury death in people over 65 years. With regard to Theme #13, consider adding a possible research strategy to identify and evaluate components of post-hospital care that contribute to improvements in outcomes for the injures. Additionally, consider adding an activity to "develop and evaluation acute injury treatment strategies for management of injury" (from draft Acute Care Injury Reserach Agenda). The addition of this activity helps strengthen the Theme by both looking at the components of the trauma system but also identifying evidence-based treatment strategies that health care professional utilize to maximize outcomes. Thank you for the opportunity to comment. --- Injury Research Center at Medical College of Wisconsin.
04/12/2005 10:36 OH 262 E As a participant in the EOHIP Research group, with a special interest in Environmental aspects, I was disappointed by the focus of the breakout group, which was heavily weighted towards Occupational Health and Injury Prevention issues. This in no way reflects on CDC but rather on the make-up of this all-volunteer group, which had only 2 or 3 Environmental proponents. What was particularly disturbing was the attitude of the other participants, who felt that there was no longer any need to conduct research, as the main problem nowadays was rather to get existing information about environmental health out to the local communities. As a researcher in the environmental area, with a special interest in Human Exposure Assessment issues, I have worked and continue to work with NCEH/DLS researchers on a variety of problems in this field. I feel it is particularly important, therefore, to emphasize that research work at CDC in environmental health, including human exposure, should continue and, if anything, should increase. The documents that resulted from the efforts of the EOHIP group in Columbus on March 31 did not reflect this concern or interest. Sydney M. Gordon, D.Sc. Research Leader Battelle Memorial Institute
04/12/2005 10:30 PU 261 E In this area, critical attention must also be given to the effects public policies , industry influence, and conflicts of interest have in shaping the built environment (both at workplace and community level that in turn lead to increased occupational exposures, injuries, and adverse health outcomes.
04/11/2005 22:17 PU 260 E The starter list is fine, though priorities within can be esatblished. I would say that biomonitoring, chemical mixtiures are important areas for epidemiologic research in workplace and communities. An explicit emphasis on imrpoving biomarkers of exposure, response (early), and susceptibility should be explored. It is important to note that this effort can dovetail with bio- and chem terrorism prevention work.
04/11/2005 16:45 PU 259 E There is an urgent need for research into the impact of smokefree workplace policies on employee secondhand smoke exposure, employee health, employer cost savings (in terms of both health care costs and productivity), and sales, revenue, and employment (for hospitality workplaces such as restaurants, bars, and casinos). An unprecedented number of U.S. communities and states, as well as a number of foreign countries, are enacting smokefree workplace laws, and many employers are adopting voluntary smokefree workplace policies. While a strong evidence base exists that these policies reduce employee secondhand smoke exposure, improve employee health, and have a neutral or positive impact on hospitality revenues, sales, and employment, the development of standardized, simple protocols and the provision of technical assistance are needed to help practitioners implement such studies at the local and state levels, since policymakers frequently ask for local data. There is also a need for more specialized studies looking at specific topics such as the impact of smokefree workplace policies on employer cost savings, the impact of these policies on rates of hospital heart attack admissions, and the economic impact of these policies on gaming venues.
04/11/2005 14:06 PU 257 E There should be an additional theme in the Enviornmental and Occupational Health and Injury Prevention List of Research Priorities. Research Theme Title and Description: Water and Health Develop and evaluate health promotion interventions to reduce waterborne disease in the United States and in other developed countries. Examples of Research Activities: Increase detection and reporting of water-related outbreaks, sporatic health and contamination events, and identify emerging contaminants by defining clinical diagnostic needs and increasing clinical diagnostic capacity for waterborne diseases. Improve water-related outbreak and sporadic health and contamination event investigations by defining environmental risk factors and antecedents for water-related and contamination events, defining essential needs, competencies, and standards of water and waste-water environmental health programs. Decrease the number of water-related outbreaks and sporadic health and contamination events by developing a systematic approach for reducing prevalence of key water-related health and contamination risk factors and antecedents and be developing appropriate public health work force, general public, and environmental interventions. Assess the magnitude and burden of acute and chronic health effects, and risk of illness associated with exposure to water-associated contaminants or treatment by-products by establish and fund CDC WaterNet (similar to and compatible with FoodNet) to answer water-specific surveillance, epidemiologic, behavioral, and environmental health research questions and identifying emerging public health issues. Assess the magnitude and buden of acute and chronic health effects, and risk of illness and decreased water quality associated with use and re-use of human and animal wastewater, stormwater, and septage by developing and improving affordable and rapid dsmpling and diagnostic tests to detect, differentiate, quantify, or measure exposures. Assess the impact of water intervention projects on public health. Create a national clearinghouse for educational information on water-related health effects, exposures, and prevention.
04/11/2005 12:01 DC 256 E These categories should not be combined. It dilutes attention from work-related injuries and illnesses with attention to non-work related injuries.
04/11/2005 10:15 PU 253 E Janet Saul jsaul@cdc.gov and her colleagues at USC have twice convened leaders from the fields of child maltreatment and youth violence to share lessons learned and experiences. While the meetings were oriented around a dissemination framework that is being developed, much of the discussion would help inform the creation of a national research agenda. I would recommend your getting input from her team (in the event this step has not already occurred).
04/11/2005 09:59 OH 251 E see general discussion comment below
04/11/2005 09:23 PU 240 E Please consider research that doesn't separate work-related exposure/illness from community environmental exposure/illness. Often, community members are exposed to the same contaminants as workers in a nearby industry. It would be nice to study them together!!
04/08/2005 16:45 PU 236 E G16 - SAFE WATER is more appropriately placed in environmental health. Also, on the water issue I have the following recommendation: Research Theme & Title Description WATER and HEALTH Develop and evaluate strategies to translate, disseminate and sustain science-based best-practices for improving drinking water, treatment of waste water and monitoring recreational waters Examples of Research Activities o Improve water-related health and contamination event detection. o Improve water-related health and contamination event investigations o Assess the magnitude, burden, acute and chronic health effects, and risk of illness associated with use of water-associated contaminants or treatment by-products o Assess the magnitude, burden, acute and chronic health effects, and risk of illness and decreased water quality associated with use and re-use of human and animal wastewater, septage, and biosolids o Develop and improve affordable and rapid sampling and diagnostic tests to detect or quantify known and emerging waterborne contaminants or exposure to these contaminants o Assess the impact of water intervention projects (e.g., fluoridation, Legionella and monochloramine use) in community settings
04/08/2005 08:45 PU 232 E The title of this category doesn't seem to fully incorporate all the sub-sections included. For example, I would not think that family violence would fit under this category, although the description seems to suggest it would and there is no other category it would seem to fit into better. Perhaps "environmental and occupational health" and "injury and prevention research" should be different categories? Or change the title to "environmental, familial and occupational health"? Something more inclusive...
04/08/2005 08:41 PU 231 E The area of biomonitoring is understated. Ask the public and they will tell you, test the people.
04/08/2005 07:39 PU 230 E Theme E1: Focus on the impact of Secondhand Smoke in Outdoor Public Environments. Impact of exposure in a variety of venues, RR, employee (such as restayrant patio), SHS exposure related disease rates in states with significantly restrictive policies versus those with pre-emption and those without formal policy.Adoption of SHS policy is perhaps the single most significant method to reduce SHS exposure, spur cessation and prevent initiation among ALL populations. States like California have proved this. It must be supported with irrefutable research from CDC.
04/07/2005 19:03 PU 227 E Injury Prevention Research is buried in this genreral category. Since injury and violence continue to be the leading causes of death and disability among the population less than 25, a separater category is warranted. In addition to evaluation of exisitng prevention efforts, there should be some emphasis on policy changes and the effects of these policy changes on the magnitude and outcome of injury prevention strategies. We continue to talk about prevention, but there has been little focus on the ways in whiich young men are raised, and differences in expectations of young boys vs. young girls. The also needs to be a foucs on community norms and community level change to impact the levels of both intentional and unintentional injuriy.
04/07/2005 16:11 PU 225 E Please consider second hand exposure to tobacco smoke in workplaces...
04/07/2005 15:59 PU 224 E E.12 - Include identification of pathways that address differences in self-esteem levels and exposure to comprehensive education
04/07/2005 13:47 PU 217 E Motor vehicle and pedestrian injuries
04/07/2005 11:47 PU 215 E Develop a Heavy Metals Research group. This will be a niche for CDC/ATSDR as we do not currently have such a group.There are a lot of hazardous waste sites that deal with heavy metals especially lead. For example: At ATSDR/DHS- we currently are working on hazardous waste sites in Ohio, Omaha, Idaho, and India dealing with following heavy metals -Beryllium, Arsenic, Manganese, lead, and cadmium.
04/07/2005 10:05 PU 208 E E20 - Organization of Work Good public health starts at home, i.e., here, at CDC. The federal government has mandated teleworking for federal employees via the telework law sponsored by Rep. Frank Wolf of Virginia. This law is followed only sporadically here at CDC. It appears that this law is not followed by many middle managers and that senior management is allowing this to happen. I have even heard a rumor that middle managers have ASKED senior managers to downplay the telwork law. Surely this can't be true--that CDC management would conspire to ignore federal law. The benefits of telework are numerous and are detailed on the federal telework website (www.telework.gov). Some CDC groups have telework. Other groups that perform similar tasks don't--and it seems to be up to the whim of individual managers, and that is FRUSTRATING to those who are repeatedly denied the opportunity to telework.
04/07/2005 09:57 PU 206 E I strongly recommend that injury prevention be separated from environmental and occupational health, as they are often quite distinct. Injury includes intential and non-intentional injuries, and occurs outside of a workplace far more frequently than at work. I also think it would be helpful for intential injuries to be labelled as "violence," and for all violence prevention and intervention (from child abuse to terrorism) to be looked at together. There are many overarching themes that connect various areas of violence that we can learn from. I am also very concerned that the current focus on international terrorism distracts us from the tremendous problem of domestically-generated violence (child abuse, teen violence, intimate partner violence, elder abuse, sexual assault, gun violence) faced by Americans.
04/07/2005 09:40 PU 204 E I see very little that addresses research of injuries in the home environment or while participating in leisure activities. The CDC NCIPC Research agenda identifies a need to study the epidedmiology, other biomedical sciences, biomechanics and other engineering sciences, social sciences and economics in seven key areas. It doesn't seem that the proposed CDC research agenda incorporates all seven areas and essentially leaves out "preventing injuries at home and in the community" and "preventing sports, recreation and exercise (SRE)" injuries.
04/07/2005 09:19 PU 201 E Since Lott and Mustard's concealed carry laws have been largely dismissed as biased, we need to revisit gun violence as an increase in should be predictable. We should assess impact of Mercury exposure downwind of bleach and coal fired plants, as well as the employees at such plants.
04/07/2005 08:14 PU 194 E Suggest adding another research theme focused on the adverse health effects of exposure to asbestos: Design, implement, and evaluate environmental health interventions and health promotion activities that address asbestos exposure
04/07/2005 08:05 PU 193 E I fully support a special emphasis on Adolescents in the CDC Injury Research Objectives, as stated. Over 75% of adolescent deaths are related to injuries, and adolescent injury deaths are the primary source of DALY lost. MV injuries in particular are the leading cause of death in teens-- two out of five deaths among U.S. teens are the result of a motor vehicle crash. Getting behind the wheel or riding with a newly-licensed friend are everyday occurrences for teenagers, yet these acts pose some of the greatest health risks that many teens will face in their lifetime. Add to this, an annual estimated economic cost of $40.8 billion. Teenage drivers are also responsible for the deaths and injuries of their passengers, occupants of other vehicles, and non-occupants such as pedestrians or bicyclists. Nearly 60% of the people killed in crashes involving young drivers are not the young drivers themselves. Many of the passengers involved in crashes with young drivers are also teens. Researchers have identified important risk factors for inexperienced teen drivers including nighttime driving, carrying teenage passengers, lack of use of seat belts, and alcohol use. Little is known, however, about the social or behavioral processes and settings that influence how inexperienced teens learn to drive, particularly those factors and interactions that foster safe driving practices within this population. Such research is needed to guide the development of interventions that parents, adolescent peers, educators, health care providers, and others could use to promote safe driving among teenagers. Ruth Shults, PhD, MPH Captain, U. S. Public Health Service Injury Center Centers for Disease Control and Prevention (CDC) 4770 Buford Highway, NE, Mailstop K-63 Atlanta, GA 30341 USA phone: 770 488-4638 email rshults@cdc.gov
04/07/2005 07:53 PU 192 E I'm particuarly glad to see E-5 on the list.
04/07/2005 06:45 PU 190 E Especially exposure to toxic substances and health effects on health within and outside the workplace should be considered an important agenda item. A number of situations have occurred already that resulted in specific CDC intervention in addition to the NHANES studies.
04/06/2005 15:23 OH 183 E CDC Research Agenda Development Public Participation Meeting Thursday, March 31, 2005 Hyatt Regency Columbus Columbus, Ohio Additions to CDC’ starter list of research priorities for Environmental and Occupational Health and Injury Prevention Research: Research Theme: Child Abuse and Neglect Prevention Research  Best practices and clarification around what works. What’s out there in terms of prevention programming? Is it effective? What are the costs and benefits in prevention programs? What prevention programs exist beyond home visiting?  Cost-Benefit Research on prevention programs to show funders and legislators why programs are doing what they do.  Ideas for having a common set of data items that similar prevention programs like home visiting programs for example, all collect to facilitate comparability of findings.  Invest in research-practice collaborations---bring together researchers and practitioners to discuss challenges and findings from our work in better understanding child maltreatment and prevention.  Better ways to measure what we do---we need more practice-based evidence in addition to evidence-based practice i.e., we need to hear from practitioners what is working and why they think programs are effective. Practitioners need to be engaged in demonstration of why programs work.  Ways for agencies doing prevention work (and who have varying degrees of sophistication and resources) can evaluate their work in a meaningful way.  Research on the application of a Life Course Health Development (LCHD) framework to healthcare delivery. The LCHD model suggests a person’s health development takes on a trajectory that results from the cumulative influences of multiple risk and protective factors as well as specific influences that are programmed into that individual’s regulatory system during critical periods in development. How can factors such as social environment and family interactions operating “outside” of the body have an effect on the biological and physiological system “inside” the body? What are the long-term effects of psychosocial factors on the biological and physiological system?  Research on marketing and educational campaigns---what is and isn’t working?  Research on the overlap between domestic violence, mental illness, substance abuse, and child abuse and neglect.  Research on how program implementation affects child health outcomes.  Research on reframing child abuse and neglect and research on the implementation of reframed messaging of child abuse and neglect.  Have a web-accessible repository of prevention programs, innovations, strategies, practices.  Research on State-National Organizations with a credentialing or chartering process (e.g., Prevent Child Abuse America Chapters) and impact on reducing child abuse and neglect: _ Cost-effectiveness of credentialing/chartering _ Research on fundraising---what is effective and most efficient _ Is computerized/electronic types of data gathering more effective/helpful to prevention?  For example, what is key to helping Prevent Child Abuse America chapters with the above would be an opportunity to acquire unrestricted funding i.e., “seed money” into our Research Center to do this type of basic evaluation consultation. Submitted by: Domarina Oshana, PhD Director National Center on Child Abuse Prevention Research Prevent Child Abuse America 200 S. Michigan Avenue, 17th Floor Chicago, IL 60604-2404 Tel. 312.663.3520, ext. 805 DID: 312.334.6805 Fax 312.939.8962 doshana@preventchildabuse.org http://www.preventchildabuse.org
04/06/2005 13:57 PU 182 E I suggest partnering with the Department of Defense regarding acoustic trauma and noise-induced hearing loss (NIHL). Many citizen soldiers (Reserve and National Guard) are returning from military deployment to their more traditional workplace with significant hearing loss due to either acoustic trauma or NIHL. Prevention, treatment and rehabilitation programs must be improved.
04/06/2005 11:10 PU 181 E ENVIRONMENTAL AND OCCUPATIONAL HEALTH AND INJURY PREVENTION RESEARCH: CHILD ABUSE AND NEGLECT IN AMERICAN INDIAN/ALASKAN NATIVE COMMUNITIES (BRIEFING PAPER) Issue Child abuse and neglect have serious health implications for American Indian and Alaskan Native (AI/AN) children, families and communities. These communities encounter child abuse and neglect in rates that are higher than children from other racial groups. There is much evidence that the environment in which Ai/AN children live has much to do with these higher than average rates. The National Indian Child Welfare Association (NICWA) has for several years investigated and publicized environmental interventions that can reduce the incidence of abuse and neglect in Indian Country. This area of prevention should be included in the CDC Starter List of Research Priorities. Background The available national data on child abuse and neglect affecting AI/AN children comes primarily from state agencies, although tribes and other federal agencies, such as the Indian Health Service and the Bureau of Indian Affairs, also collect data. Data from state agencies, which are involved in about 61% of child abuse cases (Earle, 2000), found in the National Child Abuse and Neglect Data System show that AI/AN children are abused at rates that are higher than the national average for all other children. These rates are estimated, given the lack of data, to be even higher than those reported (Fox, 2003). Tribal data would only be available by surveying individual tribes, which has not been done at this time. Definitions of abuse and neglect are diverse and include such categories as physical or sexual abuse and physical, emotional, medical, educational or institutional neglect. Definitions shape how we perceive abuse and neglect and how we respond. States and tribes have the authority to create their own definitions, which may be similar or vary significantly. Historically, mainstream definitions or interpretations of child abuse and neglect among AI/AN children have often led to inappropriate removals of these children from their families based upon cultural perceptions that were biased or false. In some cases, protective factors for preventing abuse among AI/AN children have been interpreted by public agencies as deficits that created risk for child abuse and neglect. As an example, the role that extended family play in helping care for and protect AI/AN children from abuse and neglect has been interpreted by some public child welfare workers as neglect or abandonment when the children were not living in the home of their biological parents. These types of practices were widespread and well documented in the 1960’s and 70’s by the Association on American Indian Affairs. They became the catalyst for enactment of federal legislation that would define procedures and requirements for the removal of AI/AN children by private and public child welfare agencies (U.S. House Report, 1978). The legislation, the Indian Child Welfare Act (P.L. 95-608), also led the way to further involvement of tribes in child custody proceedings involving their children to help state courts and public and private agencies make better child welfare decisions. Natural systems that originate from tribal cultural beliefs and practices that helped protect AI/AN have been marginalized or disrupted in AI/AN communities. Examples of these include the forced removal of children and placement in assimilationist boarding schools in the 19th and 20th century, the adoption of hundreds of Ai/AN children to non-Indian families in the 1950’s and 60’s through the Indian Adoption Project and the prohibition on the practice of tribal religions by the federal government on many reservations during the 19th and 20th century (George, 1997; Cross, 1986; Hull, 1982). As we look at how child abuse and neglect affects AI/AN children, families and tribal communities it is important that the cultural context is well understood and how that impacts perceptions and responses to child abuse and neglect both in and outside of tribal communities. Other factors that play a role in the risk for child abuse and neglect in AI/AN communities include poverty, rates of alcohol and substance abuse, single-parent households, children who lack prenatal care, children with disabilities, and children of teen parents. AI/AN communities have some of the highest poverty rates of any racial group in the United States. The census data make it clear that, despite increased tribal income from the 1990 to the 2000 census, “On average, Indians on both gaming and non-gaming reservations have a long way to go with respect to addressing the accumulation of long-enduring socioeconomic deficits in Indian Country. Across many indictors – even those displaying remarkable improvement – the gap remained large in the 2000 census: Real per capita income of Indians living in Indian Country was less than half the U.S. level; real median household income of Indian families was little more than half the U.S. level; Indian unemployment was more than twice the U.S. rate; Indian family poverty was three times the U.S. rate; the share of Indian homes lacking complete plumbing was substantially higher than the U.S. overall level; and the proportion of Indian adults who were college graduates was half the proportion for the U.S. as a whole” (Taylor & Kalt, 2005, p. xii). The authors also caution that the gains made in the past decade could easily be eroded if the policies of self-determination are not protected. While poverty alone is not an indicator of risk for abuse it does present additional stressors for families that are living below the poverty level. While AI/AN people as a group have some of the highest sobriety rates, alcohol and substance abuse is still prevalent in many communities and contributes to the risk for child abuse and neglect. In a recent study a third to almost half of AI/AN children in 13 states lived in female-headed households where the single caregiver was without stable employment (Willeto, 2002). The rates of inadequate prenatal care for American Indian and Alaska Native mothers in 1989-1991 was almost twice the rate of Whites with 18.1% of rural pregnancies and 14.4% of urban pregnancies for American Indians and Alaska Natives occurring without an adequate pattern of prenatal care (Baldwin, Grossman, Casey, Hollow, Sugarman, Freeman & Hart, 2002). AI/AN populations have a teen birth rate of 41.4 births per 1,000 females, compared to 29 births per 1,000 females for all population groups (Willeto, 2002). The presence of these risk factors and the rates at which they occur indicate that many AI/AAN communities will have high risk levels for child abuse and neglect. Prevention: Protective Factors Yet there are beginning indicators of factors that protect children from abuse. In tribal communities these include activities, values and attitudes that were developed decades or even centuries before contact with the western world. They work to prevent or ameliorate the effects of abuse despite many of the negative factors such as alcoholism, poverty, single parenthood and teen pregnancy cited above. Some of these protective factors appear, for example, in a list of strengths developed by NICWA and five tribal communities for a pilot abuse/neglect reporting system. They include: extended family support; community support and involvement; access to resources and tribal community programs; adequate medical services; adequate transportation; ability to economically support; subsistence planning and preparation; religious/spiritual practices; positive self esteem; positive motivation; alcohol and drug free; good health practices; good hygiene/appearance; positive elder access; problem solving and decision making skills; parenting skills. These are, in many cases, attributes which can be learned or resources that can be provided. What works in Indian Country is directly related to how well tribes can combine their proven cultural approaches to child abuse and neglect with more modern technology and resources. NICWA has also, over the past several years, provided training in Positive Indian Parenting (PIP) to tribal communities. With a primary emphasis on strengths rather than problems, NICWA is working to identify the interaction of prevention factors with the incidence of abuse and neglect in tribal communities. Summary The available data indicate that child abuse and neglect are serious problems in Indian Country that threaten child, family and community functioning. The health threats are both immediate and long term. Tribal governments have the authority and responsibility to address this serious health issue, and there are beginning indicators of elements of prevention that may be used in these efforts. There is much talk and publicity regarding “Evidence Based Practice” (EBP). The elements of EBP, however, appear to best serve mainstream rather than tribal communities. Indian Country and NICWA have begun to respond by delineating what works best for our population. This is a nascent effort, and needs the support and encouragement provided by federal priorities and funding opportunities to be thoroughly investigated. Greater attention to these efforts and commitment to supporting them will help tribal programs revitalize the protective factors and helping systems that have been proven over time. References Baldwin L. M., Grossman D. C., Casey S., Hollow W., Sugarman J. R., Freeman W. L., & Hart L. G. (2002). Perinatal and infant health among rural and urban American Indians/Alaska Natives. American Journal of Public Health, 92(9) 1491-7. Bohn, D. K. (2003). Lifetime physical and sexual abuse, substance abuse, depression, and suicide attempts among Native American women. Issues in Mental Health Nursing, 24(3), 333-352. Child Welfare League of American (CWLA). (1999). Child Abuse and Neglect: A Look at the States. 1999 CWLA Stat Book. Washington D.C.: CWLA Press. Cornell, S. & Kalt, J.P., (1998). Sovereignty and Nation-Building: The Development Challenge in Indian Country Today American Indian Culture and Research Journal 22, no. 4.November 1998. Cross, T. L. (1986). Drawing on cultural tradition in Indian Child Welfare practice. Social Casework, 67, 283-289. Dexheimer P. M., Resnick, M. D, & Blum, R. W., (1997). Protecting against hopelessness and suicidality in sexually abused American Indian adolescents. Journal of Adolescent Health, 21(6), 400-406. Earle, K.A. (2000) Child Abuse and Neglect: An Examination of American Indian Data. Seattle, WA: Casey Family Programs. Fox, K.A. (2003). Collecting data on the abuse and neglect of American Indian children. Child Welfare, 82, 707-726 George, L. J. (1997). Why the need for the Indian Child Welfare Act? Journal of Multicultural Social Work, 5(3/4), 165-175. Hull, Jr. G. H. (1982). Child welfare services to Native Americans. Social Casework, 63, 340-347. Indian Health Services, Department of Health and Human Services (1997). Trends in Indian Health. Author. Kendall-Tacket, K. (2002). The health effects of child abuse: Four pathways by which abuse can influence health. Child Abuse and Neglect, 26, 715-729. Nelson, K. E., Saunders, E. J., & Landsman, M. J. (1993). Chronic child neglect in perspective. Social Work, 38(6), 661-671. Red Horse, J.G., Martinez, C., & Day, P. (2001). Family preservation: A case study of Indian tribal policy. Seattle, WA: Casey Family Programs. Stevenson, J. (1999). The treatment of the long-term sequelae of child abuse. Journal of Child Psychology and Psychiatry, 40(1), 89-111. Taylor, J. B., & Kalt, J. P. (2005). American Indians on reservations: A databook of socioeconomic change between the 1990 and 2000 Censuses. Retrieved January 19, 2005, from Harvard University, Harvard Project on American Indian Economic Development Website: www.ksg.harvard.edu/hpaied/documents/AmericanIndiansonReservationsADatabookofsocioeconomicchange.pdf U.S. Department of Health and Human Services, Administration on Children and Families (2003). Child Maltreatment 2001. Washington DC: US Government Printing Office. United States Department of Health and Human Services, Administration on Children, Youth, and families (2004). Child Maltreatment 2002: Reports from the States to the National Child Abuse and Neglect Data Systems. Washington, DC: US Government Printing Office. U.S. House Report. (1978). No. 1386., 95th Congress, 2nd Session. Establishing standards for the placement of Indian children in foster care or adoptive homes, to prevent the breaku0p of Indian families, July 24, 1978. Washington, D.C.: United States Government Printing Office. Willeto, A. A. A. (2002). Native American Kids 2002: Indian children's well-being indicators data book for 13 states. Report available from Casey Family Programs, 1300 Dexter Avenue North, Seattle, 98109, or from the National Indian Child Welfare Association.
04/06/2005 09:44 PU 180 E In rural and agricultural areas, children are at high risk of unique disease/injury conditions. Research is needed to understand barriers to protective environments for children; and research is warranted to test interventions that would separate children from environmental/occupational exposures (e.g. what incentives will prompt parents to put children into child care programs versus be present in barn while adults are working?). Research is needed to identify policy options for improving safety practices among agricultural workers (e.g. what government or insurance policies might effectively impact safety practices in agriculture?)
04/06/2005 08:33 PU 177 E Motor vehicles are the number one cause of trauma deaths world wide, surpassing the toll taken by the casualties of war. Pedestrian injuries are particularly pernicious, disproportionately affecting the youngest and oldest members of our communities. Research is needed to establish evidence-based interventions to guide local efforts to prevent and control these injuries. Thanks for the opportunity to comment. C. DiMaggio
04/05/2005 23:13 PU 175 E important to determine body burden of chemicals and and toxic elements
04/05/2005 15:05 PU 170 E the CDC has establisheds a strong program of research on child maltreatment that is advancing the field in several highly problematic areas. I would strongly urge the CDC to expand this area of research and continue to provide leadership to the field.
04/05/2005 14:44 PU 168 E Currently, there is little information about safe dermal exposure levels to potentially harmful chemicals that exist as particles or aerosols. This information should be developed to permit assessment of health risk, and the need for engineering controls or PPE.
04/05/2005 13:14 PU 161 E Include Trauma Centers in your funding priorties. They will be responding to all terrorist and environmental challenges and the resources for Trauma Centers currently is overtaxed and needs support.
04/05/2005 12:38 PU 160 E I would like to see funding to evaluation the efficacy of specific injury prevention program (s). There are many "Canned" programs available but very few have been proven by evidence based research.
04/05/2005 07:26 PU 158 E Priorities within content areas would do well to be data driven The disparities priorities should include individuals with disabilities The work already done here is very good
04/04/2005 13:30 PU 156 E Conflicts with other federal agencies (e.g., OSHA). Would siphon monies and interest from other areas.
04/04/2005 12:20 PU 154 E Research the attitudinal, knowledge, and behavior change before and after presenting the ThinkFirst educational program-- presented by injury prevention specialists and people who have had brain and spinal cord injury-- through the National Injury Prevention Foundation, or one or more of their state chapters, such as our IL chapter at Central DuPage Hospital. For more info-- debby_gerhardstein@cdh.org
04/04/2005 11:34 PU 151 E Since injuries are the leading cause of years of potential life lost, the leading cause of death for ages 1-44, a leading cuase of hospitalization, and a leading cause of emergency department visits, more money and time should be spent in this priority area.
04/04/2005 11:19 PU 150 E An important area is the prevention of occupational fatal and non-fatal injuries and musculoskeletal diseorders, and promotion of health in commercial transportation workers, especially truck drivers. The public is also affected, especially through involvement in fatal crashes involving large trucks.
04/04/2005 11:17 PU 149 E If this is the only place for research on injury and violence prevention - there is not sufficient focus on this major social problem. A focus on both community and family - level violence is of such huge importance in terms of the health and mental health toll it takes, that only cursory attention to it is problematic.
04/04/2005 11:12 PU 148 E This category needs to differentiate between intentional and unintentioal violence/injury, and needs special attention paid to gender-based violence in ALL forms and contexts.
04/03/2005 21:43 PU 144 E E1-2 and E21. please add Meth labs to these to areas for investigation. E7-12. please make sure alcohol and other drugs (AOD)are included in these areas. alcohol is a major contributing factor to all the major causes of death and injury in teens. more study needs to be done on risk and protective factors to AOD use by children and the role all sectors of the community can play in building up protective factors. all programs or policies studied should have cost /benefit data available to help communities decide on what programs are best for them. E13. test brief interventions in these settings for AOD use and the reductions in other medical usage the interventions cause. E14 - explore the connection between parenting styles and AOD use by children. E15 - is alcohol a common thread in all these types of violence? E16 - do occupational injuries happen more frequently to moderate or heavy drinkers/ drug users? what impact does the misuse of perscription drugs have on injuries? alcoholism is a pediatric disease with life time consequenses and a peak age of addition of 18. it causes developmental delays and disabilities on one end of the spectrum and death on the other and has reach epidemic proportions in the USA. researh the relationship of alcohol as courage booster,ie taken before an act of violence so prepretrator will have the courage to do violent acts. study post traumatic stree syndrome and effects in children and adults. what effects does seeing the same tramic scene on TV over and over again have on people? what effect does serving in a war zone have on the military person as well as the family? what effect does seeing violence or experiencing violent acts have on learning and behaviors?
04/01/2005 14:35 PU 143 E The proposed CDC's structural/organizational combining of three quite diverse research areas ( environmental health, occupational health and injury prevention) may offer some rationale values for potential cost savings. However, as a seasoned injuyr control historian and student of leadership, I am concerned also with the potential to limited a level of effective creative ongoing injury prevention resources in such a "consolidated" national research structure. Combining injury with the tradtionally better funded and public supported manpower, advocacy presence for non-injury prevention will, I predict, signifcantly negatively affect the outstanding research in injury prevention and in the public health's societal savings. Injury is the leading cause of youth death and disabilty; for other age groups the potential for even more injury evidence-based outcomes also remains substantial . A catagorical joining of these three programs will limit the functioning of the newest player, namely, injury prevention. Everything has a history, even the present. And sea changes must be assessed against that history to assure ' not to break things that may be already for the most part fixed. When catagories are combined they should have more similar properties than just public health research. The question : where should injury research be? was asked in 1956 in a national Brookings Institute research publication report ( and that question was also responded to in decades of professional Journals and books) .....Environmental health and injury were part of the same national governmental structural organizational "system," in the 1940's, for a few years ( see Fisher L. Brown T. AJPH, Voices from the Past. Aug ( or June) 2004 ) . That federal reorganization placed injury into the National Security Adminstration's human factor-environmental health focus which for the most part ineffectively conducted national- state-local public informational whims common to the human factors school, blaming the victim descriptive research work of its day.... In the 1960's, under the Bureau of Community Environmental Management, PHS's , injury reorganization, the state of the art and focus on non-evidenced based broad programming very much diluted much growth on effective research and practice for injury control.... The later led to President Kennedy intital policy that injury were a public priority and his legacy under President Johnson removing 'injury control' to a newly established National Bureau of Traffic Safety ( now NHTSA) and the remains into the FDA. Afterwards, prevention of home, public and occuptional injury control became static until the 1980's when the federal Consumer Product Safety Commission (PL92-573)- to focus on the home cosumer product-injury relationships- and also the Occupational Safety Administration were created. In each generation ( see my newsletter and members' only commentaries at www.icehs.org ) injury prevention research has been significantly limited until the CDC's National Center for Injury Prevention and Control was established some 15 years ago after reports of the National Academy of Sciences, office of Medicine. Leadership requires not only assessing data on health effects ( injury is one of the largest, nationally ) but also various policy research organizational -structure options and. assurances that substantial progress in national injury prevention research will NOT be traded off by any reorganization models . If anything, injury prevention research must be maintained and expanded to highest leadership level in methods, manpower and funding, and collabrations with other fields of public health and safety. Otherwise, I see a less than meaningful Fin de Siecle ( end of an era) for saving lives and limbs by injury research and practice; a shared historical vision again, potentially, misplaced . History can not predict the future, but only possible guide in what processes and outcomes, other leadership personalities, values and events have gone through for the public's health and safety. Thank you. . Les Fisher MPH Safety Management Consultant 97 Union Avenue, South Delmar, NY 12054 USA 518-439-0326
04/01/2005 08:20 DC 142 E Provide consistent guidelines for exposure to bloodborne pathogens between the CDC and state Health Departments. NYS differs.
03/31/2005 15:55 DC 134 E Please give priority to establishing a scientifically appropriate, cost effective method for keeping healthcare workers safe from airborne pathogens. OSHA's assessment of risk has been based on industrial criteria and is not appropriate in the healthcare setting.
03/30/2005 22:35 OH 133 E The general public and people with disabling conditions in particular, will have difficulty participating in these events if more specific schedules are not posted. It's as though the object is to discourage participation.
03/30/2005 10:37 DC 131 E I would like to see more focus on air quality testing and guidelines for hospitals,ambulatory surgery centers. See more proactive stance on prevention of injuries and accountability for follow up on injuries that could be prevented. More education and resources to be used in educating and training staff on prevention. Focus on lighting and how that affects workers and their environments.
03/29/2005 15:48 DC 119 E I would like to see more information regarding indoor air pollution. We seem to have 1 unit that continues to complain about air problems. We have investigated and searched for the resolution to this problem without success. Is it possible that we have a unit of highly sensitive individuals? We have checked air exchanges, mold, chemical agents etc.
03/29/2005 10:57 DC 111 E Don't forget about secondhand smoke. It remains a significant environmental and occupational risk factor that is not being adequately and evenly addressed across all states.
03/29/2005 10:42 DC 107 E Job rotation to decrease repetitive motion injuries
03/28/2005 13:29 DC 102 E Autoimmune and allergy type conditions seem to be significantly increased in our population. Increases are evident in adult populations (working age) but also in pediatric populations (especially school age). We question the potential for further risk reduction.
03/28/2005 12:40 DC 90 E Would like to see CDC get involved with a campaign to use alternative methods to suturing lines into patients. The risk to the healthcare worker and patient increase using old methods. Also need a campaign to stop the practice of razor prepping patients for surgery. The data is out there to support a change in practice.
03/28/2005 12:25 WA 85 E E4 should be retitled, "Environmental Health Outreach and Education", and should state: "Identify, develop, and evaluate effective environmental health messages to all audiences, using community-based participatory research and culturally competent strategies to prevent environmental health threats and promote health to all communities."
03/28/2005 11:48 DC 82 E Establishing a common data base for all Environmental and Occupational Health and Injuries to be reported into by the reporting facility is basic to organizing this data and its analysis. Electronic reporting by facilities or individuals would make such information easier to report.
03/28/2005 11:33 DC 78 E Companies that manufacture safety medical devices should be encouraged to make these devices with less parts and easier to use. Cost should not be so high as to discourage facilities from purchasing them.
03/28/2005 10:14 DC 69 E Do not need annual mask fit testing. Big waste of time and money.
03/28/2005 09:35 PU 66 E As nurses comprise the largest proportion of health care providers in this country, and as nurses impact the public health at myriad points of care outside the acute, hospital-based system of care, I feel it imperative that nurses be prepared to include environmental health assessment, education, and intervention in their interactions with all patients/citizens. To this end, I request that the CDC consider increasing their commitment to nursing research, including studies which examine the validity of 1) integration of environmental health assessments into nursing practice, 2) nursing intervention to educate citizens and communities regarding environmental health risks, and 3) the effectiveness of nursing interventions on the overall health of the individuals and communities. In addition, I encourage the CDC to include nurses in any multidisciplinary team that conducts environmental health research. Finally, I request that environmental health research be directed at our most vulnerable citizens…the unborn fetus, child, pregnant woman, and aged populations. The concepts of environmental justice also requires that minority populations come under the research spotlight in order to develop a sophisticated knowledge and interventional plan for those special groups generally receiving the dregs of our health care resources. Respectfully submitted, Kathleen S. Morris MSA, RN Director of Nursing Practice Ohio Nurses Association 4000 E. Main Street Columbus, Ohio 43213-2983 kmorris@ohnurses.org 614-448-1026
03/28/2005 09:17 DC 65 E Prioritize research on the relative role and effectiveness of respiratory protection and need for fit-testing in the control of transmission of various infectious agents, including Mycobacterium tuberculosis.
03/28/2005 08:41 DC 61 E 1. Prioritize research on the relative role and effectiveness of respiratory protection and need for fit-testing in the control of transmission of various infectious agents, including Mycobacterium tuberculosis. 2. Outcome research (transmission studies) to define the relative importance of the hierarchy of controls in preventing healthcare associated transmission of Mycobacterium tuberculosis and other infectious agents potentially transmitted via the airborne route: administrative, environmental and personal protective equipment. 3. Health outcome and cost-benefit studies on the use of personal protective equipment: types of respiratory protection, frequency and utility of fit-testing. 4. The relative role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission
03/28/2005 08:10 DC 59 E CDC should definitley do as much as possible to persuade regulatory agencies to base their policies on science (evidence based) rather than trying to create standards which do not apply to all occupations or risks. Obviously, the OSHA requirement for annual fit testing for respirators in healthcare is one example.
03/25/2005 11:30 DC 49 E There needs to be further discussion and research on the requirement to have healthcare workers tested yearly for TB. Being a health care worker I would prefer to be test immediately before being assigned to a patient with TB. Changes in facial features, remembering how to apply the mask appropriately, etc. would influence my decision to request a fit test. I believe that yearly fit testing, especially for hospitals in rural locations that might see 1 or 2 cases of TB in a year, is time consuming and a waste of precious healthcare dollars.
03/24/2005 18:44 WA 45 E Housing and Health: - Characteristics of housing that affect health status: etiologic research - Measurement of indoor environmental exposures related to health: methodologiocal research -Effectiveness of housing interventions for improving health: intervention research
03/24/2005 17:47 WA 44 E Testimony for CDC Research Agenda Development Public Participation Meeting Seattle, Washington March 24, 2005 Pamela Tazioli, Breast Cancer Fund Good morning. My name is Pamela Tazioli and I am the Washington State Coordinator for the Breast Cancer Fund. I am also a 4-year breast cancer survivor. The mission of the Breast Cancer Fund is to identify—and advocate for the elimination of—environmental and other preventable causes of breast cancer. We very much appreciate the opportunity to participate in this hearing and to help shape the CDC research agenda. Breast cancer is the most common cancer among women worldwide. During the past 50 years, the lifetime risk of breast cancer in the United States has more than tripled in the United States. In the 1940s, a woman’s lifetime risk of breast cancer was 1 in 22. In 2004, it is one in 7 and rising. Breast cancer is the leading cause of death in women ages 34 to 44. Washington State has the highest rate of breast cancer in the United States and no one knows why. This year, nearly 4,000 women in Washington state will be diagnosed with breast cancer and nearly 800 women will die of breast cancer. Each one is one too many. Nationally this year, an estimated 211,000 women will be diagnosed with invasive breast cancer and another 58,000 will be diagnosed with in situ breast cancer. More than 40,000 women will die of breast cancer. For too long, breast cancer was considered a woman’s personal tragedy. For the past three decades, cancer research has focused increasingly on the personal: on genetics, as though our DNA existed not in a complex organism but in a Petri dish or under a bell jar. One author calls this limited vision gene myopia. This gene myopia has imposed a costly ignorance about breast cancer. Any disease that kills 40,000 women a year is more than a personal tragedy. It is a public health crisis—and CDC’s research agenda needs to reflect that reality. Research efforts should be focused in areas most likely to provide useful information for shaping public policies that will reduce environmental exposures and protect public health. The recommendations that follow are based on the consensus of scientists, clinicians, advocates and community representatives attending the first International Summit on Breast Cancer and the Environment held in May 2002. This summit was initiated by the Breast Cancer Fund, and co-sponsored by CDC, the University of California Berkeley NIEHS Center on Environmental Health and the International Agency for Research on Cancer. The types of research most likely to produce evidence useful in shaping public policy changes will be those examining: (1) the interplay between the timing of exposures (especially periods of vulnerability), multiple exposures and chronic exposures (including occupational exposures); (2) disparities in health outcomes and differences in exposures among racial groups (3) human contamination, measured by biomonitoring, such as the excellent NHANES research; and (4) public health studies examining unexplained patterns of breast cancer. Timing of Exposures Timing of exposure is just as important as the dose of a chemical or radiation in terms of later health effects. For example, we need long-term studies of girls who were fed soy formula as infants. This would help answer questions about whether early exposure to dietary phytoestrogens affect later breast cancer risk. Multiple Exposures All of us are exposed to hundreds, perhaps thousands, of synthetic chemicals every day, many of which may interact. The combined activity of the multi-chemical mixtures we are exposed to must be investigated. Chronic Exposures We need more occupational studies on women, who now make up nearly half the U.S. workforce. One of the earliest studies on workplace exposures found that more than half a million women were occupationally exposed to ionizing radiation and that tens of thousands were exposed to carcinogenic chemicals. Yet relatively few recent studies have been carried out in the U.S. to identify occupational risk factors for women. Many women in the U.S. have two places of work: in the home and in the paid workplace. To accurately assess environmental exposures that may increase the risk of breast cancer, researchers need to consider exposures at both sites, individually and collectively. We need more research on electromagnetic fields (EMF) and breast cancer. All of us are exposed to EMFs every day. EMFs are a type of non-ionizing radiation and include microwaves, radio waves, radar and power frequency radiation associated with electricity. In 2001, a meta-analysis of 48 published research studies on the association between EMF exposure and breast cancer found the data “consistent with the idea that exposures to EMF, as defined, are associated with some increase in breast cancer risks, albeit that the excess risk is small.” The International Agency for Research on Cancer classifies EMF as a possible human carcinogen. Despite these studies, there has been little federally funded research in this area in the U.S. since 1998. Disparities in Health Outcomes Many studies are needed to explain disparities in breast cancer incidence, mortality and environmental exposures among women of color. For example, postmenopausal Hispanic women appear to be at significantly greater risk of breast cancer related to estrogen replacement therapy than non-Hispanic white women. This difference could suggest greater sensitivity to environmental estrogens. Breast cancer rates are rising rapidly in Asian American women, particularly in Japanese American women. Research is needed to determine whether environmental exposures are contributing to these differences. Human Contamination (Biomonitoring) and Health Tracking We need to know more about the pollution in people. For example, a study conducted at the University of Washington found that nearly all children in Seattle are likely to have measurable levels of organophosphate pesticides in their urine. CDC’s own biomonitoring research shows that our bodies have become contaminated with more than 100 synthetic chemicals. Each of us is a walking, talking toxic waste site. Breast Cancer Fund urges CDC to expand the biomonitoring component of the National Health and Nutrition Examination Survey (NHANES) to measure the chemical body burden in not only blood and urine but also in breast milk. A study of flame retardants in breast milk showed that levels of these compounds in the milk of Pacific Northwest women are higher than levels in breast milk from Japan, Sweden, Canada and Texas. Monitoring breast milk reveals the environmental contamination of our bodies and our communities and provides a clear direction for policy changes that will protect public health. Biomonitoring, together with diligent tracking of health outcomes, can help explain the role of environmental toxicants in breast cancer and other cancers. Yet health outcomes tracking is inadequate for most chronic diseases and even in cancer. All cancer registries should be adequately funded to cover the entire U.S. Current U.S. cancer statistics are estimates based on data from 18 regional sites, calculated by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program. Theses estimates are based on actual cancer cases in about 74 million people or about 25 percent of the population. We also urge CDC to revamp NHANES so that state-specific exposure information can be pulled out and used to inform policy changes. This may not be possible for all states but for states with large populations, it would provide data useful in shaping public policy. CDC’s Second National Report on Human Exposure to Environmental Chemicals shows that public policy changes based on biomonitoring make a difference. Body burdens of PCBs, DDT, and cotinine (the breakdown product of nicotine) have all declined since PCBs and DDT were banned in the U.S. and smoking controls were implemented. Precautionary public health measures, based on information about the dangers of toxic chemicals, can and do make a difference. Unexplained Patterns Of Breast Cancer We urge CDC to conduct studies in states such as Washington and Oregon which lead the nation in breast cancer incidence. These studies should look at the relationship between specific chemicals and breast cancer in these areas, based on point source, ambient contamination, and human biomonitoring. Breast cancer is a symptom of a larger cancer epidemic in America. For the first time, cancer has surpassed heart disease as the leading cause of death in Americans under age 85. The lifetime risk of breast cancer is 1 in 7. The lifetime risk of some kind of cancer is 1 in 3 for women and 1 in 2 for men. These terrible numbers are not the result of pollution in the gene pool but the pollution of our bodies and our communities. CDC research is essential to halting this costly onslaught of cancer. As a woman who lives in the shadow of breast cancer, I urge CDC to focus research on cancer and chronic diseases as a public health issue. Ten U.S. states with highest incidence of breast cancer Washington 148 Oregon 145 Massachusetts 143 Connecticut 143 District of Columbia 143 Alaska 139 Minnesota 138 New Jersey 138 New Hampshire 135 Wisconsin 135 _____________________________________________________________ Pamela Tazioli Washington State Coordinator Breast Cancer Fund Pamela@breastcancerfund.org www.breastcancerfund.org
03/24/2005 12:15 DC 43 E Severe injuries take an important but unmeasured toll on family members. These “secondary” impacts of severe injuries, such as depression, suicide, post-traumatic stress, divorce, family violence, on family members are not well documented. The loss or disability of a spouse, the breadwinner, siblings or children, all have different social dynamics associated with such events. However, we know little about how to quantify, predict or prevent these secondary impacts. In many areas, especially child abuse and domestic violence, important strides have been made in increasing the visibility of the role of acute care providers in identification and referral. However, most studies have shown a large fall off in compliance over time. Efforts to understand what factors lead to long term success of these programs in the acute care setting are needed. From the ages of 10-44 poisonings are the leading cause of injury hospitalization in women. This is a tremendously understudied public health burden that appears to be derived from mostly intentional behavior. While analgesic and tranquilizer agents predominate, little is known about risk factors, long term impacts, costs, or effective preventive measures.
03/24/2005 11:51 OH 42 E I would like to comment on theme ID# H3, Health Birth Outcomes. In general I strongly support this research theme. What is missing however is implicit inclusion of injuries and violence among the types of maternal exposures that may lead to adverse birth outcomes and the need to specifically acknowledge trauma as more of a priority for maternal exposure prevention. Although violence during pregnancy has received some attention (I commend CDC for the 1997 publication on “Key Scientific Issues for Research on Violence Occurring Around the Time of Pregnancy”), research has shown that unintentional injuries are an even greater burden during pregnancy. However, they are not mentioned in the Research Agenda for Injury Prevention priorities nor have they received much attention from the Reproductive Health Branch. Recent linkages between ED visits and birth records in one state showed that about 4% of all pregnancies involved an ED injury visit during the pregnancy. Among leading mechanisms, motor vehicle occupant injuries accounted for (22%), falls (17%), cutting and piercing (10%), struck by/against (10%), overexertion (8%), and poisonings (3%). Among the injuries with known intent, 92% were unintentional, 7% assaults, and 1% self-inflicted. This translates to over 160,000 ED level injury exposures per year with little follow-up if the impact on the baby. Schiff & Holt recently reported large relative risks for placental abruption among women hospitalized for severe, non-severe and minor motor vehicle injury (9.0, 4.8, 6.6, respectively) [Pregnancy Outcomes following Hospitalization for Motor Vehicle Crashes in Washington State from 1989 to 2001. Am J Epidemiol, 161(6), 503-10, 2005]. Yet little work focuses on expanding primary prevention programs for these events. It is an area that needs its own research agenda and needs to be included in both the Health Promotion and Injury Prevention Workgroup research priorities. Currently this area of research need is claimed by no CDC Coordinating Center. It needs to be claimed by both in a coordinative fashion. Cordially, Hank Weiss MPH, PhD Director and Associate Professor Center for Injury Research and Control University of Pittsburgh Building/Room: Scaife 532D Mail: 200 Lothrop St., Suite B-400 Pittsburgh, PA 15213 hw@injurycontrol.com or weisshb@upmc.edu Phone: 412/648-9290 Fax: 412/648-8924
03/23/2005 17:48 WA 40 E Several comments regarding occupational health: 1. With very few exceptions, there is little state and local public health infrastructure centered on occupational safety and health. Unlike injury prevention and environmental health surveillance data is poor and the capacity for prevention and intervention outside of a regulatory framework does not exist at the state and local level. Fewer than 15 states receive federal money for surveillance programs and the states that do are very poorly funded. The rationale for occupational health investment is clear; workers spend approx 1/3 of their lives at work; occupational injuries and illnesses are expensive and cause signficant disability. Relatively few individuals have meaningful training in occupational epidemiology, occupational medicine. occupational safety and other occupational health specialties. Investments in occupational health are not exclusive of impacts on other important areas of public health. A component of emergency preparedness for natural disasters, and events related to terrorism would be wisely spent with an emphasis at workplace preparedness. Dedicated funding within state departments of health/labor may facilitate employer preparedness. Occupational injury programs and research are sparse and lack depth and resources. Injury prevention research funding traditionally has not integrated occupational injury prevention.
03/21/2005 12:19 WA 36 E Good afternoon, It is essential that the CDC enhance funding and broaden the research agenda to include translational research projects that explore the impact of environmental health assessments and risk reduction measures conducted by nurses out in the community. In Wisconsin, we have been actively involved with a number of projects to reduce the health effects of environmental expsosures through our community nursing centers which provide primary health care, as well as community based health promotion and disease prevention programs. One example are the mercury hair screening programs conducted in conjunction with the Wisconsin State Health Department, as part of the Nationwide Health Tracking initiative. We have tested over 125 persons in the last 9 months and held numerous health education sessions related to the health effects of mercury toxicity. In addition, we are planning to submit a research grant in the next year to translate recommendations for environmental health assessment within the primary care setting. These clinics are managed and care is provided by nurses. The public's health (particularly of vulnerable populations) will be vastly improved should nurses increase the capacity to conduct funded research projects that embrace applied and translational designs in the community setting. Sincerely, Laura Anderko RN PhD Associate Dean for Practice and Associate Professor University of Wisconsin- Milwaukee 414 229-2313 landerko@uwm.edu
03/21/2005 08:58 WA 35 E A. Intervention studies to determine the effectiveness/validity of: 1)Integration of individual and community-wide environmental health assessments into nursing practice 2)Nursing intervention to educate individuals and communities about environmental health risks 3)Nursing intervention to reduce individual's and community's environmental health risks B. Community-based participatory research as a mode of research whereby community members co-direct all aspects of the research C. Encouragement of multidisciplinary approaches to assessment, intervention, evaluation research in which clinical, advanced practice, and community/public health nurses are involved in the research teams. D. Research to understand the environmental health risks posed by multiple exposures, as well as the risks posed in our most vulnerable populations - children, the frail elderly, and pregnant women. E. Research regarding intervention to improve Indoor Air Quality (IAQ) in schools.
03/18/2005 13:14 WA 34 E To make progress in reducing risks to vulnerable groups, we need a research agenda that balances basic research with applied and translational research. Public health (PHNs) and occupational / environmental health nurses (OEHNs) are the primary contact point for many families in need of health services. Nurses are the main health care providers in: 1) worksite settings and 2) local public health departments. There can be significant "value added" when nurses incorporate occupational and environmental health interventions (e.g., risk reduction messages, safe product selection and disposal) into their daily nursing activities. However, CDC resources to develop and test nursing research have been very modest and not at a level to conduct RCT studies. CDC's efforts to date to improve nursing capacity in occupational and environmental health have been commendable. However a larger commitment will be needed to test interventions addressing salient topics (e.g., rural methampetamine use, household hazards, cottage industries) and groups (e.g., low-income, minority, and communities of elders). It is not sufficient to commit modest resources to nursing, while allocating the lion's share of resources to other groups. CDC would be well served by an RFA that specifically aims to test the effectiveness of nursing occupational and environmental interventions with homes and communities. The public's health will be well served when nurses have both the will (which they already do), the science (which is needed), and the capacity to integrate science-based occ and env health messages into daily nursing activities. Thank you for the opportunity to comment. Thank you for holding these hearings and public participation meetings.
03/17/2005 16:42 WA 33 E I work in the state of Washington for Public Health – Seattle & King County as the team lead in our Illegal Drug Lab Program. We have been dealing with the contamination caused by illegal drug manufacturing, primarily methamphetamine, since the late 1980’s. More recently this has become a nationwide problem. There is a great need to have information regarding the effectiveness of decontamination processes and how to accurately determine when it is safe to reoccupy a structure. Questions include: How many samples are necessary to determine that the contamination level in a structure has been reduced to an established limit? Is it possible to decontaminate a furnace and ductwork or do they need to be removed from a structure because they can recontaminate a structure? How might the level of contamination change once people reoccupy a structure? (i.e. Will contaminants that were imbedded in the drywall or encapsulated in paint come to the surface as heat, air flow and activity in the structure resume?) How effective are various cleaning compounds and methods ? Do any of the cleaners, such as oxidizers, create a problem by chemically changing methamphetamine or by-products into something perhaps even more harmful but since methamphetamine is used as the indicator, goes undetected? And of course there is the very difficult question, what level of decontamination is needed to protect public health? Terry Clements Illegal Drug Lab Program Public Health – Seattle & King County 206-296-3993 fax 206-296-0189
03/17/2005 11:07 WA 32 E .
03/15/2005 17:15 WA 30 E There is a lack of research focused on prevenetion strategies in relation to intentional injury. There shoudl be an emphasis on research focused on sexual violence pimary victim preventions and sexual violence primary perpetrator prevention. This will enable us to define best practice as we move forward. The majority of research focused on the issue of sexual violence has been prevalance and incidence studies as well as evaluation of current intervention/treatment strategies. Although this data has been extremely important in the fight to end sexual violence, this data has limited applications in relation to the development of effective prevention strategies
03/15/2005 14:12 WA 28 E I hope that environmental justice can be a part of the agenda. Specifically, there is a need to collect data and conduct scientific research to more specifically identify the human health and environmental risks created by multiple exposures to contamination in low income and minority communities. Many non EJ researchers have stated that the statistical power to meanifully study these populations in not available.
03/11/2005 15:59 WA 19 E Research for development of remediation standards and guidelines for methamphetamine drug lab sites.
03/08/2005 14:27 OH 13 E Injury is consistently the # cause of death among all ages in the US yet it receives a fraction of the funding directed toward infectious and chronic disease.
03/04/2005 14:59 DC 11 E The CDC is leading the way in measuring chemicals in the human body. However, for most of the chemicals in its National Exposure Reports, it has left to others the task of interpreting the data. We think the CDC should devote more efforts to develop the tools needed to interpret biomonitoring data to enable the CDC, the public, and policy makers to better understand and distinguish those exposures which are of little or no consequence to health from those that may pose some degree of potential health risk. We think it is important for the CDC to consider devoting some research program resources aimed at developing the necessary methods to interpret human biomonitoring concentrations in the context of potential health risks.
03/02/2005 11:19 OH 8 E I do hope this area will include issues concerning workplace violence, psychological aggression, and bullying.
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Date Time Type ID Group Comment
04/19/2005 21:38 PU 468 G The G17 examples will need some development, for example working on prevention of preterm birth and developing strategies to prevent neonatal infections. Overall this looks pretty good. With vaccination, CDC has a clear role in helping countries set up surveillance for vaccine-preventable diseases to enable policy-makers to determine if they should adopt a vaccine and then, once a vaccine is adopted, to help them determine the vaccine's effect on disease.
04/19/2005 17:26 PU 463 G Does social capital include poverty? Poverty is a key cause of healht problems, and the relationship between poverty and health should be examined and addressed. Community-based participatory research should be thematic here. Attention should be paid to careful development and evaluation of the *processes* by which we work towards global health goals-- goals which involve complex systems, multiple cultures, and widespread geographic areas.
04/19/2005 16:57 PU 460 G make it clear that global health problems include the US--women and children, exploitation and abuse, reproductive health, HIV, etc.
04/19/2005 16:13 PU 457 G Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:54 PU 455 G Consider research theme relating to Consequences of the AIDS epidemic on diminished provision of Public Health services to the population. Explanation: The AIDS epidemic in Africa and elsewhere disproportionately effects the most economically productive members of society, including public health workers. What is the impact on public health programs (immunizations, maternal child health, Tb, etc.) beyond the burden of AIDS and AIDS-related diseases themselves)?
04/19/2005 15:31 PU 452 G G1 is not specific to global health research. Many examples are not research activities.
04/19/2005 14:46 PU 449 G I would like to propose a new research theme: “Strengthening health systems.” The description is: “Develop and evaluate strategies to strengthen health systems, with an emphasis on improving health workers’ adherence to clinical guidelines.” Examples of research activities include: 1) Develop an empirically-based theory that explains health worker practices, 2) Evaluate the cost and effectiveness of interventions to improve health worker performance, and 3) Develop and test strategies to scale-up interventions to improve health worker performance and integrate the interventions into national health systems. The justification is that numerous efficacious technologies (antimicrobials, malaria bednets, etc) exist that can prevent many deaths in developing countries; and a key barrier to preventing such deaths is that health workers in hospitals, clinics, and villages often to do not adhere to clinical guidelines that recommend use of these technologies. Inadequate health worker performance is an enormous public health problem that directly impacts health status and affects nearly every geographical area and health field. In fact, this topic is linked to numerous other Global Health Research Themes (e.g., G5, G9, G12, G13, G14, and G17). Furthermore, health systems are weakest in areas with the poorest populations, therefore research aimed at developing practical solutions for such areas are likely to reduce the large imbalance between the quality of care for poorer and wealthier patients.
04/19/2005 14:20 PU 446 G G1 – Educational impact to prevent binge drinking and alcohol use should be included in research. G2 – Improvement in the determination of causes death, i.e., those that are attributable to certain risk factors such as binge drinking and heavy alcohol use. G4 – Improve global alcohol surveillance capacity by working with local governments and World Health Organization G13 – Include the study of risk factors that increase the risk of HIV transmission such as binge drinking and sexual assault
04/19/2005 08:30 PU 420 G The relationship of global biopsychosocial challenges to the next wave of terrorism. The significance of effective family planning and prevention programs in global stability.
04/18/2005 13:47 PU 402 G Many of these themes would seem to fit logically in other Research Priority areas - Infectious Diseases, Injury Prevention, Health Marketing, etc.
04/18/2005 12:19 PU 393 G 1. Curbing Global Population Growth is a critical issue for CDC and all health agencies around the world, yet it does not appear on the Starter List of Global Health Research. It is critical that this topic be added to the list, and that family planning be an integral part of activities geared towards slowing down the rate of population growth. 2. As chronic diseases become more prevalent around the globe, it is critical that increasing attention and resources be directed towards preventing the conditions which promote chronic disease.
04/18/2005 11:15 PU 389 G Support research-based practices to optimize child birth and developmental outcomes, in the United States and in the world.
04/18/2005 10:21 PU 388 G I feel that we need to assist with the developmental disability issue globally. Many underdeveloped countries allow children with autism or developmental delay to go untouched and untreated.
04/18/2005 08:23 PU 380 G Global Health is going to become magnified in the coming future. As CDC directs its focus on health/prevention here at home, our next challenge will come from abroad and most importantly from the developing nations. I see in the CDC's plan of reorganization Global Health is one of the strategic imperative, but I am a little disappointed that they did not include the wording "DISEASE PREVENTION" which is by the way a part of our name as well as what we do in other nations. We try to prevent diseases from spreading, for example: Polio vaccination, safe water project in Asia and so on...perhaps we should try more ties with local NGO’s to have a greater impact. Spreading our knowledge and reaching those remote areas of the world will give us the best results in disease control and prevention. Yes we do need research and we can do a lot more being active in the fields (more health hygiene educators to talk to people). There are a lot of people at CDC with country specific knowledge in culture, way things are done, language etc. that can help. Participation should be encourage. Thank you!
04/18/2005 06:24 PU 374 G Good that you include evaluation of quality and consider standards.
04/15/2005 15:30 PU 365 G Will there be any items on human resource development (empowerment, and self-sustainability-even though this would be a long long range item) in developing nations.
04/15/2005 14:13 PU 361 G The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 09:54 PU 352 G Teach the approprate people of the diseases that are not normally seen in the USA
04/15/2005 09:54 PU 351 G Teach the approprate people of the diseases that are not normally seen in the USA
04/15/2005 07:16 PU 345 G HIV/AIDS is currently listed 13th on the priority list. Given the global impact and magnitude, the CDC priority for this disease in global health research is very much under emphasized. Also the treat of influenza, the importance of TB/malaria are under emphasized in these priorities.
04/14/2005 15:48 PU 339 G Is there a means to prioritize needs across geographic areas and encourage replication?
04/14/2005 14:18 PU 337 G Where is surveillance? As one of the Trailblazers is influenza and recent outbreaks of SARS and other emerging infections, it is amazing that surveillance is left off. This should be listed much more prominently!!! Hello!!?
04/14/2005 13:49 PU 333 G I was pleased to see a focus here on injury prevention, as well as the need for improved data globally. However, I was very sorry not to see a specific item included under the maternal mortality goal about access to contraception and increasing rates of contraceptive use. Obviously, access to contraception and other aspects of healthy sexuality are critical to imrpoving maternal health and reducing maternal mortality. I would strongly recommend including an item on contraception and reducing unintended pregnancy.
04/14/2005 13:26 PU 332 G Operations research on global immunization issues, along with approaches to assessing health burden of vaccine-preventable diseases, is very important.
04/14/2005 13:22 PU 331 G LIke evaluatIion of cost effectiveness on stategies.
04/14/2005 10:35 PU 309 G The list includes some treasures of CDC such as an interest to coordination of surveillance methodology (stdization of health data) etc. However, when it moves to topic areas it looks just like donor funding in a typical resource poor country-unqeual distribution of interests. Rahter than what CDC should be doing given the distribution of disease burden or country needs, the list appears to be more of what selected programs are doing given how they have managed to navigate funding, generate an interest, or benefitted from some global events. This list would have benefited from a closer look at the 2002 World Health Report, which highlights leading public health issues in countries in various stages of development. For instance, micronutrient malnutrition, is highlighted but howabout nutrition in general? Alcohol is #1 cause of disability in medium developed countries and action is needed in this area. Emerging lifestyle and impact of globalization such as obesity, low fruit vegetable intake, tobacco, alcohol etc are among the top 10-15 causes of illhealth in developing countries. If leading infectious diseases are listed, why not address other leading issues. The list reflects lack of a child health lobby at CDC (OVC is mentioned but that emanates from the HIV interest group). For instance, child health cohort development is a useful investment for medium developed countires, at least one in each continent, similar to the emerging diseases centers. If DHS have been successful with USG investments, so would such initiatives. No mention of cancers, though cancer burden is expected to triple by 2015 (probably reflects lack of a global cancer work group at CDC?). In short the list may not be compatible with the epidemiologic and risk transition that is occuring across the world, rather an expanded wish list list of existing CDC programs, or who participated in the planning.
04/14/2005 10:31 PU 308 G Health Services Research area related to what are the determinants are of governmental investment in public health is needed. We are active in many areas where local health care is still facing basic challenges in availablility of water and electricity, let alone surveillance systems and response capacity. Without the basic infrastructure, including communication, general recommendations for imporving reporting and integrated surveillance are challenging at the least. Laboratory capacity for example, depends on clean water and electricity. Surveillance depends on communication systems working. We can afford not separate these issues in development work? Hospital acquired infections are an area that may deserve a special mention, as there presence in many countries are inhibiting helath-care seeking behaviors?
04/14/2005 10:30 PU 307 G It is wonderful to see women and chilren's issue highlighted by CDC. We are no longer looking away from the white elephant. However, in order for us to be effective we will need more than the traditional data collection, we will have to start looking at the roots of the social injustice, and violence against women and children. The mental health approach should focus on prevention and identifying causes and interventions both for men and women to prevent violence. Are we going to be brave enough to challenge media, policies, and otehr factors contributing to these disparities.
04/14/2005 10:14 PU 304 G This list is ambitious but should include an agenda for tobacco which is projected to become the single biggest cause of death world wide in the next 3 decades.
04/14/2005 10:09 PU 302 G G8 MUST include FOLIC ACID
04/14/2005 09:45 PU 300 G With diabetes growing, focus on related growth of severe vision problems.
04/13/2005 19:50 PU 294 G Much more needs to be done in the area of the patient-doctor relationship to promote changes in behavior, improved communications, and improved outcomes. Advanced patient involvement results in greater awareness, a feeling of control, and confidence in the health care system. My book, The Art of Being a Patient (Taming Medicine- an Insider's Guide) has resulted in new research by Case Western Reserve University and the Esther Lewis Warburton Foundation demonstrating the value of improved patient understanding and compliance in reducing health care costs. There is a tremendous need to look more closely at this area to help rein in double digit health care inflation partially related to unprepared and unfocused patients. I'm an expert in preventive medicine and in promoting patient compliance and follow through. Philip Caravella, MD, FAAFP The Cleveland Clinic Foundation caravep@ccf.com
04/13/2005 16:06 PU 288 G G2 Research Theme is very ambitious. Global data standards will require compliance all the way down to the local level. I do not believe this message has transcended throughout the CDC CIOs even.
04/13/2005 10:37 PU 273 G HIV/AIDS epi and behavioral risk-reduction research, particularly for currently underserved populations such as men who have sex with men
04/13/2005 09:59 PU 271 G In this age of new pneumococcal/streptococcal vaccines (both newly licensed and in the pipeline) It is imperative that we continue to monitor pneumococcal and group A streptococcal serotype and strain distribution on a global level. It is also imperative that we continue to provide our internationally recognized pneumococcal/streptococcal reference lab expertise.
04/12/2005 14:51 PU 264 G • Global Health Research: Please consider the priority actions developed by the Oral Health Program at the World Health Organization: http://www.who.int/oral_health/action/en/ and Research for Oral Health http://www.who.int/oral_health/action/information/surveillance/en/index2.html
04/12/2005 10:30 PU 261 G What role do the people from "around the world" play in shaping the policies and research agenda set by the US? How are "they" contributing to decision making on "what", "how", "when", and "where" things need to happen?
04/11/2005 22:17 PU 260 G Collaborative research in environmental and occupational diseases and injuries can provide important information for risk assessment in the USA, as well as assist the partner from the developing world.
04/11/2005 09:59 OH 251 G see general discussion comment below
04/09/2005 18:43 PU 237 G A very important area that CDC has overlooked concernss the issue of global workforce capacity and policy issues - especially with regard to the developing world. Most recently the issue of workforce equity has been raised by WHO (and other international associations) through various WHA resolutions. The recruitment of health care providers, most notably nurses from Africa and the Carribean to the UK and US, is having a significantly negative and deleterious impact in key regions of the world. CDC needs to capable of providing sound techincal assistance in this area -i.e., information systems to track and account for a scare health care workforce. Without this system in place and without strategic planning, million of dollars will be wasted on promoting and introducing interventions for which there is no workforce to implement.
04/08/2005 08:45 PU 232 G I would like to see a particular focus on the importance of access to 'reproductive control technologies' in improving the lives of women and their families, including an awareness of these issues in interaction with other issues such as domestic violence and HIV transmission. This contextualized, interactional understanding is essential!
04/08/2005 07:30 PU 229 G Need to utilize CDC resources (NCHS and NCCDPHP-DOH to more actively participate (if not co-lead) in the development of international standards for assessing oral diseases and conditions, evaluations of programs that promote oral health, development of new preventive measures to prevent oral diseases and promote oral health. CDC should consider the establishment of a CDC international dental epidemiology officer position (NIH/NIDCR has an international dental officer position) to help facilitate communication between CDC and international chief dental officers and others. NCHS could greatly benefit from such a position. CDC should consider a temporary assignment of an international dental officer to the WHO or to the European Union's CDC-like institution.
04/07/2005 19:03 PU 227 G An additional topic for research should include the effects of the trade agreements(particularly NAFTA) on rates of motor vehcile related injuries, there was some concern regarding the potentilal effects of unsafe motor vehicles as a result of increased access to US roads by trucks bringing in produce and other products from Mexico and other Latin American Countries..
04/07/2005 15:59 PU 224 G G.13 - Include assessment of the standardization of baseline public health infrastructure for effective HIV/TB prevention in developing countries, operational and infrastructure parameters. Analysis of the links between systems and intervention programs.
04/07/2005 11:47 PU 215 G There is lack of training in Epidemiology in India. There was one course offered recently by ATSDR/DHS but there is need for several Environmental Epidemiology Courses/ training in India.
04/07/2005 10:20 PU 210 G I strongly encourage consideration of research on the US-Mexico Border. If the Border region is considered a separate entity, it has a greater incidence and prevalence of disease than individual states in both countries. The transmission of disease across the Border is also significant.
04/07/2005 09:19 PU 201 G We have to develop important vaccines with Asian and African countries to contain diseases, and have the vaccines avialable for the first and second world countries.
04/07/2005 06:45 PU 190 G Also very important. Prevention of disease world wide will decrease disease at home.
04/06/2005 17:47 PU 187 G G17: Develop community interventions which ensure appropriate reproductive health services for families. Assess strategies designed to prevent major causes of maternal mortality. Evaluate and identify surveillance methodologies for maternal, perinatal, and child health. Another Topic: Information, Communication and Technology. Develop, implement, and evaluate effective uses of information, communication, and technology in global health research 1. Define the ICT conceptual model for health promotion and prevention of disease, injury and disability. 2. Identify challenges which can affect ICT development 3. Identify successful implementation models for sustainability. 4. Identify Toolkits for dissemination and use. 2.
04/05/2005 15:05 PU 170 G There is a significant need for research at the international evel on the epidemiology of child maltreatment and the CDC could provide leadership in this area.
04/05/2005 11:11 PU 159 G This area of research is a top priority and is directly tied to #5 Health Promotion. I am very much interested in addressing the incidence of childhood obesity and increasing onset of Type 2 diabetes mellitus in children. As a fellow in pediatric psychology I see this area spreading into EVERY case I see and would very much like to participate in ongoing research and intervention. How can I get involved?
04/04/2005 13:30 PU 156 G Take care of the USA. We still have too many unsolved problems. It is recognized that many of the problems infiltrate into the USA.
04/04/2005 11:05 PU 147 G Please consider the social and cultural aspects of disease, especially in other countries.
04/03/2005 21:43 PU 144 G alcohol is very much a global disease that triggers other diseases, disabilities, injuries and death. G13. research the relationship between marketing by US companies and increase use of addictive substances and the subsequent deteriation of health and increase in STD/HIV/AIDS, TB, and chronic diseases. i like the emphasis on cost effectiveness and developing marketing messages that might counter act those that encourage risky behaviors. G14. be sure to look at alcohol as a major risk factor G17. alcohol is now being linked to stillbirth, SIDS and FASD. please do forget to study it when you look at maternal and under 5 mortality.
04/01/2005 08:20 DC 142 G Most difficult and valuable. Air travel should be a large part.
03/30/2005 10:37 DC 131 G Formal conferences or lectures to bring topic to light in rural communities.
03/29/2005 10:57 DC 114 G Research needs to be performed on diseases that are now being transmitted between species around the world, i.e. avium flu. It seems imperative that we look at how to develop vaccines etc. to prevent the spread of disease between species.
03/28/2005 13:29 DC 102 G Concerned about exposure to contagious and other hazardous materials: for our military, religious/other civilian groups providing support services in many countries, and for the people living in countries where the USA is involved in industry and military activities.
03/28/2005 11:48 DC 82 G Explore methods to expand the work of WHO and simplify data collection with regard to activities.
03/28/2005 10:27 DC 72 G use of engineering controls on mass public transportation methods (i.e. air exchanges and air filtration units on airlines or water storage and purification on airplanes or ships)
03/15/2005 14:12 WA 28 G Chronic diseases (tobacco, obesity) are causing morbidity and mortality problems equaling infectious diseases and a new health paradigm/s should be examined.
03/15/2005 00:18 WA 25 G As mentioned above, focus on infectious disease outbreak control on a global scale, and also vaccine distribution (cost, new development, supply, etc.)
02/25/2005 08:43 GA 7 G Promoting directly observed therapy for TB control in developing countries. Partnering with the private medical sector to promote standard treatment guidelines for TB treatment TB Screening of immigrants, refugees, coming to the U.S. Partnering with WHO for improved TB reporting and surveillance
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Date Time Type ID Group Comment
04/19/2005 17:33 PU 464 S Theme ID# S4 * Apply prediction algorithms. Description Additon: Apply recent developments, determine accuracy and identify refinements. zbq5@cdc.gov
04/19/2005 17:26 PU 463 S Important goal: comprehensive integration of health information services and systems, both inside and outside the agency. Data collection and data mining should be considered together-- data are collected for specific purposes/questions, which limits the effectiveness of using the same data for other purposes. It's important to recognize and anticipate these limits, both when developing data collection plans, and developing a data mining project. Information dissemination is also very important-- as much of our data and information as possible should be made accessible to folks inside and outside the agency-- it belongs to the American people, not the staff of CDC--or, moreover, its contractors, who often have motivation to keep data to themselves, at least for awhile, and to the detriment often of the purposes for which the project was initiated.
04/19/2005 16:59 PU 462 S Please, please, PLEASE don't ignore the workplace! For S12 in particular, workplace needs to be added to the listing of care/information delivery settings. The quality of information workers receive about hazards on the job is abysmal in many cases, and CDC/NIOSH has a distinct role to play in this setting. [comment from Barb Grajewski, NIOSH]
04/19/2005 16:13 PU 457 S Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:31 PU 452 S Again, many examples are not research activities.
04/19/2005 10:29 PU 425 S Suggest inclusion of rural and frontier areas, especially in regard to syndromic surveillance focused on emerging infectious disease threats.
04/19/2005 10:29 PU 424 S I would like to see real effort and foresight used to design appropriate IT resources and support, including choosing IT leads who actually consider the users (and not just their own career development) when developing systems. CDC is way, way behind in IT development. This hampers the success and efficiency of our surveillance systems.
04/19/2005 10:23 PU 423 S Themes S.12, S.13, and S.17 seem to assume that messages generated by CDC are sufficient to change behavior. I recommend that the research activities for S.13 include: Develop messages to inform and direct persons to supportive and skills-building resources. I recommend that the research activities for S.12 and S.17 include: Identify risk/benefit perceptions and barriers to behavior change for population segments in order to develop salient messages. I recommend that the research activities for S.16 include: Create and improve health literacy and communication skills among health professionals and health communicators so they can explain health-related matters using easy-to-understand terms and examples.
04/19/2005 06:48 PU 417 S Theme ID # S19 Research theme title and description Partnerships as Health Marketing Channels Investigate how prevention and health protection messages can be more effectively delivered through private-public partnerships Examples of research activities • Develop methods of quantitative evaluation of the effects of partnerships on public health outcomes • Develop tools and guidelines that will enhance partners’ ability to affect public health outcomes • Compile profiles of prevention partners by sector (medical care, employers, educational institutions, other government agencies) • Develop typology of private-public partnership arrangements and investigate their effects on health outcomes • Analyze variations in delivery of preventive services across sector partners, develop and test sector-specific strategies for targeted delivery of prevention messages
04/18/2005 16:26 PU 414 S CDC support for evaluation (qualitative analysis) software & analysis. Qualitative Analysis workgroups around program evaluation activities in states. (this may be more applicable under Cross-Cutting Research: not sure)
04/18/2005 14:02 PU 403 S Including Theme ID# 1, 2, 4, 5, 6, 7, 8, & 9 in the Health Information Services Research seems to be more directly relevant for the cross-cutting research area than this area. It more directly supports the p.h. science than information services. These areas are really the core sciences necessary for analysis & interpretation of data to support cross-cutting p.h. research.
04/18/2005 13:47 PU 402 S Other than trying to fix everything related to Health Information Services, the main ideas put forth are solid, and just need to be focused on prioritieis.
04/18/2005 11:15 PU 389 S Identify other sources of important public health information, such as educational records and standardize agreements for public health access and use of these data.
04/18/2005 09:15 PU 383 S Research/pilot projects regarding interconnection of large health information systems (e.g. EMRs, immunization registries, disease surveillance systems, etc.) - this seems to be spread among themes S3-S5, S8, and S9.
04/18/2005 08:26 PU 381 S The development of methods for the centralized automated real-time monitoring of infectious diseases should be included as a priority- especially disease in travelers who may be the sentinel cases.
04/18/2005 07:27 PU 376 S Research should be done on systems of care for children with mental health problems building on the national evaluation of the SAMHSA funded Comprehensive Community Mental Health Services for childrn and Their Families Program.
04/18/2005 06:24 PU 374 S Good that area includes consideration of data collection. Some of the examples are similar to cross cutting topics.
04/15/2005 14:13 PU 361 S The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 12:28 PU 355 S The Emergency Medicine Network (EMNet, www.emnet-usa.org) at Massachusetts General Hospital strongly supports the CDC’s Theme S 12 (Health Communication). In particular we believe that the emergency department (ED) is an untapped opportunity for health education, both for patients and families. Pilot work on health education in the ED, by EMNet investigators, shows strong patient interest in learning about asthma, smoking cessation, and other public health topics while in the ED. We believe that the ED can serve as an appropriate and useful venue for health education and encourage further development of such strategies.
04/15/2005 09:54 PU 352 S Communiciation is important especially for those who who cannot read English
04/15/2005 09:54 PU 351 S Communiciation is important especially for those who who cannot read English
04/15/2005 09:34 PU 350 S I would like to see greater effort focused on finding the cause(s) of SIDS. I have worked in Law Enforcement for over 15 years and have seen firsthand the devistation it has caused families. I have been in the homicide unit for the past 5 years and our protocol requires a response to all infant death scenes. I feel that a national standard/protocol regarding infant death investigation could assist with gathering valuable data that may help lead to a greater understanding of SIDS and therefore prevent needless deaths.
04/14/2005 18:12 PU 341 S Hello, I am an advocate for those who suffer from chronic pain, as well as for individuals/survivors of sexual assault. In regard to public health information services, I would like to see: research on multicultural perspectives on pain and healing and sexual assault understanding or perspective, psychological type studies/investigations in understanding the social impact of pain and the contrast/difference in those with proper support systems (what can the public do to enhance this ect), and research on community perpectives on sexual assualt (does the community still shun victims/survivors). In addition, more research is needed to investigate any positive or negative reactions/connections of alternative methods of treatment for both pain and sexual assault individuals. Also, if possible, more public knowledge and awareness is needed to inform (parents, youth, children, ect.) of the overwhleming amount of sexual harrassment and victimization on the internet; which I see as a public health concern. Finally, would there be any possible studies to find the outcome of community services for people who suffer from pain or sexual assault - as I have heard endless times how they would not have made it without help ect. (therefore to ultimatley have this informaiton - if it confirms what I already know - to gain more support from federal and local government for funding to support so many failing public servcie 501 c3 organizations) visually representing the life saver that floats in an ocean, often with no land in sight. Thank you for the availability for me to speak my voice. If any of these ideas apply more to other sections, please forward. Sincerely, John
04/14/2005 15:48 PU 339 S Technology has birthed a volume of information - need to address quality of information and a means to evaluate the information without spending alot of time.
04/14/2005 14:18 PU 337 S No comments.
04/14/2005 13:26 PU 332 S These research topics cannot fruitfully be undertaken in isolation from specific programmatic areas. Care needs to be taken in implementation of this research agenda to assure that these activities are undertaken as part of specific programs. Data exchange with immunization registries should be noted under "Electronic medical records."
04/14/2005 13:22 PU 331 S LIke translating public health messages into practice.
04/14/2005 12:30 PU 326 S Greater emphasis should be placed on developing internet based MIS, HIS, and GIS systems for gathering and disemminating PH and health service information. Also, explore ways to link the 3 in ways that encourage stronger partnerships among NGO health providers and the federal, state and local PH providers
04/14/2005 12:19 PU 325 S Please include the following: 1) More HIV and STD Messages for teens. 2) Holistic approach to hiv prevention messages 3) Developing a curriculum to train doctors on how to deliver messages in a manner that does not admonish them but instead encourage patients to take ownership for their health 5) CDC should get more involved with technology re: the delivery of health information. 6) Monitoring the quality of health information provided on internet 7) Recruiting individuals from the community who can more effectively transfer health information to those disproportionately affected. 8) Empowering the patient to ask those questions that are typically afraid to ask their health care provider-many of these questions are brought up with community based organizations.
04/14/2005 11:43 PU 318 S Some ideas in data collection methodology are mentioned, although these could be more specific, covering numerous facets of measurement error related to survey samples, questionnaires, interviewer effects, mode of data collection, imputation, and others. Such research could actually apply to many of the focus areas and should not be limitd to health information services research.
04/14/2005 11:05 PU 315 S Need to provide information for the public and clinicians on laboratory testing - create a resource where the public can found out which tests are generally accepted and which are controversial and shy.
04/14/2005 10:41 PU 312 S I strongly suggest a modification to the ID# S7 theme title: "[Geospatial] Information and Data Visualization." This theme pertains to georeferenced or geospatial information. Geospatial information can be nominal, address matched (geocoded) or located through latitude and longitude. The term "geospatial" conforms to OMB's Federal Geographic Data Committee (of which I represent DHHS) designation of terms, is universally identified in metadata and data dictionaries of all federal agencies, and is a standardized term for georeferenced information provided by state and local public health departments. [Please contact me if there are any questions: Chuck Croner at cmc2@cdc.gov, NCHS]
04/14/2005 10:39 PU 311 S H14, H15 I'm no expert - but seems the lion's share of chronic disease burden is caused by US. How can we partner with other industries (food, health care) to help US?
04/14/2005 10:31 PU 308 S What is the effect of functional illiteracy in the US on the ability of the US to maintain higher standards of health? Put in a plug for improving education, because it is a primary determinant of health.
04/14/2005 10:30 PU 307 S We have created a Diabetes Indicators and Data Sources Internet Tool that has identified 38 diabetes indicators and its associated data sources and their specifications. Having most of the diabetes-specific information needed for diabetes surveillance has been a tremendous help. Wish we could expand this to include sections on data analysis methodology, etc. For programs with limited resources and capacity, this is a big help and promotes efficiency and consistency in addition to the obvious accuracy and quality in data analysis.
04/14/2005 09:45 PU 300 S Up to date data on causes and costs of vision impairment throughout the USA
04/13/2005 16:31 PU 290 S THis is a critical area that needs research. A recent review conducted by the RAND Evidence Based Practice Center has found that despite the extensive resources placed in IT and support, there isvery little research in this area.
04/13/2005 15:19 PU 283 S This should include technology to support training. For example, effectiveness of the new learning management system. I noticed that there was a section for training in the cross-cutting issues also.
04/13/2005 15:13 PU 281 S For Theme ID S11: add Explore the opportunites of Personal Health Records and investigate strategies that consumers are currently using to seek and manage personal health information.
04/13/2005 10:22 PU 272 S Evaluations of media such as social marketing consumer-focused campaigns would be very helpful. For example: Comparisons of radio vs. print as a means of reaching parents with science-based prevention messages Assessments of print campaigns focused on multi-cultural audiences (cultural adaptations of substance abuse prevention booklets, incentives, and or innovative distribution channel such as ethnic-oriented stores, etc.)
04/13/2005 09:59 PU 271 S We must do a better job conveying our surveillance and reference services to the general population. Our current stifling security measures concerning web based databases must be more logically applied. For example, The CDC has the most comprehensive searchable M protein database in the world (currently streptococcal multivalent M vaccine is estimated to be 3-5 years from licensure). Yet results from this frequently used database (thousands of hits per year), used globally by vaccine researchers and others, relies on error-prone email-based servers. Surely the CDC can do better!! I also feel that we should generally convey critical serotype distribution data in a more timely manner. We should not rely so much upon publishing certain key data (which can take an inordinate amount of time), when we can simply display it very accurately and quickly.
04/13/2005 07:49 PU 266 S Research priorities National Vision Program /CDC/ DDT S 2 Data Collection • Identify, develop and establish strategies to develop efficient and effective data collection instruments and surveys. 1. Develop best interventions to improve quality checks and ensure the use of appropriate statistical, analytical, and reporting techniques. 2. Identify the best way to capture and share best interventions. S 8 Electronic Medical Records (EMR) • Explore practices and strategies for using electronic and personal health records for public health. 1. Work with OCHIT in assuring the most effective and efficient use of electronic eye/health data. 2. Provide public health information to EMR to support the creation of clinical decision support tools. 3. Provide public health information to EMR to support the creation of patient decision support tools. 4. Evaluate EMR eye/ health use in health care settings. 5. Monitor and assist with EMR surveillance efforts including participating in the development of the architectural design of a coordinated National Health Information Technology (HIT) System. 6. Assure a linkage of eye/health records into all forms of HIT architectural designs including those related to managed care organizations, government monitored systems and privately linked systems. S 12 Health Communication • Explore strategies to develop effective tools and practices that will translate public health messages into health practices and will inform and motivate people to make behavior changes to maintain healthy lifestyles, improve their health status, and prevent or minimize the impact of disease, injury and disability. 1. Explore interactive web designs that would empower individuals with improved understanding of public health messages. 2. Explore tools; including educational campaigns, that effectively translate messages into health practices.
04/12/2005 17:58 PU 265 S I have 6 comments: 1. Starting with S12, the "examples" provided are far too general -- they are not research activities, but broad categories of research. 2. The expression "populations who aren't familiar with branded organizations" strains credulity. What group hasn't heard of Coke? Are you really talking about populations whose members have negative associations or no associations with certain organizational brands? Precise language is necessary even in a "starter list" for a research agenda. 3. Research cannot identify "best ways." It can show that one way works under the circumstances tested, and/or that, among several strategies that are compared, one is superior. You can write clearly without saying things that are actually scientifically invalid. 4. There is a redundant example -- developing and testing messages -- in S13 and S17. What is this an example of? 5. The meaning of the 3rd bullet in S17 is unclear. 6. The idea of studying message bundling before it becomes CDC policy is an excellent one.
04/12/2005 14:51 PU 264 S • Health Information Services: There is a need to tie together electronically the now disparate dental and medical records systems to pursue research regarding the systemic/oral relationships. The American Dental Association, through its Subcommittee on Dental Informatics, has made significant advances in developing information standards for dentistry.
04/12/2005 11:56 PU 263 S Very good list of key issues in health communication and information. One suggested addition to the Theme list is Media Advocacy. Activities under this theme could include: Explore ways for public health professionals to use earned media to communicate to the public and policy makers about the injury and disease burden and solutions to reduce this burden. Develop and test approaches for developing stronger relations between public health professionals and journalists. Provide journalists will skills to understand the rates, causes, and solutions to public health problems. (goal would be to have more and improved coverage of public health stories)
04/11/2005 09:59 OH 251 S see general discussion comment below
04/11/2005 09:26 PU 242 S Please include data collection on the population categories of: Sexual orientation (lesbian, gay, bisexual, heterosexual) Gender identity (male, female, transgender) Sexual behavior (MSM, WSW, bisexuality, etc.)
04/11/2005 09:23 PU 241 S S16 HEALTH LITERACY - We would like to endorse and encourage your inclusion of this important function in the Research Agenda. The CDC Health Literacy Work Group (currently applied for official status) is working to advance the use of plain language to promote greater literacy on health and prevention matters and behaviors among the lay public. As you discuss and work to incorporate health literacy research as an integral function across CDC, we want to share the following resources to assist your efforts: 1. Report by the Agency for Heatlhcare Research and Quality (AHRQ), Literacy and Health Outcomes, published in April 2004 Available at http://www.ahrq.gov/news/press/pr2004/litpr.htm 2. Report by the Institute of Medicine (IOM), Health Literacy: A Prescription to End Confusion, published in April 2004 Summary available at http://www.iom.edu/report.asp?id=19723 3. Health Resources and Services Administration (HRSA) Resources Available at http://www.hrsa.gov/quality/healthlit.htm Also, please look for upcoming articles on the value and utility of health literacy as a public health function that our Work Group is posting on both CDC Connects (http://intranet.cdc.gov/) and the CDC Communications (http://www.cdc.gov/communication/index.htm) websites. Much continued success in your important work. Linda Carnes DHHS Liaison CDC Health Literacy Work Group
04/11/2005 07:49 PU 238 S Wrong title Should be health services research.....
04/08/2005 14:10 PU 234 S - Develop web-based tutorials for analyzing complex population surveys (e.g. NHANES, NHIS, MAMCS, BRFSS, etc) since internet access to these datasets has greatly expanded the user base and level of expertise. - Develop the technology and analytic approach/capability for interactive survey datasets
04/08/2005 08:45 PU 232 S It would be informative to include here some attention to issues of whether particular means of health intervention (e.g. pharmacological versus cognitive behavioral therapeutic interventions for depression) are being inappropriately over-promoted due to profit or market considerations rather than due to actual outcome considerations.
04/07/2005 19:03 PU 227 S No comment.
04/07/2005 16:14 PU 226 S Competency should not be limited to "literacy" and the targeting of "non-english" speaking individuals. Competency should be broadend to include components relevant to larger aggregations such as communities, inclusive of the embedded diversity or heterogeneity. Thus, in addition to literacy, research should address ways of discerning the signficicance of history, culture, context, geography, positive imagery, salient imagery, language, literacy, multi-generational appeal, and diversity in the development of materials, messages, research instruments and intervention protocols.
04/07/2005 13:47 PU 217 S Impact research
04/07/2005 10:02 PU 207 S Inclusion of social marketing practices in public health
04/07/2005 09:44 PU 205 S Only 2 general comments: 1) Has the topic of bioethics research as it relates to public health information and practice been considered in the other focus areas? As we all know, this can relate to many issues including: a) optimal approaches to obtain consent for minors to participate in public health activities; b) standarization of practices for appropriate linkage of health information; or c) use of stored/maintained biological specimens. 2) Should research efforts include an ongoing evaluation of the "parameters of health" to assess deficiencies in current research approaches or the need for health research changes over time. By "parameters of health", I am referring to the broad spectrum of components that can impact health, namely: a) physical or mental health conditions; b) personal, cultural, or societal behaviors; c) Influences of economic changes or legal decisions; d) community factors (e.g. urban planning); or e) health care factors (e.g. changing prescription drug patterns).
04/07/2005 08:45 PU 198 S Health information services are a means, not an end. Information services should assit programs, not dictate policy to them. CDC successfully aquired almost universal positive recognition by the U.S. public by helping provide top notch infectious disease expertese; not by "marketing" hollow messages to them.
04/07/2005 06:45 PU 190 S Important if not overdone with fancy electronic networks that do little more than impress. Those that will be used are important, such as links to state health departments for reporting, recently developed links for online microbiological diagnostic assistance to physicians and laboratories.
04/06/2005 17:47 PU 187 S Informatics Evaluation. Develop and identify informatics evaluation methodologies for health surveillance and reporting systems. 1. Define the conceptual models for informatics evaluation methodologies. 2. Develop valid evaluation methodogies based in computer science, operational research, business, and lessons learned. 3. Develop toolkits for dissemination and use.
04/05/2005 18:11 PU 172 S All of these areas are deperately needed in health care.
04/04/2005 13:30 PU 156 S More funding and attention needed. More attention on injury prevention and control is needed.
04/04/2005 11:05 PU 147 S Cool. Media research is needed for the public health field.
04/03/2005 21:43 PU 144 S at a minimum, add questions to the YRBS that would capture additional data on childhood drinking such as brand and product preferences, information about extreme use, ie 10+ or 15+ drinks at a sitting, and questions for children younger than 6th grade . the CDC should take up where CAMY is leaving off and monitor alcohol advertising aimed at the under 21 population much useful information could be gleaned from death reports if the CDC monitored every unnatural death for the involvement of alcohol. S3. be sure to inclued change in rules, regualtions and laws in the policy changes you evaluate and develop cost benefit ratios in the same way as they are developed for other programs so the results are cocmparable. S5. it would be wonderful if this could be developed so that all the major AOD surveys could be yield comparable incidence and prevalance data S6-7-9-12. this would be very helpful to the many communities that are trying to set common risk and protective factors and ojectives across all social services in the community and is being promoted by the SPF/ SIG grants from CSAP/SAMHSA. S13-18. are important in changing behaviors which needs to be done if we are ever going to impact the life-style dieseases , including alcohol that cost us the most money and heart ache.
04/01/2005 08:20 DC 142 S Develop a national data base. Include immunizations.
03/30/2005 10:37 DC 131 S Ability to communicate from hospitals to MD to health dept to state labs would improve timeliness of reporting and therefore impact on treatment and intervention
03/30/2005 08:50 DC 123 S If the reporting of healthcare acquired infections becomes a requirement, I feel we need to all have the same reporting computerized system.
03/29/2005 10:57 DC 111 S Timely release of information should be prioritized. Those in the scientific community realize that from research to peer reviewed publication often takes years, but three and five year old data has a hard time being taken seriously by the public and policy makers.
03/28/2005 14:56 DC 104 S As Mandatory Public Reporting of Healthcare-associated Infections is what consumers are asking for, it is imperative that there is a nation-wide emphasis on a specific healthcare-associated infection reporting data system that can be risk-adjusted and utilized by all health care facilities. If not, each state will be devising their own systems that may mislead the public and impact their trust of the Healthcare environment.
03/28/2005 13:29 DC 102 S Priority is preventative health including improved access to health screening and early health care. Basic health information such as vaccination, lab screening data, Xrays, etc should be easily accessible by the person (or parent/legal guardian) when seeking followup health care. Health findings need to be more easily accessible by the individual person.
03/28/2005 10:19 DC 71 S User friendly health surveillance and reporting systems. Coordination of the many systems into ONE would be wonderful.
03/28/2005 10:14 DC 69 S Need more advancement in syndromic surveillance. Better links between our county health departments and the hospitals and doctor offices.
03/28/2005 08:10 DC 59 S Promotion of standardization across all information systems is paramount. Alothough systems exist for surveillance, reporting, etc., they are very costly and smaller organizations cannot afford them.
03/27/2005 16:24 DC 55 S Utilize more social marketing techniques to disseminate the ALREADY known info so the Public may truly benefit.
03/25/2005 11:30 DC 49 S Research regarding affordable methods to protect health information from being compromised by invaders/hackers will need explored.
03/15/2005 00:18 WA 25 S Virtual PICU and other computer software aids in sharing information and should be expanded, research dollars are too expensive to have new information not be shared with other health care groups of similar settings.
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Date Time Type ID Group Comment
04/19/2005 22:38 PU 469 H H5 - Although CDC has a strong focus in the needed area of prevention of disability, there is not a priority on surveillance and research related to the needs of people with disability. For instance, in the well-funded National Breast and Cervical Cancer Early Detection Program, support of programs to serve the hard-to-reach population of women with disabilities is minimal or lacking. The program has made an assumption that these women are covered by Medicaid and thus not eligible for NBCCEDP services. Yet research, to determine actual numbers of women with disabilities who fall through the insurance crack, has not been done. Evidence is available in census and other surveillance tools to determine a population based need for women with disabilities within the intended age-range. CDC has not done this basic study. Thanks. I hope this helps CDC to not overlook this important population.
04/19/2005 17:26 PU 463 H Kudos for H11! H14, adolescent health: don't forget about mental health. We want to prevent suicide and homicide and Columbine incidents by understanding and improving mental health of at-risk adolescents. Social determinants of health, and their interaction with other factors mentioned here (such as genomics), should be thematic for this entire set.
04/19/2005 16:59 PU 462 H Hello, dear workgroup: where have all the occupational exposures gone? The word "occupational" or "workplace" is nowhere to be found in this document. There are very, very strong arguments beyond the space allocated here for adding "workplace exposures" to Theme IDs H3, H4, H6, H10, H12, H14, H15, H17, H19. We're talking about exposed men and women in the workplace (and the culpable exposures include a lot more than chemicals: physical agents including radiation and noise; stress; ergonomic effects which may impact pregnancy; shiftwork and other circadian disruption or sleep disturbance) . We're also talking about whether a working mother should breastfeed. And have you thought about workplaces of handicapped people (H6) or adolescents (H14)? It's time to close this exposure gap. Please add occupational exposure to these questions! [comment from Barb Grajewski, NIOSH and co-chair, NIOSH's National Occupational Research Agenda Reproductive Team]
04/19/2005 16:57 PU 461 H Theme ID# H14 & H15: I strongly suppport the need for translation research related to the prevention of alcohol use among adolescents and alcohol abuse (or, more generally, excessive alcohol consumption) among adults. I would specifically recommend that additional funding be provided to assess effective approaches for mobilizing community support around policy and environmental interventions to reduce underage and binge drinking, including increasing alcohol excise taxes, enforcing minimum drinking age laws, and restricting alcohol outlet density. This translation research would nicely complement the new chapter on the Prevention and Control of Excessive Alcohol Consumption that's being developed for the Guide to Community Preventive Services. However, it would also be useful to conduct additional evaluation studies to assess the effectiveness of various intervention strategies. For example, relatively little is known about the impact of point-of-purchase alcohol marketing and pricing on youth alcohol consumption. In addition, it would be very helpful to assess the cross-over effects of policy interventions directed toward one leading actual cause of death (e.g., alcohol) on another (e.g., tobacco).
04/19/2005 16:23 PU 458 H H-15 Improving Adult Health: This theme puts a disproportionate emphasis on personal behavior. CDC should also address the social determinants of health, structural barriers, and the behaviors of health care providers. In addition, more attention should be given to quality of life and quality of care issues among persons with chronic diseases. H-16 Improving Health of Older Adults This theme puts a disproportionate emphasis on personal behavior. CDC should also address the social determinants of health, structural barriers, and the behaviors of health care providers. In addition, more attention should be given to quality of life and quality of care issues among older adults with chronic diseases. H-18 Care for Children with Chronic Diseases - Coordination of care is an important issue for adults with chronic disease - attention should not be limited to children. H-19 The National Children's Study - this is an activity, not a research theme. If the interest is on the environmental influences on children's health, attention should also be given to environmental influences on adult health. This theme fits more appropriately under Environmental and Occupational Health, NOT Health Promotion.
04/19/2005 16:13 PU 457 H Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:57 PU 456 H I believe we have just started to uncover some of the associations between indicators of mental health, mental illness, and subsyndromal symptomatology of certain mood disorders (e.g. depression, anxiety) with chronic disease and disability. I believe it is appropriate that work in these areas continue and is designated a research priority.
04/19/2005 15:43 PU 453 H It would be useful to engage in research that addresses the many people with more than one disease--comorbidities--and how best to reach them.
04/19/2005 15:31 PU 452 H The group name needs to be changed. We need a specific group for Chronic Disease Research similar to the one for Infectious Disease Research. Health Promotion is a cross-cutting objective or content area rather than its own research group. The research themes are disportionately high for pregnancy, birth defects and developmental disabilities, and child development (H1-H7; H12) and Genetics (H8-H11) in comparison to the three lifespan research themes for all of chronic disease plus injury, violence, HIV infections, STDs and unintended pregnancy (H13-H16). The examples of research activities are very specific for H1-H12 but not for H13-H16 where all of chronic disease is lumped together. Compare H4 to H15. The disportionate number of research themes does not reflect the disease burden in the US or the number of CDC employees working in these areas. Also, what is new in the research activities for H15? All of that is being done now and much of it isn't considering research but just routine surveillance. e.g., (Describe the burden of and risk factors for chronic conditions). This is research?? I think this area needs extensive reworking and input from a broader group of people. This reads as though employees working in reproductive health, birth defects and developmental disabilites, and genetics were either more involved in the drafting of this section or were more successful in getting their issues to the forefront than members from chronic disease research areas.
04/19/2005 15:17 PU 451 H Add 1) integrated chronic disease programs and 2) practice-based evidence.
04/19/2005 14:33 PU 448 H There was nothing in this plan about combining mental health in with traditional notions of physical health, and nothing about studying the effects of "alternative" therapies and integrating these in with community based health interventions, such as yoga and meditation.
04/19/2005 14:20 PU 446 H H2 – Development of programs for better identification of children with fetal alcohol syndrome H3 – Development of educational campaigns to warn women of dangers of alcohol use during pregnancy and measure the effectiveness of such educational campaigns H17 – Include in the community-based participatory research efforts focused on reducing binge drinking in communities
04/19/2005 14:04 PU 443 H For Theme H12, this area is lacking in several important areas of research and especially in the reducing extrememe disparities in birth and maternal outcomes among women of color and the majority populations. Studying the Mechanisms of pre-term delivery is a good start, as is increasing access and quality of care before, during and after pregnancy. Overall this whole list has too much emphasis on genomics (5 themed areas of 20), an area where we don't know as much about with regards to public health impact, what can be done about such factors, and where there are still vast ethical concerns and cost-prohibitive intervention (especially in H8). Contrast that to areas where we need to understand emerging issues of child development (H1, H2, H7), addressing inequitable birth outcomes (H3, H4, H12). The genetics stuff is important to have on the agenda, but in light of the importance of lifestyle factors that we already know are effective, this list seems to give little priority to eliminating health disparities and promoting healthy lifestyles for all regardless of genetics. There needs to be more about promoting research on interventions that work on reducing the health risks to development we already know about: lead poisoning, heart disease, exposure to toxins, air pollution, and poor living conditions, reducing smoking during before and after pregnancy, etc.
04/19/2005 12:21 PU 435 H Theme H16 Study the actual behavioral and environmental contributions to longevity. what factors most support living long and healthy life? What is economic impact of not providing preventive care and promoting healthy environments that support healthy living?
04/19/2005 12:03 PU 434 H This is a very comprehensive and well designed plan. I would encourage the committee to think about addressing the specific health needs of foreign born and refugee populations as they related to increased needs and in preventing the spread of contagious disease.
04/19/2005 11:45 PU 432 H Continue to expand research efforts in follow-up after diagnosis of hearing loss among infants and young children (0 - 4 years) for both hearing loss and speech disorders.
04/19/2005 11:18 PU 430 H CDC needs to better coordinate and utilize scarce resources. It seems that many of the genomics activities overlap NIH activities and divert resources away from other, more difficult prevention activities. The genomics activities further perpetuate prevention activities dependent on allopathic medical care and thus continue the fostering of disparities and blaming the victim. Much more resources should be devoted to population-based, societal impacts on health (not disease).
04/19/2005 10:59 PU 428 H distinct focus on maternal health, nationally and worldwide, to reduce maternal morbidity and mortality and improve fetal, neonatal and child health
04/19/2005 10:23 PU 423 H I recommend that the research activities for H.5 include: Determine infectious disease prevention strategies specifically for persons with developmental or physical disabilities and ways to provide eduction on these strategies for persons with disabilities, especially for those persons with special learning needs (i.e., visual, hearing, or mental impairment). I oppose H.9, H.10, and H.11 on the grounds of privacy, stigma, and negative impact on persons' insurability. I recommend that the first research activity for H.14 include individual-level and group-level interventions. I recommend that the first research activity for H.15 include individual-level and group-level interventions.
04/19/2005 09:59 PU 422 H There is an unwarranted and unbalanced emphasis on child health related research (10 themes) compared to adult health (2 themes). No identified chronic disease prevention themes except imbedded in lifestage goals, whereas birth defects , disabilities and genetics all have identified themes.
04/18/2005 16:26 PU 414 H Create special focus on disparities (ses, race, etc.): as applies to adult & child health (ie: tobacco use, etc.).
04/18/2005 16:04 PU 412 H Although Mental health and Substance Abuse are listed in the Cross-cutting Research category. I think that mental health deserves a greater focus in the health promotion area. For example, there is increasing evidence that depression is linked to health conditions such as heart disease. I am working in the area of physical activity and mental health benefits. I am sure that there are other connections people can make in terms of health promotion and mental health. The CDC Mental Health interest group can be helpful in this regard. Thank you for the opportunity to provide input.
04/18/2005 15:37 PU 411 H The theme titles and examples seem to be disease, individual care issues rather than what is the long time definition of health promotion relating to policy, systems and ecological approaches, such as the Healthy Communities (H 17). There is also a lack of cross-cutting risk factors such as tobacco use/exposure, nutrition, physical activity, which needs additional research in the areas of policy, social support systems, community collaboration, etc. Suggest building on behavioral and social science lit. that exists.
04/18/2005 15:10 PU 408 H As a Medical Anthropologist who previously worked at CDC as a Post Doctoral Fellow, I strongly encourage the institution to support more behavioral research specifically in areas such as cultural behavioral patterns within all chronic disease prevention programs.
04/18/2005 15:01 PU 407 H I realize that the examples given next to each area are not comprehensive but they appeared to favor certain areas more than others. Why is fitness used in multiple examples (H13-14) when other health promotion areas are barely mentioned? Why is depression and psychiatric disorders mentioned only for older adults? These are issues for children, adolescents, and adults as well.
04/18/2005 14:44 PU 406 H Patients with developmental disabilities are very much understudied. As neuroscience has moved forward, this population with the most to gain has been left far behind. Please fund research into making their lives better!
04/18/2005 13:47 PU 402 H The themes that recur within this document include childhood issues, persons with disabilities, genetic issues that relate to chronic diseases, with adolescent and adult health almost an after thought.
04/18/2005 13:42 PU 401 H Include communication disabilities across the age span, including speech (articulation, voice, fluency) and language (receptive and expressive in areas of phonology, morphology, syntax, semantics, pragmatics)
04/18/2005 13:42 PU 400 H I am unclear as to the purpose of the CDC wide agenda, and how it will be used to guide decision making. I've reviewed the HPDP agenda. There is a lack of specificity, and lack of rationale explanation for why some items are a priority and why others are not. The NCCDPHP research agenda of several years ago is a better approach.
04/18/2005 13:16 PU 398 H CVD and its risk risk factors (which are greatly increasing in their prevalence) are a global problem not just limited to industrial countries but also is rising in the developing areas such as China and Africa. By 2030, there will be 24 million annual deaths world-wide will be due to heart disease and stroke and 6 million will be in China--much of it related to increasing obesity and high blood pressure. We need more primary and scondary prevention and translation research addressing how best to remove barriers and improve compliance with treatment, lifestyle, policy, and environmental recommendations. CDC needs to make significant efforts to improve the effectiveness of the IRB and OMB review processes because the extensive delays (perhaps due to staff shortages) are causing signifcant harm to the conduct of research. OMB clearance is, by law, to be completed in 60 days but the average clearance time is 12 months at CDC. And IRB isn't much better.
04/18/2005 12:35 PU 394 H Dear Spengler and Dr. Wagner: Thank you for asking the Tourette Syndrome Association, Inc. (TSA) to comment on the CDC Health Protection Research Guide, 2006-2015. We are excited about the opportunity and look forward to positive outcomes. Unfortunately I was unable to attend, nor was I able to send my staff to any of the four Public Participation Meetings. The very quick turn around time precluded our participation. We at the TSA feel it is very important to include the External Partners in any discussion and subsequent agenda development. I encourage the CDC not to move forward without input from each member of the External Partners Group. The themes you have identified in focus area #5 are of great concern to the TSA and the people we serve. We are concerned that our inability to participate in this process at this time, will keep issues effecting people with Tourette Syndrome from inclusion in this most important Agenda. We look forward to hearing from you and having the opportunity to provide our input. Sincerely, Judit Ungar President Tourette Syndrome Association, Inc. judit.ungar@tsa-usa.org
04/18/2005 12:19 PU 393 H The Starter List for this category leans too heavily towards victim blaming and genetics. While it is important to both help individuals change their behaviors and to understand the contribution of genetics, it is much more important and the benefits are much greater if we place the emphasis on understanding the social and environmental contexts that encourage, promote and most importantly enable healthy living.
04/18/2005 12:11 PU 392 H Study rates of addictive behaviors over time (including overeating) to see if they are on the increase; study ways public health could help prevent or treat these problems
04/18/2005 11:45 PU 391 H EXCLUSIVE BREASTFEEDING TO BE PROMOTED FOR THE FIRST 6 MONTHS OF LIFE AND THE IMPACT ON CHRONIC ILLINESSES- DIABETES, OBESITY, HIGH CHOLESTERAL LATER IN LIFE.
04/18/2005 11:44 PU 390 H Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16. http://www.rsvpbook.com/custom_pages/792_public_comment.php
04/18/2005 11:15 PU 389 H Excellent start concerning topics of vital importance, but that are often overlooked.
04/18/2005 10:21 PU 388 H I feel we need to do whatever it takes to fund the National CADDRE study. It is the most comprehensive study of its kind looking into risk factors for and causes of autism. In order to say we are doing all that we can for those affected with autism, this study is an absolute necessity.
04/18/2005 10:00 PU 386 H Theme H-16: Improving Health of Older Adults - add tobacco cessation.
04/18/2005 09:41 PU 385 H I noticed under Cross-Cutting Research there was a suggestion to address mental health and substance abuse. Under "Improving Adolescent Health" there is no mention of addressing mental health among adolescents. This needs to be included for both children and adolescents, since mental health is related to behaviors. Also, I didn't see a mention of quality of life in this section for adolescents and adults (it was mentioned for older adults). Measures of life satisfaction and quality of life in relationship to program evaluation would be salient to examine; the subjective well-being of individuals at all life stages is important to consider when thinking about health promotion.
04/18/2005 08:36 PU 382 H Fund programs designed to help people (especially older adults) obtain a greater amount of assisance to navigate health services. This will foster higher quality of life and timely use of appropraite services. Greater research on understanding and increasing effectiveness of small dosage follow up education booster sessions for older adults and for rehabilitative services
04/18/2005 07:52 PU 378 H Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16.
04/18/2005 07:27 PU 376 H Mental health promotion (including early identification and treatment) should be a prominent component at every stage of development especially for infants, children, and adolescents.
04/18/2005 06:57 PU 375 H 1) Under "research Theme...Optimal Child Development" (theme ID H1), recommend ammending second half of sentence to read: "...including conditions that cause significant mental or physical disability or illness, reduced quality of life for children and adolescents and their families, and death." 2) Under Examples of Research Activities Theme ID H1, add bullet: "Monitor the benefits, use and outcomes of early identification of and intervention for developmental disabilities and other cognitive, social, emotional, or behavioral health problems of childhood and adolescence."
04/17/2005 12:20 PU 369 H In H3, "maternal exposures," "environmental exposures" and "social factors" each include work and outside work issues. If this is not the intended message, it should be. If this message might be missed, then the language should be changed to make it clear. Similarly, H9, H12, H14, H15, and H16 include important workplace aspects. If this is not the intention, it should be and the language should make it clear.
04/15/2005 14:24 PU 364 H Given that many of the focus areas of health promotion research deal with conditions/diseases that are multifactorial, the current research starter list is too general. A greater specificity within the research agenda needs to be developed. This specificity should address the specific risk factors/correlates/determinants of these conditions. For example, the exploration of the moderators and mediators of physical activity (a fundamentally important health behavior linked to many chronic diseases/conditions) needs to be expanded across the spectrum of prevention - from primary through therapeutic, and rehabiliative/restorative applications. This level of specificity has relevance across many of the stated focus areas, especially child/adolescent health and development; disparities; and disability (where the consequence of inactivity often far outweighs the consequence of impairment or presence of a condition per se).
04/15/2005 14:22 PU 363 H The focus needs to be on differing needs (social, emotional, etc.) and tasks that people have during various stages of their life span. For example, the need for socialization and interaction with peers is especially important for teens and early adults who are trying to meet the developmental tasks (Erickson's) of trying to establish an identity and intimacy. Additionally, research needs to be conducted into how people in differing life stages react and adjust to the onset of a chronic illness or disability especially mental illness which is predominately diagnosed in late adolescence and early adulthood. Last but far from least..... we need more research into the impact pain medications have on improving the quality of life of people with painful chronic disorders and disabilities. Many people are trying to self-medicate with alcohol and over the counter medications which are more harmful to their livers that properly administered and supervised long term pain meds. Nancy J. Adams, Ph.D. CRC Assumption College Wocester, MA Nadams@assumption.edu
04/15/2005 14:15 PU 362 H To Theme H14, "Improving Adolescent Health", under "Examples of Research Activities", would suggest adding the following : " Develop and evaluate interventions to promote health and prevent secondary physical and mental health conditions for adolescents with chronic medical illnesses (e.g., obesity, diabetes, cancer, HIV infection)"
04/15/2005 14:13 PU 361 H The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 13:36 PU 360 H Most important issue. I suggest that CDC fund Evidence-based best practice community-wide social ecological primary prevention interventions to address physical inactivity, poor diet and other lifestyle patterns, instead of fragmenting communities into less meaningful pieces. We must address lifestyle problems within the context of where people live.
04/15/2005 09:34 PU 350 H I would like to see greater effort focused on finding the cause(s) of SIDS. I have worked in Law Enforcement for over 15 years and have seen firsthand the devistation it has caused families. I have been in the homicide unit for the past 5 years and our protocol requires a response to all infant death scenes. I feel that a national standard/protocol regarding infant death investigation could assist with gathering valuable data that may help lead to a greater understanding of SIDS and therefore prevent needless deaths.
04/15/2005 07:38 PU 346 H H 13, H14 It is essential that research be implemented at CDC to better understand the determinants of what we can do to help keep children healthy. It is important to study those determinants at the individual, family, school, and community level. A longitudinal research study such as Healthy Passages (currently collecting baseline data on 5th grade children, their parents, schools, and neighborhood) will provide a scientific basis for the development of social and educational policies and interventions to help keep children and adolescents healthy. The study will help us understand the relative contribution of important, multilevel factors that influence health behaviors and outcomes across time as well as understand the factors that cause disparities in health, educational, and social outcomes by race/ethnicity and gender. As Healthy Passages is designed to assess kids and their parents biennially until they kids are 20 years old, the study will also help us understand how to improve adolescent health.
04/14/2005 15:48 PU 339 H Important - whenever can prevent we save money and quality of life.
04/14/2005 14:18 PU 337 H No comments.
04/14/2005 13:57 PU 335 H The CDC should not focus on genetics except as it relates to birth defects or elevates risk of occupational diseases. The CDC should be focusing primarily on the impact of environmental and behavioral factors that contribute to higher rates of injury and disease, not DNA's contribution.
04/14/2005 13:49 PU 333 H I was very happy to see that the item on adolescent health included reducing unintended pregnancy, but was sorry to see that in the next column this translated only into reducing unsafe sexual behaviors. It is obviously critical increase adolescent's knowledge about and access to contraceptives and abortion services, and those items should be included in the agenda. I would also recommend including contraceptive use and access in the adult health sections. It is inadequate to include only a passing mention of "improving pre-prgnancy care" but rather an item on women's health which includes better understanding barriers to contraceptive use and promoting health sexuality should be included.
04/14/2005 13:26 PU 332 H Maternal immunization is an important strategy for improving maternal and infant health and research in this area should be included. Developing effective strategies for optimal use of vaccines (influenza, pneumococcal, and ultimately zoster) in older adults should be included.
04/14/2005 12:38 PU 328 H It seems that we can have the biggest impact by conducting community-based health promotion efforts that target life-styles and behaviors related to health. Often, unfortunately, this means getting people stop doing things considered to present a risk to health. True health promotion should focus on helping people maximize healthy behavior and life style choices within the paprameters of their culture and socioeconomic realities.
04/14/2005 12:14 PU 323 H I would like to see a proposed research addition to research theme: "imporve data to better prevent sudden, unexplained infant/toddler deaths (SUID) in the United States.SIDS is the most common reported SUID and is the leading casue of infant death among infants 28-364 days. Planned research should include: * Evaluate the effectivenss of the newly revised Sudden, Unexplained Infant Death Investigation Reporting Form(SUIDIRF) in improving data qualitiy on the death certificate. *Evaluate the utility and acceptability of the SUIDIRF among coroners, medical expaminers and death scene investigators in the US *Pilot test and elcectronic reporting system whereby those conducting infant death scene investigations can submit data from the SUIDIRF among coroners and medical examiners thus enhancing the the capacity if the medical examiner/coroner to assign cause and manner of death. Create a surveillance system whereby thedata from the SUIDIRF would be submitted to the CDC along wih the death certificate to assist in monitoring trends and identifying newly emerging risk factors in SUID *Conduct analytical studies usings data from the electronic system to identify risk factors amenable to prevention. Respectfully, Deborah Robinson Infant Death Specialist SIDS Foundation of WA
04/14/2005 12:13 PU 322 H Health promotion research should be placed at number 1.
04/14/2005 11:05 PU 315 H Consider using family history to stratify risk. The public has not responded well to the "one message fits all". We need to consider targeted messages.
04/14/2005 10:54 PU 313 H We suggest adding a new theme to the "H" list. Our proposed research theme title and description is, "Improve data to better prevent sudden, unexplained infant deaths (SUID) in the US". There are currently about 5000 SUID each year in the US. Sudden infant death syndrome (SIDS) is the most commonly reported SUID and is the leading cause of postneonatal death, that is deaths among infants aged 28 to 364 days. Planned research activities include: * Evaluate the effectiveness of the newly revised Sudden, Unexplained Infant Death Investigation Form (SUIDIRF) in improving data quality on the death certificates. *Evaluate the utility and acceptability of the SUIDIRF among coroners, medical examiners, and death scene investigators in the US. * Pilot test an electronic reporting system whereby those conducting infant death scene investigations can submit data (from the SUIDIRF) directly to the medical examiners prior to autopsy thus enhancing the capacity of the medical examiner/coroner to assign cause and manner of death. *Create a surveillance system whereby data from the SUIDIRF would be submitted to CDC along with the death certificate to assist in monitoring trends and identifying newly emerging risk factors in SUID. *Conduct analytical studies using data from the electronic surveillance system to identify risk factors amenable to prevention. Under H12: We suggest adding the following research activities: * Conduct analytical studies to determine the risk of morbidity and mortality among near term infants (aged 34 to 36 weeks) compared to term infants. * Conduct analytical studies to determine risk factors for fetal death.
04/14/2005 10:39 PU 310 H This research area should include research on the trends in chronic disease prevalence and disablity prevalence among various age groups (children, adults & older adults).
04/14/2005 10:30 PU 307 H We really need to start looking at non-traditional data sources. If >80 percent people with diabetes see their diabetes provider every year how come <70% report receivng the recommended preventive care services. We can't dig deeper to find the answer because we dont' know a whole lot about what their insurance covers and what are the barriers preventing them from getting these basic tests/exams.
04/14/2005 08:07 PU 298 H Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16.
04/14/2005 08:06 PU 297 H CDC Recommendations Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16. http://www.rsvpbook.com/custom_pages/792_public_comment.php
04/14/2005 08:06 PU 296 H CDC Recommendations Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16. http://www.rsvpbook.com/custom_pages/792_public_comment.php
04/14/2005 07:51 PU 295 H CDC Recommendations Research Theme: Health Professional Training and Treatment Impact Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes. Add “vision loss” to e.g. in H16.
04/13/2005 18:52 PU 293 H This is a call for CDC to addresses the health disparities mentioned in Healthy People 20101 regarding race and ethnicity; gender; and disability. Chapter 19 of the national health agenda1 highlights disparities in obesity prevalence rates, citing 38% for women with a disability compared to 25% for women without a disability and 38% for African American women compared to 23% for non-Hispanic White women. Funding opportunities are needed to first obtain preliminary data on the feasibility of a disability-sensitive weight management and health promotion program for women with physical disabilities. Once feasibility and then efficacy are establised, large-scale trials should be funded to ameliorate and/or prevent obesity and overweight in people with disabilities whose mobility limitations may serve as additional barriers to exercise and other health behaviors.
04/13/2005 16:31 PU 290 H Given the growing population of older Americans, this is also one of the top three research priorities that the CDC coudltake a critical lead on.
04/13/2005 15:26 PU 284 H Would like to see much more research and dissemination of information on connective tissue disorders such as Ehlers-Danlos Syndrome, which is sadly under-diagnosed and may in fact comprise more than 30% of the Fibromyaligia, Lupus and Chronic Fatigue population. I am President of an Information & Support group for EDS and speak daily to patients that have been badly harmed by medical treatments, especially surgery, which were completely ignorant of EDS complications or that would have been better cared fro with alternative means such as chiropractic, massage and accupuncture. The gene for the most prevalent type, hypermobility, has not been found, nor has proper pain control been established for these patients. Instead, almost 100% of funds are still diverted to the Vascular form, which comprises less than 10% of the EDS sufferers. It has lately been documented that over 38% of the hypermobile patients may also be at risk for vascular and heart problems too, so attention to their care needs to be addressed, and their risks for serious internal problems disseminated for ALL doctors to learn about.
04/13/2005 10:37 PU 273 H research on health promotion instead of HIV disease prevention for men who have sex with men, particulalry in the current HIV epidemic (vs the old AIDS epidemic)
04/13/2005 10:22 PU 272 H Alchohol, inhalant and other drug prevention as a means of decreasing birth defects long term.
04/13/2005 07:49 PU 266 H Research Agenda: National Vision Program (NVP) CDC/ Division of Diabetes Translation (DDT) NCCDPHP H 1 Optimal Child Development • Develop a research- to- practice initiative to promote and improve access to diagnosis, referral and intervention for developmental conditions of childhood including amblyopia and dyslexia. 1. Implement and evaluate coordinated treatment services for children with amblyopia and dyslexia. 2. Develop programs that addresses HP 2010 objectives 28.2, 28.3, 28.4. 3. Identify factors that promote or hinder early identification, diagnosis, and treatment of amblyopia and dyslexia. 4. Determine if refractive errors play a role in social, emotional or behavioral problems (ie.ADD) of childhood and early adolescence. H 3 Healthy birth outcomes • Identify and assess the impact of maternal exposures on birth outcomes. 1. Identify new risk factors ( CMV, Toxoplasmosis, Toxocariasis, etc.). 2. Implement interventions before and during the pregnancy. 3. Expand primary prevention programs for birth defects. H 7 Epidemiologic Studies on Child Development • Study the prevalence of risk factors among children in order to improve public health planning. 1. Study the possible connection of uncorrected refractive error and ADD. H 10 Develop Family History as a Tool for Prevention • Develop and evaluate strategies that use family history to promote awareness of risk and motivate prevention behaviors. 1. Activities are being developed to evaluate the usefulness of risk assessment screening and the usefulness of family history in early disease detection and intervention of adult vision diseases and disorders. 2. Develop and evaluate provider and patient education tools. H 13 Improving Children’s Health • Develop, implement and evaluate strategies that enable families, schools and communities to improve children’s health and fitness. 1. Research the most effective ways to increase interventions such as the delivery of vision health services in school settings. 2. Measure the effectiveness of school policies and programs related to vision. H 16 Improving the Health of Older Adults • Develop and implement strategies to establish and maintain behaviors during older adulthood that sustain health and reduce the risk of chronic disease and disability, maintain the quality of life, and decrease health care costs. 1. Assess the burden and risk factors for chronic eye diseases (BRFSS, NHANES, Economic Studies). 2. Develop effective public health interventions to prevent or delay the onset of chronic eye diseases. 3. Prevent or control complications and disabilities that result from chronic eye diseases. 4. Promote preventive services 5. Develop and implement interventions to maintain quality of life including both mental and physical.
04/12/2005 14:51 PU 264 H • Health Promotion: Oral health care can be difficult to obtain for children with developmental conditions. Many patient advocacy organizations exist to support or provide research dollars to expand research aimed at improving access to care. Cleft lip & palate, ectodermal dysplasias, and Sjögrens Disease are just a few of the conditions which could be aided by timely availability of oral health care. Given the growing evidence of a link between periodontal disease and low birth-weight babies, the development of model programs for pre-pregnancy care should include oral care. We commend the CDC for including research to increase the delivery of needed oral health services in school settings. School delivery mechanisms are a logical means to address the low prevalence of preventive services such as dental sealants, and the lack of needed restorative care in lower socio-economic groups. Initial studies have shown that tobacco cessation conducted in the dental office can be effective and are in fact desired by patients; nonetheless, yet such services are not offered on wide-spread basis. Dental Practice-based Networks, soon to be supported by the National Institute of Dental & Craniofacial Research, may offer an avenue for testing such interventions. Lastly, oral health issues should most definitely be included in the National Children’s Study to provide answers to questions related to the incidence of tooth decay, dental infection and pregnancy outcomes and to compare total fluoride exposure and enamel fluorosis at the individual level.
04/11/2005 15:51 PU 258 H This list seems very broad except for the genetics part. I am not sure how such a list will help select priorities as I could fit just about everying under the chronic disease "sun" under this framework.
04/11/2005 09:59 OH 251 H see comment on general discussion below
04/08/2005 08:45 PU 232 H Should this also include a focus on the prevention of childhood maltreatment, given research on the long term physical health effects of such experiences? So, should this category include longitudinal research of that sort?
04/08/2005 07:39 PU 230 H H17- Impact of SHS policy on community wide health concerns.
04/08/2005 07:30 PU 229 H CDC should revisit the basic tenets of oral health promotion and disease prevention. To support public health research that evaluates the effectiveness of many dental prevention activities that have been place for decades but have not been systematically evaluated within the past couple of decades--given the demographic and lifestyle shift of the US, many of the core dental prevention activities may not be as effective as they were once. Such research would stimulate the development of more relevant and meaningful oral health promotion.
04/07/2005 19:06 PU 228 H Please take into consideration the thousands of community anti-drug coalitions that are raising awareness of the substance abuse issue, coalescing communities to address the issue, and developing effectivie strategies and programs to prevent and reduce substance abuse and its harm to the community.
04/07/2005 19:03 PU 227 H Research which attempts to determine why public health meassages regarding iknown injury prevention strategies, and effectife marketing of these messages would be very helpful. For example, we need to know how to make sure that the public health prevention messages are effective with hard to reach populations. For example how can we do a better job of convincing low income, high risk-families of the importance of using seat belts and child passenger safety seats, helmet, etc.
04/07/2005 16:14 PU 226 H Interesting the heavy focus on genomics. In any case "healthy communities" is hopefully sufficiently substantive to include targeted efforts to race/ethnic communities, including L/G/B/T communities. A focus on disparities would require a targeted effort related to community development (capacity and infrastructure + social capital). Baseline measures of capacity and infrastructure (e.g., research/researchers, programs, leaders, organizations, networks)) needs to be discerned (new methodologies are needed) and developed (intervention protocols consistent with an emphasis on community development). Capacity and infrastructure should be given priority relative to social capital (e.g., cooperation, collaboration, trust); although both are important.
04/07/2005 16:11 PU 225 H Please consider dedicating research dollars to what works in the prevention of youth substance abuse.
04/07/2005 10:20 PU 210 H I would like to see more research on strategies/mechanisms that have been proven effective in communities for a variety of disease.disability states but have not been included in 'gold standard' comparison group studies. For example, the use of promotoras or community health workers at all levels of research including community mapping, program development, material production, evaluation planning and implentation, etc. The advantage is that this proven strategy can be used across various disease prevention efforts
04/07/2005 09:24 PU 202 H Need to prioritize translation research. Focus should also be specifically on intervention research for prevention.
04/07/2005 08:53 PU 199 H Under H14(Improving Adolescent Health) and H15 (Improving Adult Health) where specific diseases are mentioned please include asthma. Asthma along with emphysema and bronchitis is the 4th overall leading cause of death, 3rd for those 55-64 year, 4th for those older than 65 years, 7th for those 5-24 years and 9th for those 45-64 years. Asthma is commonly believed to be the most common chronic disease of children. Although there is no cure for asthma currently, health promotion research on treatment and prevention of exacerbations is crucial to address the rising prevalence over the last 20 years.
04/07/2005 08:16 PU 195 H For item H 14 Improving Adolescent Health Develop and implement strategies to establish health behaviors during adolescence that promote lifelong health and reduce the risk of the leading causes of illness and death among youth and adults, asthma is not included. Asthma is a leading chronic condition among children and youth, a major cause of school absences (with almost 15 million days lost due to asthma in 2002), and the 3rd leading cause of hospitalizations among children and youth under 15. I think this makes it a leading illness among youth, and therefore, it should be included in the list of health topics decribed in item H14. Thanks for considering my request.
04/07/2005 07:02 PU 191 H Consider the development of an Office of Exercise Anthropology and Extinct Exercise Epidemiology. One focal question to research is the evolutionary location of the genetic marker for coronary aretery disease and diabetes, i.e. how far back in time does the inheritance of CAD and IDDM occur in hominids? Why did it occur? Can it be reversed? What, if any, evolutionary genetic protection mechanisms where present? What were the dietary factors? Were the genetic markers for obesity present in the early hominids? What differences occured in the physical activity patterns in nomadic desert dwellers compared to dense vegetation dwellers; these effects on death rates and birth rates; these patterns compared to comtemporary physical activity patterns? Etc., etc., etc.
04/07/2005 06:45 PU 190 H Chronic diseases resulting from tobacco are the major preventable disease category in the U.S. Inverstment in this area would be health cost efficient, very important. Genetic diseases, birth defects, disabilities also important because of the cost of caring for tvictims of these. This is not intended as a cold cost/benefit analysis, but in consideration of family expenses, which are many times unaffordable.
04/07/2005 06:44 PU 189 H Stress and burnout have been named as influencing factors that lead to risky behaviors in numerous studies in both clients and providers (i.e., HIV, STD, smoking, violence, less attention from care providers, less effective prevention counseling). I respectfully submit the addressing stress and burnout would improve decision-making skills and decrease risky behaviors. vem4
04/05/2005 23:13 PU 175 H obesity appears to be one of the major challenges public health. research needs to continue on how to get people to exercise more.
04/05/2005 14:55 PU 169 H CDC I appreciate the opportunity, on behalf of the Ohio Department of Mental Retardation/Developmental Disabilities to provide input into your long-range plan for research projects. My suggestions are the following: · Research into the causes of autism and the appropriate treatment once it has been properly identified; · Research to help eliminate the effects of Fetal Alcohol Syndrome (FAS) onthe individual; and · Public messages around alcohol and drug usage especially to women who are pregnant or contemplating pregnancy and around child protection (e.g. shaken baby syndrome, using car seats, etc.) If you would like detailed information on these topics, I would be happy to provide that to you. Thank you Ken Ritchey, Director Ohio Department of Mental Retardation Developmental Disabilities
04/05/2005 11:11 PU 159 H See above comments. Health Promotion should be targeted as a systems level intervention. That is, at a cultural, school, family, institutional, religious level. Am interested in establishing a community-wide program that begins at the local children's Hospital. I am a Ph.D. specializing in pediatric psychology. How could I get funding to establish a health promotion program???
04/04/2005 14:19 PU 157 H I believe that intentional injury should be included in this list
04/04/2005 13:30 PU 156 H More attention on injury prevention and control is needed.
04/04/2005 11:47 PU 152 H The research priorities should not include chronic diseases prevention only. It should also include chronic disease control. Because there are very many chronic diseases that one can not prevent them, but the control of these chronic diseases are possible.
04/03/2005 21:43 PU 144 H Every one of these themes should be run through the AOD lens, since FASD is a developmental disability and childhood alcohol use leads to developmental delays and disabilities. H1. easy pediatric tests for FASD need to be developed and used in birthing centers and hospitals and taaught to docs. beter dianostic tools need to be developed to determine the placement of a child's FASD disabilities. H2. since FASD is the only known preventable cause of birth defects, it shoudl get a high proirity in your studies. moe and more babies andchildren are coming into the world affected by meth and other drugs and that should be studied too. schools criminal justice systems and others who deal with the growing child sould be educated in the signs and symptoms of FASD and how to interact effectively with FASD children. H3-4. the ATOD use of mother and father should be assessed, etc. H5-7. be sure FASD and AOD use is considered in the studies H8-9. it would be nice to know more about the intergenerational passage of addiction and the role genes and environment play. H10. family histories should include a prompt for AOD addictions or abuse H12. don't forget the risk of alcohol use/abuse in maternal and child health. the impact of alcohol in breast milk on the baby's loong and short term health or increased seceptibilty to later addiction. don't forget the paternal use of AOD on the babies outcomes. H13-17. besides measuring and sending to parents the BMI index of children, like information about school based eye exams, please evaluate the impact that community anti drug coalitions have in improving the health of children and families. alcohol is a contibuting factor of many of hte cronic dieseas you list so inculde community coaltions in your research. H19. alot of useful information can be gleaned from the NCS, especially if alcohol is considered as one of the toxins. whichi it is to the brain pre- and post-natal. it is a disease with a genetic and environmental component that needs further study.
04/01/2005 07:08 PU 136 H Add “vision loss” to e.g. in H16.
04/01/2005 06:48 PU 135 H Research Theme: Health Professional Training and Treatment Impact  Comparison of providers and their relative success in identifying new cases of (e.g. eye disease) and success in referring for specialty treatment.  Look at general physicians, nurses, LPN’s PBA’s, etc. and how each group does with case finding and why. Research Theme: Vision Screening  Measure community-level interventions related to adult vision screening, referral, follow up, and brought to treatment versus public and professional education versus doing nothing.  Assess vision screening tools for sensitivity and specificity, particularly screening related to glaucoma and diabetic retinopathy. Research Theme: Children’s Eye Care  Measure need and long-term economic and educational impact of children receiving early vision screening/eye exam versus children receiving no eye care services.  Measure # of children who get their vision assessed and where – primary care setting, eye doctor, early childhood education setting. Research Theme: Measure Impact of Diabetes on Vision  Measure obesity data and its impact on diabetes and the development of diabetic retinopathy.  Measure the rate and onset of diabetic retinopathy in obese adolescents with diabetes.
03/30/2005 11:55 OH 132 H As chief of Communication and Training for Ohio's single state authority on alcohol and other drug prevention, treatment and recovery services, I'd like to address the CDC&P's role in raising the awareness of serious health concerns such as FASD prevention and alcohol and drug abuse by our youth. Although Partnership for a Drug-Free America and ONDCP do a good job with a media campaign about drug use, very little is said about the devastating effects of alcohol use on youth brain development and the development of the fetus.
03/30/2005 10:37 DC 131 H Disseminate brochures, videos or training material to be used in community wide education
03/30/2005 08:48 OH 121 H A major research agenda should be mounted on the behavioral and environmental aspects of preventing obesity. Research suggests that treatment of obesity is not a promising public health approach. Ergo, a major initiative is to focus on prevention of obesity among children and young adults. A second major research agenda for CDC could be translation research in which evidence based programs are carefully studied for mechanisms of action. What aspects make the programs effective? Another dimension to this initiative would involve dissemination studies in which processes of program diffusion are studied and refined. A final dimension to this initiative would be sustainability of effective interventions. Cost-benefit studies could carefully document esstential program support efforts and the costs of these efforts. This would create a more realistic conception of program sustainability. Often it is now assumed that effective programs generate political and community support once effectiveness is established. I do not believe this is the case for prevention programs. Effective prevention tends to undermine public support by reducing the visiblity of the targeted health problem.
03/29/2005 14:18 OH 117 H Oral health has implications relevant to all the chronic disease programs established by the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), including cancer control, diabetes, healthy aging, healthy youth, heart disease and stroke, nutrition, safe motherhood, and tobacco. Additionally, several reports have provided evidence for the potential correlation between oral diseases such as periodontal diseases, and systemic disorders such as cardiovascular disease and adverse pregnancy outcomes. For these reasons, the topic of the role that oral health has on an individual’s overall health should be added to its research agenda. The feasibility, efficacy and cost-effectiveness of integrating rapid HIV –testing in dental clinics were highlighted in the CDC’s Division of Oral Health Research Opportunities. This should be expanded to include additional infectious diseases such as the hepatitis B and C viruses, oral diseases such as caries susceptibly, periodontal disease and oral cancer, and systemic disease such as diabetes and cancer. Thus, this topic should be expanded to include research on multiple forms of salivary diagnostics as well as potential applications, practice implications, economics, and liability issues. In line with this, research is needed regarding the role of dentistry in the screening of systemic disease and the development of guidelines for referral to medical specialties for corresponding diagnosis and treatment.
03/29/2005 10:57 DC 111 H There is a disturbing lack of research about tobacco use cessation for youth. Many people under the age of 18 have been smoking for a few years and would like to quit, but services are limited and proven programs are non-existent. Tobacco use is no longer the sexy research topic it once was, but it is still the number one preventable cause of death.
03/28/2005 13:29 DC 102 H There is a perceived significant widespread increase in persons with severe allergies, asthma, autoimmune diseases, lung disease, diabetes, etc. These conditions seem to be affecting more children, and environmental issues are a concern. A renewed focus on prevention and control measures is needed to improve quality of life.
03/28/2005 12:40 DC 90 H Would like to see public service TV ads for handwashing for children and adults.
03/28/2005 11:05 DC 75 H Here again, it would be nice for all to download and adopt a standardized educational process which has been carefully researched as to the effect of the educational approach.
03/28/2005 09:17 DC 65 H Obesity is a epidemic in North America. This is an important research area to focus on with the outcome affecting chronic disease and disabilities.
03/27/2005 16:24 DC 55 H They should use Health Promotion techniques to promote the information they ALREADY know, instead of "Keeping It a Secret" by using the same old techniques.
03/25/2005 11:30 DC 49 H Prevention of obesity needs to top the agenda items. Obesity in children is becoming far too common. As children age, the incidence of other chronic diseases that can be related to obesity, such as heart disease, will continue to rise.
03/24/2005 11:51 OH 42 H I would like to comment on theme ID# H3, Health Birth Outcomes. In general I strongly support this research theme. What is missing however is implicit inclusion of injuries and violence among the types of maternal exposures that may lead to adverse birth outcomes and the need to specifically acknowledge trauma as more of a priority for maternal exposure prevention. Although violence during pregnancy has received some attention (I commend CDC for the 1997 publication on “Key Scientific Issues for Research on Violence Occurring Around the Time of Pregnancy”), research has shown that unintentional injuries are an even greater burden during pregnancy. However, they are not mentioned in the Research Agenda for Injury Prevention priorities nor have they received much attention from the Reproductive Health Branch. Recent linkages between ED visits and birth records in one state showed that about 4% of all pregnancies involved an ED injury visit during the pregnancy. Among leading mechanisms, motor vehicle occupant injuries accounted for (22%), falls (17%), cutting and piercing (10%), struck by/against (10%), overexertion (8%), and poisonings (3%). Among the injuries with known intent, 92% were unintentional, 7% assaults, and 1% self-inflicted. This translates to over 160,000 ED level injury exposures per year with little follow-up if the impact on the baby. Schiff & Holt recently reported large relative risks for placental abruption among women hospitalized for severe, non-severe and minor motor vehicle injury (9.0, 4.8, 6.6, respectively) [Pregnancy Outcomes following Hospitalization for Motor Vehicle Crashes in Washington State from 1989 to 2001. Am J Epidemiol, 161(6), 503-10, 2005]. Yet little work focuses on expanding primary prevention programs for these events. It is an area that needs its own research agenda and needs to be included in both the Health Promotion and Injury Prevention Workgroup research priorities. Currently this area of research need is claimed by no CDC Coordinating Center. It needs to be claimed by both in a coordinative fashion. Cordially, Hank Weiss MPH, PhD Director and Associate Professor Center for Injury Research and Control University of Pittsburgh Building/Room: Scaife 532D Mail: 200 Lothrop St., Suite B-400 Pittsburgh, PA 15213 hw@injurycontrol.com or weisshb@upmc.edu Phone: 412/648-9290 Fax: 412/648-8924
03/11/2005 07:02 GA 18 H primary prevention Contraception
03/04/2005 08:23 DC 10 H 1. Need to emaphasize the need for longitudiinal studies on idenitfying effective intervention strategies to reduce the incidence of secondary conditions in people with disabilities. 2. Evidence based practice-health promotion and wellness for people with disabilities. 3. Disaparities in health screenings for disabled and non disbled populations.
02/23/2005 14:17 WA 3 H It will be important to find ways to more fully engage consumers and patients in their health and health care. Tailoring care to patients' level of knowledge skill and confidence for self-management is an important direction for more fully engaging patients. Improving support for the patient role in care is an important component of quality that is not currently being measured, but one that could make a huge difference in costs and outcomes.
02/22/2005 09:17 OH 2 H We need to recognize that the single biggest public health problem not already being addressed by NIH is the epidemic of poor quality medical care. NIH and AHRQ have not responded adequately. Having CDC lead this effort would be important as a signal that the public health impact of this problem is enormous. Thus, the best thing CDC could do to promote health would be to make sure medical interventions are applied and applied correctly whenever they are appropriate (and are not used when they are not appropriate).
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Date Time Type ID Group Comment
04/20/2005 09:53 PU 473 I INOCULATIONS: THE TRUE WEAPONS OF MASS DESTRUCTION CAUSING VIDS (VACCINE INDUCED DISEASES) (AN EPIDEMIC OF GENOCIDE) by Rebecca Carley, M.D. Court Qualified Expert in VIDS and Legal Abuse Syndrome January 2005 “One basic truth can be used as a foundation for a mountain of lies, and if we dig down deep enough in the mountain of lies, and bring out that truth, to set it on top of the mountain of lies; the entire mountain of lies will crumble under the weight of that one truth. And there is nothing more devastating to a structure of lies than the revelation of the truth upon which the structure of lies was built, because the shock waves of the revelation of the truth reverberate, and continue to reverberate throughout the Earth for generations to follow, awakening even those people who had no desire to be awakened to the truth.” (by Delamar Duvaris as written in the preface of “Behold the Pale Horse” by William Cooper). The basic truth that served as the foundation for the mountain of lies known as vaccinations was the observation that mammals which recover from infection with microorganisms acquire natural immunity from further infections. Whenever cytotoxic T cells (the little Pac man cells which devour and neutralize viruses, bacteria, and cancer cells, thus conferring cellular immunity and are also responsible for allograft rejection) and B cells (antibody producing cells which confer humoral immunity by circulating in the body’s fluids or “humors”, primarily serum or lymph) are activated by various substances foreign to the body called antigens, some of the T and B cells become memory cells. Thus, the next time the individual meets up with that same antigen, the immune system can be quickly triggered to demolish it. This is the process known as natural immunity. This truth gave birth to a beLIEf that if a foreign antigen was injected into an individual, that individual would then become immune to a future infection. This beLIEf, (you see the lie in the middle), was given the name, “vaccinations”. What the promoters of vaccination failed to realize is that secretory IgA (an antibody found predominately in saliva and secretions of the gastrointestinal and respiratory tract mucosa) is the initial normal antibody response to all airborne and ingested pathogens. IgA helps protect against viral infection, agglutinate bacteria, neutralize microbial toxins, and decrease attachment of pathogens to mucosal surfaces. What this author has realized is that bypassing this mucosal aspect of the immune system by directly injecting organisms into the body leads to a corruption in the immune system itself whereby IgA is transmuted into IgE, and/or the B cells are hyperactivated to produce pathologic amounts of self-attacking antibody as well as suppression of cytotoxic T cells (as explained shortly). As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they cause chronic disease and thus further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment. This is especially true with viruses grouped under the term “stealth adapted”, which are viruses formed when vaccine viruses combine with viruses from tissues used to culture them, leading to a lack of some critical antigens normally recognized by the cellular immune system. One example is stealth adapted (mutated) cytomegaloviruses which arose from African green monkey (simian) kidney cells when they were used to culture polio virus for live polio virus vaccines. Thus, not only was the vaccinee inoculated with polio, but with the cytomegalovirus as well. The mechanism by which the immune system is corrupted can best be realized when you understand that the two poles of the immune system (the cellular and humoral mechanisms) have a reciprocal relationship in that when the activity of one pole is increased, the other must decrease. Thus, when one is stimulated, the other is inhibited. Since vaccines activate the B cells to secrete antibody, the cytotoxic (killer) T cells are subsequently suppressed. (In fact, progressive vaccinia (following vaccination with smallpox) occurs in the presence of high titers of circulating antibody to the virus[1] combined with suppressed cytotoxic T cells, leading to spreading of lesions all over the body). This suppression of the cell mediated response is thus a key factor in the development of cancer and life threatening infections. In fact, the “prevention” of a disease via vaccination is, in reality, an inability to expel organisms due to the suppression of the cell-mediated response. Thus, rather than preventing disease, the disease is actually prevented from ever being resolved. The organisms continue circulating through the body, adapting to the hostile environment by transforming into other organisms depending on acidity, toxicity and other changes to the internal terrain of the body as demonstrated by the works of Professor Antoine Béchamp. He established this prior to the development of the “germ theory” of disease by Louis Pasteur. Pasteur’s “germ theory” was a plagiarist’s attempt to reshape the truth from Béchamp into his own “original” premise – the beLIEf that germs are out to “attack” us, thereby causing dis-ease. Thus, treatment of infection with antibiotics as well as “prevention” of disease with vaccines are both just corrupted attempts at cutting off the branches of dis-ease, when the root of the cause is a toxic internal environment combined with nutritional deficiency. However, since Pasteur’s germ theory was conducive to the profits of the burgeoning pharmaceutical cartels that only manage dis-ease, no mention of the work of Professor Béchamp is made in medical school curricula. To make matters worse than the suppression of cellular immunity which occurs when vaccines are injected, adjuvants (which are substances added to vaccines to enhance the antibody response) can actually lead to serious side effects themselves. Adjuvants include oil emulsions, mineral compounds (which may contain the toxic metal aluminum), bacterial products, liposomes (which allow delayed release of substances), and squalene. The side effects of adjuvants themselves include hyperactivity of B cells leading to pathologic[2] levels of antibody production, as well as allergic reaction to the adjuvants themselves (as demonstrated in Gulf War I soldiers injected with vaccines containing the adjuvant squalene, to which antibodies were found in many soldiers). Note that the pathologically elevated hyperactivity of antibody production caused by adjuvants also results in a distraction from the other antigens that the immune system encounters “naturally”, which must be addressed to maintain health. In addition to the transmutation of IgA into IgE leading to allergic reactions described shortly, the overall hyperactivity of the humoral (antibody producing) pole of the immune system is, in this author’s opinion, the sole cause of all autoimmune diseases. The only thing which determines which autoimmune disease you develop is which tissues in your body are attacked by auto-antibodies[3]. If the inside lining of the gastrointestinal tract (the mucosa) is attacked by auto-antibodies you develop leaky gut syndrome (which leads to food allergies when partially digested food particles are released into the bloodstream, are recognized as antigens foreign to the body, and elicit an antibody response against those food particles that becomes heightened every time that same food is eaten and released into the bloodstream partially digested again). Crohn’s disease and colitis are also caused by auto-antibody attack on the mucosa of the GI tract itself. If the islet (insulin producing) cells of the pancreas are attacked by auto-antibodies, you develop insulin dependent (juvenile) diabetes. If the respiratory mucosa is attacked by auto-antibodies, you develop “leaky lung” syndrome where, just as with leaky gut, antigens recognized as foreign to the body which are inhaled are able to traverse the lining of the respiratory tract, causing the creation of antibodies against those antigens (usually dust, mold, pet or pollen antigens). When these substances are inhaled again, IgE (the pathologic form of IgA created after corruption of the immune system due to inoculation rather than inhalation of disease) acts as a reagin[4] and sensitizes mast and basophil cells, causing release of their histamine and slow reacting substance granules on contact with the allergen to produce constriction of the bronchioles leading to asthma. This process is also responsible for the immediate hypersensitivity reaction known as anaphylaxis, which is a potential side effect noted in the Physician’s Desk Reference for every vaccine; as well as the wheal and flare reaction of the skin known as hives. If the components of the articular surface of the joints are attacked by auto-antibodies, you develop rheumatoid (or juvenile) arthritis. If the skin is compromised on a chronic basis, you develop “leaky skin” syndrome, where contact antigens which could not otherwise traverse the skin lead to skin allergies to contact antigens (a delayed hypersensitivity reaction where inflammation occurs due to release of soluble factors). Additionally, depending on which level of the skin is attacked by auto-antibodies, (i.e., the epidermis or dermis), you develop eczema, psoriasis or scleroderma. If the kidney tissue is attacked by auto-antibodies, you develop one of the many types of nephritis, depending on which component of renal tissue is attacked (for example, with glomerulonephritis, the basement membrane of the glomerular apparatus within the kidney (which filters blood to form urine) is attacked by auto-antibodies, thus allowing protein to escape from the serum into the urine). If you develop auto-antibodies against thyroid gland tissue, you develop Grave’s disease. If you develop auto-antibodies against the tissue of the thymus gland (which is crucial in T cell production and function), you develop myasthenia gravis. If you develop auto-antibodies against the very DNA in the nucleus of all cells, you develop systemic Lupus (thus, the autoimmune potential of DNA vaccines being developed now is self evident; worse yet, DNA components from these vaccines can be incorporated into your DNA, leading to actual genetic changes which could cause extinction of all (vaccinated) life on the Earth, as will be discussed shortly). And on, and on, and on. The brain and spinal cord can also be attacked with auto-antibodies (which this author refers to as vaccine induced encephalitis), leading to a variety of neurological diseases. The most severe of these, leading to death, are sudden infant death syndrome (SIDS) and most cases of “shaken baby syndrome”. If components of the myelin sheath (the insulating covering of nerve fibers which allows proper nerve conduction) or the actual neurofilaments themselves are attacked by auto-antibodies, the resultant condition is determined solely by the location of the damage done. Such neurological conditions include but are not limited to minimal brain dysfunction, ADD/ADHD, learning disabilities, mental retardation, criminal behavior, the spectrum of pervasive developmental disorders (including autism), multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, Guillen Barre’, seizure disorders, etc., etc. etc. (Please note that other factors are also sometimes involved, such as: the organism which causes Lymes disease, aspartame and mercury in cases of MS; aspartame in seizures; or pesticides in cases of Parkinson’s). Thus, when detoxing to reverse these diseases, these other substances must also be removed to obtain a full recovery. However, the corruption of the immune system caused by the injection of vaccines is a key component in these disease states leading to immune malfunction, and is the reason why an autistic child may also have leaky gut or eczema, etc. Note that myelin production, for the most part, does not begin until after birth. Most myelin is apparently laid down by age 5 years and usually completed by age 10 years, judging by the level of success at various ages in reversing autistic and other neurological VIDS symptoms that this author has observed in hundreds of children by detoxing the viruses with homeopathic nosodes[5], and repairing the immune corruption by simultaneous administration of bovine colostrum (i.e., after 10 years of age, the ability to stop and repair auto-antibody induced damage in the myelin sheath and neurofilaments themselves is dramatically decreased). In summary, the hyperactivity of the humoral arm of the immune system in autoimmune disease is caused by adjuvants added just for that purpose. However, the damage caused by the autoimmunity itself (i.e., antibody against self) has several mechanisms, including the following: 1. The antigens present in the culture media itself cannot be completely filtered and separated from the organisms cultured thereon. Thus, any antibodies formed against antigens from the culture cells themselves (for example myelin basic protein from chick embryos or the 13 vaccines which now contain aborted human fetal cells) can cross-react to form an autoimmune reaction against the myelin basic protein in your myelin sheath, etc. 2. Molecular mimicry is due to similarity of proteins contained in organisms and mammals. (For example, the measles virus is made up of proteins similar to myelin basic protein; thus, antibodies formed against the measles virus antigens subsequently also cause an auto-antibody attack against myelin basic protein in the myelin sheath due to cross reactivity of these antibodies). 3. Formation of immune complexes occur as antigens and antibodies interlock into clusters which can then become trapped in various tissues, especially the kidneys, lung, skin, joints, or blood vessels. Once trapped, these complexes then set off an inflammatory reaction which lead to further tissue damage. 4. Intentional inclusion of antigens in vaccines to cause formation of antibodies that attack specific hormones or races (for example, experiments done on women of childbearing age in the Philippines and probably other locations where HCG (human chorionic gonadotropin)[6] placed into vaccines given these women resulted in antibodies against the HCG hormone, and subsequent spontaneous abortion thus occurred when the women became pregnant. It is also this author’s hypothesis that the epidemic of vitiligo in people of color (hypo pigmentation of skin caused by auto-antibody attack on melanocytes[7]) is also occurring due to intentional inclusion of melanin in vaccines given to people of color. Another heinous (and obviously genocidal) creation of the Anti-Hippocratics is the DNA vaccines now being developed. These vaccines contain plasmids, which are closed rings of recombinant DNA that make their way into the nucleus of a cell and instruct the cell to synthesize encoded antigenic proteins[8]. Thus, the very genetic makeup of the individual, plant or animal will be altered to produce a never ending supply of antigens to distract the immune system. These genetic changes will remain as cell division occurs, and will be transmissible to offspring. This is the TRUE “mark of the beast” , and could lead to extinction and/or modification (including behavioral) of any group inoculated. In addition to the above phenomena which lead to simultaneous depression of cellular immune function and hyperactivity of humoral immune function, vaccines also contain other toxic substances which can cause serious side effects themselves. The following ingredients are actually listed on the CDC website with this introductory statement: “Many things in today’s world, including food and medicines, have chemicals added to them to prevent the growth of germs and reduce spoilage.” Translation: you’re already toxic, so what’s the big deal with adding more poison? This author’s answer to that question is that any immunotoxin can end up being the “straw that breaks the immune system’s back” in that individual, leading to dis-ease. This is where genetics is key; i.e., not that what disease you develop is actually caused by some “gene” in most cases; but rather that your genes determine the strength of your immune system (i.e., how many assaults your immune system can take before it reaches critical mass, and you develop a dis-ease). Some additional ingredients in vaccines (as listed by the CDC on their website) include antibiotics, aluminum gels, formaldehyde, monosodium glutamate (MSG), egg protein, and sulfites. Thus, we have antibiotics (which you could be allergic to); aluminum (which when combined with silicon deficiency, results in the neurofibrillary tangles seen in Alzheimer’s disease); formaldehyde (a toxic carcinogenic substance used to preserve dead people); MSG ( a potent excitotoxin[9] which, like aspartame, can cause seizures, brain tumors, etc.); egg protein (to which you could have a life threatening anaphylactic reaction); and sulfites (another toxin which we are advised not to consume much of orally, but in vaccines, it is injected directly into the body). Is this not a veritable witch’s brew of chemicals, organisms, and animal parts? What the CDC does NOT list is that 13 vaccines at present (and more are in the works) are actually cultured on aborted human fetal tissues (go to www.cogforlife.org for more info). THIS IS CANNIBALISM. Note in this list that they also fail to mention the ethyl-mercury containing preservative thimerosol, which has been the only dangerous substance in vaccines to receive mainstream media attention (albeit most of that being disinformation) after the explosion in the rate of occurrence of autism in the last generation became self-evident proof that vaccines are the causative factor. For, although the scientists working for the medical mafia continue to use statistics to twist and spin their data to make us beLIEve that vaccines are not the cause, too many thousands of parents have watched their children enter the downward spiral into autism after their children received the vaccine which was the straw that broke the back of their child’s immune system. No matter what the “white coats” tell these parents, they know the truth! Mercury (also in dental amalgam fillings) is a highly toxic heavy metal, has been documented to cause cancer, and can be absorbed through the digestive track, skin, and respiratory track. Mercury is 1,000 times more toxic than lead, and is second only to uranium as the most toxic metal. If children receive all recommended vaccines, they will receive many times the “allowable safe limit” for mercury in the first two years of life (as if there is such a thing as a “safe” amount of a toxic poison). Yet, even after Congressional hearings instigated by Congressman Dan Burton (whose own grandchild became autistic after receiving vaccines) resulted in the FDA requesting (not ordering) vaccine manufacturers to remove this toxic heavy metal from their products, mercury is still present in many vaccines. Although the symptoms of mercury poisoning have been described as identical to the symptoms of autism, it should be noted that most children who descend into the hellish state known as autism do so after the MMR vaccine. The MMR vaccine is one of the few vaccines that do not contain mercury. Thus, it is self-evident that the removal of mercury will not make vaccines “safe”. (This is why the mercury is the only thing being addressed at all; because when the people reading this paper realize that the very mechanism by which vaccines corrupt the immune system means that NO vaccine is safe and effective; there will be an evolution of consciousness where the structure of lies telling us vaccines are safe and effective disintegrates.) The good news is that these VIDS can be reversed using natural remedies (especially homeopathy) contained in the Hippocrates Protocol (www.drcarley.com). This “surgical strike” detoxification approach which has the potential to reverse ALL of the aforementioned conditions under the VIDS umbrella as long as detoxification is started early enough will be the one truth put on top of the mountain of lies (that vaccines are safe and effective) that will cause the entire mountain of vaccine lies to crumble. Thus, the vaccine-induced holocaust (where instead of people being put in concentration camps, the concentration camps are being put into the people) will finally be put to an end. In this author’s opinion, it will be the reversal of VIDS (especially autism) in children and reversal of Gulf War Syndrome in the vaccine damaged soldiers and vets of the American Gulf War Veterans Association (www.agwva.org) led by Peter Kawaja which will stop this holocaust on humanity caused by vaccines, since the reversal of dis-ease subsequent to detoxification of the vaccines makes it self-evident that the vaccines caused the problem. Unfortunately, we can no longer pretend that this epidemic of VIDS is merely a “mistake” made by well intentioned, albeit misguided mad scientists. Because it’s even worse than the above, folks…we are talking TREASON and CRIMES AGAINST HUMANITY, PETS, and even PLANTS, (which are also being genetically modified to create vaccines). The evidence for this is as follows: As concern for population growth started to grow and the final plans to bring in the New World Order were put in place, this lie called vaccines was transformed into pure evil, as it was realized that such delivery systems could be used to intentionally cause disease, which is now being done under the US Code, Title 50, Chapter 32, § 1520 and 1524. You can read it for yourself at your local library. This law has been in place since the 1960's, and it was last modified in April of 2000. The only stipulation made for experimentation on human subjects is that local civilian officials be notified 30 days before the experiment is started. Section 1524 adds that the Secretary of Defense may enter into agreements with the Secretary of Health and Human Services to provide support for vaccination programs through use of excess peacetime biological weapons (i.e., weapons of mass destruction). In April 2000, § 1520 (a) was passed to put alleged restrictions on the use of human subjects for testing of chemical or biological agents after a caller on C Span mentioned this law in 1999, which revealed this treasonous law to a huge audience of listeners (including this author, who has been including it in lectures and written materials since that call came into “Washington Journal”). However, the exceptions written to Title 50, chapter 32 under § 1520 subsection (b) in the 2000 law passed by our aiders and abettors of treason in Congress not only loophole back in a test carried out for "any peaceful purpose that is related to a medical, therapeutic, pharmaceutical, agricultural, industrial, or research activity"; but add that such biological and chemical warfare agents can now be also used for any law enforcement purpose, including "any purpose related to riot control” (just in case those C Span listeners should actually get off the couch at the horror of what the traitors in Washington, D.C. are doing to God’s people). Subsection (c) of this law now mandates that “informed consent” be required. In reality, not a single vaccine has ever been tested for its long term side effects (including carcinogenic potential). Additionally, the intentional introduction into vaccines of stealth viruses, (including man-made viruses that cause cancer, mycoplasma and the HIV virus), antigens which target certain races, and silicon and/or DNA chips in the future makes it self evident that informed consent is impossible, as it would initiate impeachment proceedings and war crimes trials against every “public servant” involved in perpetrating these crimes against the American people, in violation of the Nuremberg Code (which was written after the end of WW II to prevent the barbaric experiments that occurred in the Nazi concentration camps) . What most people don’t know is that the top level mad scientists from Nazi Germany were actually brought to the United States after the war through “Operation Paperclip”, and have been continuing their work to this day in places like Brookhaven labs, Cold Spring Harbor and Plum Island in this author’s backyard on Long Island. In 1969 the U.S. military/CIA and Rockefeller directed National Academy of Sciences-National Research Council (NAS-NRC) announced that a research program to explore the feasibility of "creating a new infective microorganism..[HIV]..which would be refractory to the immunological and therapeutic processes upon which we depend to maintain our relative freedom from infectious disease" could be completed at a total cost of $10 million. Yes, this is what your tax dollars are going towards, folks. But hang on to your hat, because it only gets worse. Dr. James R. Shannon, former director of the National Institute of Health reported in December, 2003 that “the only safe vaccine is one that is never used”. However, the reverberating truth, “the shot heard round the world” which will lead to the evolution of consciousness necessary to stop the holocaust against humanity known as vaccinations, will be that not only are vaccinations not safe or effective, but that they are actually weapons of mass destruction being perpetrated upon humanity in the name of health, for the purpose of genocide and to bring in the New World Order. Part 2 of the genocidal plan could drop anytime with activation of the Model State Health Emergency Powers Act whenever the next fabricated terrorist attack using biological agents occurs. Worse yet, the Congressional traitors in Washington posing as public “servants” are doing all they can to pass “Codex” legislation which will make the natural remedies and supplements used in the Hippocrates Protocol developed by this author to reverse all dis-eases only available by prescription. So, you didn’t hear about that on your local news station either? Please go to the site of John Hamill of the International Alliance for Health Freedom (who reversed his schizophrenia symptoms with these natural supplements and has dedicated his life to stopping Codex from passing) at www.iahf.com . The most heinous, bone chilling and evil piece of this puzzle has been revealed to the world by an American hero named Habib Peter Kawaja, who worked in the late 1980’s as a security and counter terrorism expert for the United States government (a service for which he has been rewarded with the murder of his wife, torching of his home, issuance of a War Powers Act search warrant to (they thought) confiscate all his evidence, illegal IRS liens on all subsequent income, and multiple attempts on his own life, all funded by YOUR tax dollars). Please go to www.agwva.org/mission.htm and read some of the 34 counts that Mr. Kawaja brought against the domestic traitors to America (in both their individual and governmental capacities) in a federal lawsuit in which the perpetrators, again, used your tax dollars to hire themselves attorneys from the Department of “Justice” whose defense of their war criminal clients was that they are “immune, under color of law[10]”. (You can listen to Mr. Kawaja on one of his multiple internet radio shows, including “What’s Ailing America?” which he co-hosts with this author at www.againstthegrain.info every Monday and Friday at 11 PM, EST). Wake up, America-it's getting very late….it is time for the mountain of lies to crumble. Please spread the world to everyone you know….we will make it happen! The time to stop chopping at branches and get to the root of this evil is now ! Refer everyone you know to www.againstthegrain.info, where in the spring of 2005, Habib Peter Kawaja, as prosecutor for the people, and this author will commence trials on the internet against the traitors of America for their crimes against humanity. These traitors include William Atkinson, MD, MPH of the National Immunization Program at the CDC. On December 9, 2004, Dr. Atkinson informed a NYS Department of Health minion that a child to whom this author had given a medical exemption from further inoculation “should be vaccinated unless he has an anaphylactic allergy to hepatitis B vaccine” as there is “no such syndrome [as VIDS]”. Yet, in a document published by the CDC on May 4, 2000 (# 99-6194) entitled “Vaccine Information Statements; What You Need to Know”, on page 9 the following is printed under the heading “The Law (Recording Patient Information and Reporting Adverse Events): 42 U.S.C. § 300aa-25. Recording and Reporting of Information, (b) Reporting (2) “A report under paragraph (1) respecting a vaccine shall include the time periods after the administration of such vaccine within which vaccine-related illnesses, disabilities, injuries, or conditions the symptoms and manifestations of such illnesses, disabilities, injuries, or conditions, or DEATHS occur, and the manufacturer and lot number of the vaccine.” Thus, while Dr. Atkinson informed this author on January 8, 2005 that “having a judge in the Bronx Family Court “qualify” you as an “expert witness” neither makes you an expert, nor proves the existence of so called “vaccine induced disease syndrome”; the CDC’s own documents refer to the federal mandate for such to be reported to the secretary. Dr. Atkinson, who received a copy of the draft of this paper on 12/30/04, has not offered a single rebuttal to the mechanism whereby the mechanism of VIDS is explained in this paper. Ergo, this author hereby formally charges Dr. Atkinson and his co-conspirators in the CDC with the following counts, including but not limited to: 01.) False statements within a Government Agency, Title 18 USC § 35.1001. 02.) WAR CRIMES - crimes when death occurs, Title 18 USC § 34. 03.) Concealment, removal - Title 18 USC § 2071. 04.) Aiding and Abetting, Title 18 USC § 3. 05.) Obstruction of Justice, Title 18 USC § 1505 / USC § 2 (26). 06.) Defrauding America, Title 18, USC § 1101 (25). These charges also surround covert counter-terrorism activities in a lawsuit (go to www.agwva.org/mission.htm) brought by Peter Kawaja and the International Security Group, Inc., (1994) as Plaintiffs v. various [named] Agents (agencies/US attorneys etc) of the U.S. Government and 100 John Does (Bush Administration), and will also be submitted to the People of the United States and the World in the aforementioned internet trial to be conducted in the Spring of 2005. The charges laid in Kawaja's suit have never been refuted by the accused. Instead, the United States Government made a determination to appoint the US Attorney's Office to represent the Defendants, thereby admitting to the criminalities (and guilt). This decision to appoint "government" attorneys and the U.S. Attorney's Office to represent the Defendants was made after an initial response to the Plaintiff (Kawaja) filing Suit, and places these individuals, sworn to uphold the Constitution of the United States and defend against terrorists (whether foreign or domestic) into the defendant’s box as well. If the People lead, the “leaders” will follow…and we have found a true leader in Habib Peter Kawaja. SILENCE IS CONSENT. If you do nothing, before long highly trained Special Operations commandos with state of the art weaponry will be used in the U.S. to “execute quarantine and certain health laws”, including the Model State Health Emergency Powers Act passed in all states where, following another domestically perpetrated biological scare (such as the anthrax mailings to the Congress), a solution in the form of a vaccine will be offered only to those who will accept the national ID chip being injected into them. All others will be considered a danger and threat to society, hunted down, and imprisoned in concentration camps already built or be killed. Americans will welcome this solution, and turn in their neighbors or friends in order to survive themselves. This was all predicted by Peter Kawaja in 1994 when he wrote “The Saddest Chapter of America’s History”. If you are not part of the solution, therefore, you are part of the problem. Please do all you can (including telling others about the internet trial and donating whatever you can at www.agwva.org) to make this happen. It is now in your hands, People of the United States of America. Respectfully submitted by Rebecca Carley, MD www.drcarley.com (The author wishes to thank Mr. Chris Barr, a fellow radio host on www.highway2health.net and www.againstthegrain.info for his invaluable additions and editorial assistance in the writing of this document; and Meryl Dorey of the Australian Vaccination Network, Inc., whose additions for the publication of this paper in their magazine “Informed Choice” in Australia have also been included in this February, 2005 updated edition of this document.) -------------------------------------------------------------------------------- [1] “IMMUNOLOGY” by Ronald D. Guttman, MD, Professor of Medicine, McGill University, et. al., (ISBN # 0-89501-009-7), 1983. [2] Pathologic = pertaining to or caused by disease [3] Auto antibodies = antibodies produced by the body that attacks its own tissues. [4] Reagin = antibody of a specialized immunoglobulin class (IgE) which attaches to tissue cells of the same species from which it is derived, and which interacts with its antigen to induce the release of histamine and other vasoactive amines. [5] A nosode is a homeopathically prepared remedy, made from a disease or a pathological product. Nosodes are used in the same way as vaccines; they sensitize the body, prompting the immune system to react (and detox, or eliminate, the offending agent). However, as they are extremely dilute and oral in application, they do not lead to the corruption of the immune system caused by inoculation with disease. [6] Human chorionic gonadotropin = the hormone produced when women first become pregnant [7] Melanocytes = melanin producing cells in skin [8] “GENETIC VACCINES”, Scientific American, July 1999, pgs 50-57 @ p. 52. [9] Excitotoxins are usually amino acids, such as glutamate and aspartate. These special amino acids cause particular brain cells to become excessively excited, to the point they will quickly die. Excitotoxins can also cause a loss of brain synapses and connecting fibers. Food-borne excitoxins include such additives as MSG and aspartame, both toxic substances approved for use in humans by the FDA (Fraudulent Drug Administration). [10] “color of law” = the appearance or semblance, without the substance, of legal right. Misuse of power, possessed by virtue of state law and made possible only because wrongdoer is clothed with authority of state, is action taken under “color of state law”. Atkins v. Lanning, D.C.Okl., 415 F.Supp. 186, 188. Action taken by private individuals may be “under color of state law” for purposes of 42 U.S.C.A. § 1983 governing deprivation of civil rights when significant state involvement attaches to action. Wagner v. Metropolitan Nashville Airport Authority, C.A.Tenn., 772 F.2d 227, 229. Acts “under color of any law” of a State include not only acts done by State officials within the bounds or limits of their lawful authority, but also acts done without and beyond the bounds of their lawful authority; provided that, in order for unlawful acts of an official to be done “under color of any law”, the unlawful acts must be done while such official is purporting or pretending to act in the performance of his official duties; that is to say, the unlawful acts must consist in an abuse or misuse of power which is possessed by the official only because he is an official; and the unlawful acts must be of such a nature or character, and be committed under such circumstances, that they would not have occurred but for the fact that the person committing them was an official then and there exercising his official powers outside the bounds of lawful authority. 42 U.S.C.A. § 1983. (The above definitions are from Black’s law dictionary, 6th edition, pgs. 265-266)
04/19/2005 21:38 PU 468 I For antibiotic resistance, should CDC be doing drug trials? That seems out of character for us. We should be evaluating means of preventing resistant infections, like vaccines and infection control measures. For I16, CDC has a clear role in vaccine development also -- we can use our surveillance data to guide vaccine development (eg, what strains a vaccine should target). It is also our role to develop and maintain policies for vaccine use. We also need better surveillance for influenza, as system for measuring influenza vaccine effectiveness each year, and improved vaccines for pneumococcal disease in adults.
04/19/2005 20:12 PU 467 I I 10 appears to be a subset of I 13 I 15: with the tremendous reduction in GBS rates, the next most frequent fatal infection among extremely low birth weight newborns, for whihc a prevention strategy is nearly identified, is neontal candidemia, this should be added to your list.
04/19/2005 17:26 PU 463 I Needs to be better linked with focus area #1, community preparedness and response research-- including links to topics like health disparities, and engaging communities to address health risks.
04/19/2005 16:13 PU 457 I Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:54 PU 455 I Comment 1: None of the Research Theme Title and Descriptions relate to the pathophysiology of infectious diseases. In select instances, such research provides a direct basis for prevention applications. Some proposed studies relating to Herpes Zoster are a case in point. Comment 2: Suggested added bullet for "Examples or research activities" for item I-11 (Infectious Diseases of Vulnerable Populations), with some explanation: "Determination of the point-prevalence of immunosuppression in the population (by age)." Immunosuppressed persons comprise an important population for many CDC programs, e.g., Foodborne Branch (Listeriosis), Parasitic Disease/waterborne diseases (Cryptosporidiosis), Healthcare Quality (infection control), Immunization Program (safety of live-attenuated vaccines, post-exposure prophylaxis), etc. While prevalence data exist relating to specific categories of immunosuppression (transplants, HIV, types of cancer), these are incomplete, and furthermore they do not include the possibly enormous number of persons on immunosuppressive medications (e.g., pulse prednisone, MTX, etc.) for a host of indications. It would be very useful for many programs at CDC to have better data on this issue, stratified by age. This could be collected via NHIS survey by asking respondents a limited number of questions whether they do or do not meet criteria for immunosuppressed as defined by specific lists of conditions and medications. Several definitions could be used (e.g., criteria of the General Immunization Recommendations).
04/19/2005 15:31 PU 452 I Probably the best of the bunch in terms of specificity and examples of actual research activities although again, some activities were not research.
04/19/2005 14:07 PU 444 I Conduct reasearch to evaluate efficacious approaches to reducing and elimintating disparities in HIV among ethnic and racial minorities.
04/19/2005 10:29 PU 425 I Suggest inclusion of rural and frontier areas, especially in regard to syndromic surveillance focused on emerging infectious disease threats. Urge particular attention to vector-borne diseases.
04/19/2005 10:29 PU 424 I These look good. The importance of appropriately-funded laboratories at CDC cannot be overemphasized. The labs are not currently funded in adequate amounts in order to enable them to remain national reference labs/experts in diagnosis, etc.
04/19/2005 10:23 PU 423 I I recommend that the research activities for I.13 include: Disseminate effective disease prevention interventions for implementation in the "real world." and Identify the best mechanisms for disseminating and maintaining effective disease-prevention interventions for implementation in the "real world." [See E.8 and E.9 for parallel wording; recommendations incorporate X.10]
04/19/2005 07:30 PU 418 I For theme idea #19 of this section (chronic disease), an important research activity would be to increase screening, outreach, medical, and support services to those who are chronically infected with a disease, such as viral hepatitis. It is important to prevent new infections, but equally important to find and serve the millions who are already chronically infected.
04/18/2005 18:28 PU 415 I Further research is very much needed to support alternative delivery systems i.e., intradermal administration of flu vaccine and use of lower doseages i.e., 0.25cc flu vaccine IM healthy adults.
04/18/2005 14:03 PU 404 I For H6 I would add hearing loss. Fo H7, I would add hearing loss, especially slight/mild-moderate bilater and unilateral hearing loss. For H12 I would add prevention of non-vaccine preventable congenital infections such as cytomegalovirus and toxoplasmosis.
04/18/2005 13:47 PU 402 I Some of these themes fit better in other areas - Chronic diseases; Behavioral sciences, Health Promotion, and Prevention. Also need to try an prioritize all the competing needs.
04/18/2005 11:15 PU 389 I Carefully evaluate the cumulative and combined exposure of all ingredients that children receive via vaccinations to ensure safety before new vaccinations are recommended in isolation.
04/17/2005 18:06 PU 372 I An evaluation of all tests used by CDC to determine their specificity and sensivity and their predictive value positive and predictive value negative for different prevalence rates. This is important for many reasons. People should not be treated for diseases or conditions they do not have and with the fear of biological terrorism, it is especially important that all scientists involved understand what the probability of a false positive or false negative result is for any test that is used.
04/17/2005 12:20 PU 369 I At least I3, I5 and I6 have clear workplace relevance. If that is not the intent, it should be and the language should make that clear. For example, "workplaces" could be inserted in front of "communities" in the list in parentheses in I3.
04/15/2005 16:18 PU 366 I Some additional suggestions: 1. Economic Analysis of Interventions to Decrease the Use of Antibiotics 2. Changing patterns of meningococcal disease after introduction of the new meningococcal conjugate vaccine.
04/15/2005 14:13 PU 361 I The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 12:28 PU 355 I The Emergency Medicine Network (EMNet, www.emnet-usa.org) at Massachusetts General Hospital strongly supports the CDC’s Theme I 1 (Antimicrobial Resistance). EMNet is currently conducting an AHRQ-VA funded study of antibiotic use in acute care settings, particularly for respiratory tract infections. Monitoring current antibiotic use and developing strategies for prudent future use should be a high priority. EMNet also strongly supports the CDC’s Theme I 8 (Immunization Services Delivery Research). EMNet investigators recently completed an analysis of vaccine administration in the emergency department (Pallin et al. Vaccine 2005; 23: 1048-1052). While some tetanus vaccination was common, influenza and pneumococcus vaccination were extremely rare. The tetanus experience demonstrates that the ED provides a potential venue for coordinated vaccination efforts. EMNet encourages efforts to expand and implement vaccination programs, including those based in the ED. Finally, EMNet strongly supports the CDC’s Theme I 14 (Patient Safety). EMNet is currently conducting an AHRQ-funded, 85-center study of patient safety in the emergency department (ED). Results will inform recommendations for preventing adverse events in the ED. We believe that patient safety is a critical component of quality healthcare and encourage the CDC to actively promote this goal.
04/15/2005 09:25 PU 349 I This is a comprehensive list and well thought through. I have the following comments: 1) The patient safety goal speaks only to reducing medical errors. It should also include "and decreasing transmission of infectious diseases from health care workers". This would be consistent with studies of improving immunization rates among health care workers against infectious diseases such as influenza. Low vaccination coverage is not a "medical error". And under research activities, I would recommend adding: Develop and evaluate new strategies to improve HCW compliance with immunization recommendations. 2) On goal I -16, I would add in after "efficient coverage" "and control strategies". The real goal is disease control not immunization coverage. 3) I would add several potential research activities such as: a) Evaluate strategies to simplify the immunization schedule such as dropping doses, changing intervals etc. b) Evaluate prospectively and on a continuing basis the effectiveness of vaccines and vaccine strategies c) Develop and evaluate mathematical models to determine their usefulness for designing and implementing disease control strategies 4) Under the 4th bullet of I-16, I would clarify that this means herd immunity and the indirect means of protection is vaccination of the key groups involved in transmission to reduce exposure of other groups to the pathogen. 5) Also in I-16, the 6th bullet on waning immunity in adolescents, is that meant to be for pertussis or for other diseases such as tetanus, diphtheria, and meningococcal disease? 6) Under I-17, I would add a bullet - Develop and evaluate interventions to help improve coverage in populations that currently object to vaccines. 7) Under I-2, it would also be important to use Genomics to understand risk groups for drug or vaccine failure, mechanisms of those failures and strategies to overcome them.
04/15/2005 07:16 PU 345 I New approaches to antimicrobial resistance, broader use of genomics and genomic approaches to public health should be included as examples of research priorities. HIV/AIDS is underemphasized especially in health disparities. The agenda should be more targeted and priortized to major infectious threats.
04/14/2005 20:50 PU 343 I Starter list not functioning Need to further study funding for adult immunizations-- a VFC like program. Ethics research is missing from the portfolio to my knowledge. Keep vaccine safety as a priority. Consider K-awards. Think about tailored interventions so as to make prevention in the broader scope (including immunizations) as more feasible and sustainable and able to reach all ethnic groups. The issue of tailored interventions is relatively new and needs alot of study I believe. CDC has funded a number of good studies - nice job!
04/14/2005 16:20 PU 340 I There needs to be more balance in ID research portfolio. In addition to epi and lab, need more applied research, in general, and behavioral science research in particular. Also, need more public health services research, eg, identify gaps at state local level in surveillance systems.
04/14/2005 14:18 PU 337 I Excellent list although I would probably list surveillance further up. It is great that resistance and applied genomics are listed as these are very important areas! This workgroup did an outstanding job! Thank you!!
04/14/2005 13:57 PU 335 I Focus on TB, AIDS, and malaria. There is no reason that as many as one-third of the world's population has TB (including quiescent states rather than clinically obvious infections) except the lack of political will to eliminate TB from the globe. CDC should be educating our policy-makers so that they make better funding choices. In terms of AIDS, CDC staff need to forthrightly proclaim that abstinence-only intervention programs do not work.
04/14/2005 13:26 PU 332 I Methods for economic analysis are very important. Approaches to eliminating health disparities in immunization should be explored. Health services research in immunization, especially aimed at services for adolescents and adults, is high priority. There is overlap between the patient safety area and vaccine safety, but important to keep in mind that patient safety focuses on elimination of medical error, which only occasionally is a factor in vaccine safety. Epidemiology and surveillance of vaccine-preventable diseases is a priority. Additional behavioral and communication research needed in vaccine safety. A major need for better understanding of the economics of the vaccine market.
04/14/2005 12:13 PU 322 I I think this should be placed within the top five priorities.
04/14/2005 11:05 PU 315 I Also need to include susceptibility and response to treatment.
04/14/2005 10:25 PU 306 I A research agenda for biodefense vaccine safety (incl. anthrax vaccine) was developed with input from the National Vaccine Advisory Committee, CDC, FDA, and DoD in 2004 and a manuscript describing this agenda has been cleared and submitted for publication. These vaccine safety topics include studies of whether or not specific vaccines used by the US military are related to: optic neuritis, systemic lupus erythematosus, arthritis, and erythema multiforme. An assessment of whether the practice of administering multiple vaccines near-simultaneously is related to health outcomes is also included. Second-tier study endpoints in this research agenda include Guillain-Barre Syndrome, atrial fibrillation, diabetes mellitus in adults, and yellow fever vaccine-related neurotropic disorders.
04/14/2005 08:42 PU 299 I I believe that there should be a category for complementary and alternative medicine and what it can bring to fighting infectious diseases. For 92% of the world's HIV-infected population, access to drugs or vaccines are not possible. However alternative treatments, such as seaweed and spirulina, can decrease symptoms and increase symptom-free survival before drugs are needed. This type of research could have global impact. Algae and other indigenous treatments for HIV are inexpensive, can be locally acceptable, and their use will support local economies. Natural products are both good for the environment, providing a locally available and sustainable crop, and may offer hope for developing countries. To me, it is just not acceptable to suggest that millions of people merely wait for drug companies to provide drugs or die waiting. It would be good for our national image to help identify the miriad of indigneous treatments that are already in use, and to assist in making them more widely available. This would require support for collecting information on these treatments and at least preliminary testing for efficacy.
04/13/2005 15:42 PU 285 I Food- and waterborne pathogens are not mentioned specifically. Many of these are zoonotic agents and most are also emering pathogens. Would suggest to add to the research activities under I13: characterization of virulence profiles of food- and waterborne pathogens and their correlation with disease.
04/13/2005 13:14 PU 277 I During the past decade or so testing/screening for infectious diseases has changed rapidly as a result of agressive marketing of nucleic acid amplification tests (NAATs). However, many of these tests have not been properly evaluated before marketing. Thus, it would be useful to conduct a judicious evaluation of these NAATs by an interdisciplinary group of statisticians, clinicians and laboratory scientsists.
04/13/2005 10:37 PU 273 I HIV behavioral research to address the meth epidemic and its link to sexual risk behavior among men who have sex with men; the community is ripe and asking for more CDC work and expertise in this area; address the link between subtance use and sexual risk in general for MSM, as well as just meth use
04/13/2005 09:59 PU 271 I In this age of new pneumococcal/streptococcal vaccines (both newly licensed and in the pipeline) it is imperative that we continue to monitor pneumococcal and group A streptococcal serotype and strain distribution. This will be very critical in our fight against pneumococcal disease. Already, there is significant replacement disease following introduction of the very effective 7 valent conjugate vaccine. Just note this: The replacement disease is relatively low now, but penicillin resistance was rare 25 years ago. Where there is a biological means to escape selection, the pneumococci will adapt. Formulating more effective pneumococcal vaccines depend upon our continuing serotype and pneumococcal genetic surveillance. Pneumococcal genetic surveillance, allows us to understand how strains change and where they are coming from in this continuing "arms race".
04/13/2005 09:35 PU 269 I Will these categories be furthered subdivided by types of disease? For example, will "Infectious Disease Surveillance and Response" be broken down into types of infectious disease agents (i.e. viruses, bacterial, rickettsial, parasitic, etc.). All the categories mentioning "Infectious Disease" seem very general.
04/12/2005 14:51 PU 264 I • Infectious Disease: Consider effectiveness of water fluoridation, dental sealants, and caries vaccine in reducing disparities in at-risk populations. Investigate the feasibility and cost-effectiveness of integrating rapid-HIV testing into dental clinics. Consider developing a resource optimization model that could be used to identify the most effective combination of prevention interventions within a given budget situation.
04/11/2005 11:15 PU 255 I I cannot emphasize enough how important it is for this agency to focus on hand hygiene research if it is to remain the leader in infectious disease research. Hand hygiene affects all infectious diseases, and contributes to the overall health of individuals. There are many gaps in the research, and CDC need to make hand hygiene a priority now, but specifically including it in this list, and dedicating funds to it - which it has not done in the past. We have no experts on hand hygiene for the general public, nor hand hygiene a funded research topic currently. It needs to become a priority for CDC.
04/11/2005 09:59 OH 251 I see general discussion comment below
04/11/2005 09:30 PU 243 I under either or both the topics of "economic analyses of infectious disease" and "infectious disease diagnostic methods," please include the need to conduct cost-effectiveness analyses of the various diagnostic methods under "health disparities" please include in the description of structural factors "economic" factors
04/11/2005 09:26 PU 242 I Please include a definition of populations to be included under the topic of health disparities, otherwise it may succumb to being defined soley by race/ethnicity. The Healthy People 2010 plan for eliminating health disparities discribed the following populations as a minimum for data collection of health disparities. Here are the HP2010 populations: * race/ethnicity (American Indian/Alaska Native, Asian/Pacific Islander, Black/African American, White, Hispanic/Latino, Not Hispanic/Latino) * gender * SES: family income level (poor, near poor, middle/high income), and/or education (less than high school, high school grad, at least some college) these populations when they are at risk: * geographic (urban, rural) * health insurance status (private, public, none) * disability (disabilities, not) * sexual orientation * select populations (age, school grades, selected medical conditions)
04/11/2005 07:59 PU 239 I Could development and evaluation of new vaccine candidates be considered part of the research activities for infectious diseases? Also, very few activities were targeted to the study of therapies/vaccine/diagnosis and surveillance of HIV/AIDS.
04/08/2005 13:56 PU 233 I Please indicate how we can submit our comments now available in Word file of the Stater list, relying on track changes. Thanks, Kenneth G. Castro, M.D. kcastro@cdc.gov
04/08/2005 08:45 PU 232 I This is something that seems to have a need to be connected somewhat to the 1st category, that of preparedness.
04/07/2005 15:59 PU 224 I I9 & I11 - Define populations at risk that links disparities based on socio-demographic, behavioral and attitudinal characteristics. Develop tools, materials that respond to intersections of health disparity-based identities.
04/07/2005 13:40 PU 216 I I read the Infectious Diseases Workgroup list of research priorities. There is little in the entire list of categories that will gladden the heart of medical microbiologists, or molecular biologists working in infectious diseases. Although Genomics has a prominent category, a closer reading reveals this applies to Human Genomics, and not Microbial Genomics. This at a time when microbial genome sequences are now becoming generally available for further study. Although Diagnostics is invoked as a "mantra" in item 10, it is unclear what type of diagnostics is meant. Is it the development of fundamental knowledge of microbes that might lead to novel tests, or does it mean development of tests to the point of clinical utility, which brings the CDC into competition with the companies with large staffs, like Abbott Laboratories, who have this as their role and purpose. Does it mean concentrating on diseases of low prevalence which do not attract the attention of commercial companies? I have searched the research priorities to find some way to identify one of the strengths of CDC that distinguishes it from NIH intra- and extramural research: the knowledge of population genetics of microbes that is exploited to develop tests to trace their transmission in the hospital and community: simply put: molecular epidemiology. Is this topic meant to be covered in item 12? If so parsing that category and its subcategories fails to delineate this type of research. Many of the goals are not laboratory based. Goal 3, goal 5, Goal 7, goal 8, goal 9, goal 11, goal 14, goal 16. Whereas such goals are laudable and can meet the definition of research, one is left with the impression that the laboratory is a mere adjunct to the data gathering and surveillance activities. I do not believe this is intentional but perhaps reflects the fact that the strategists are quite removed from the laboratory and are not stakeholders in the laboratory. One merely has to look at the infrastructure improvements in laboratories that are now well underway and wonder how it will be able to recruit and retain staff who read this type of Infectious Diseases Priorities. How will newcomers and , for that matter, the thin red line of laboratory researchers here view their future in the organization?
04/07/2005 11:24 PU 214 I Incidence and other studies related to HIV Counseling, Testing and Referral should include CCR5 Delta 32 genotyping to exclude those individuals who are not at risk of HIV infection. These individuals should be excluded from studies to improve the accuracy of the denominator value in risk statistics. Many studies have demonstrated that individuals carrying a homozygous deleted form of the Delta 32 gene were protected against HIV-1 transmission. The CCR5 heterozygous genotype may confer partial protection against HIV-1 infection. Another consideration is that Delta 32 is rare in people of African and Asian descent . Therefore, it seems plausible that interactions between genetic susceptibility, social and behavioral factors may contribute to the rapid heterosexual spread of HIV-1 among individuals of African, Asian or non-Eurpean ancestry. Submitted by: Evelyn McCarley-Foxworth (contractor) PERB/ Couseling and Testing
04/07/2005 10:39 PU 212 I In Section I 9, CDC should sponsor research on the possible infectious etiology of Crohn's diseases, one of the two inflamatory bowel diseases. There is evidence that Crohn's may be caused by Mycobacterium paratuberculosis, but the evidence is incomplete. There are claims (poorly supported) that the organism is transmitted in milk, even pasteurized milk. This makes it a potential public health problem that would be preventable. Better research is needed in this arena. I would be happy to provide more information, if needed. Myron G. Schultz
04/07/2005 10:09 PU 209 I Consider serious etiology research for diseases that are ruled out, based on national diagnostic criteria. e.g. What is the actual agent causing thousands of cases of disease that "look like" Lyme disease, especially in areas where Lyme disease is not known to be endemic.
04/07/2005 09:19 PU 201 I We need better resolution on defining species and subspecies and varieties of pathogenic bacteria and viruses. We need references which are defined in all aspects including antibiotic susceptibility in a readily accessible format. Untill we can absolutely describe organisms, we are unable to assess full health impact of lesser yet persistant pathogens.
04/07/2005 08:45 PU 198 I CDC should continue to participate in pathogen discovery and characterization (once referred to as emerging infectious diseases). This can only be done by trying to maintain an infrastructure that has expertise in a wide variety of microbial systems including those that may not be percieved as front row pathogens. CDC history is rich in identification/discovery of important agents (e.g.,Legionella) by specialists who routinely work with disease groups with lesser public visibility.
04/07/2005 06:45 PU 190 I All very important. Influenza, for example, is an established infectious disease, yet every year, recombination results in new strains. To drop the ball here would be unwise.
04/06/2005 17:43 PU 186 I Where does research on i) the prevention of complications from infectious diseases and ii) understanding the clinical presentation of infections and their complications fall? These research activities are critical to the the understanding and recognition of infectious diseases and the many facets of their prevention.
04/06/2005 08:53 DC 179 I Before writing guidelines on respiratory protection and the need for N95 respirators to control transmission of TB and other infectious agents, research is needed on the relative role and effectiveness of masks and N95 respirators. Are N95 respirators necessary to control transmission of TB and, if so, is annual fit-testing needed? Studies needed to define importance of the hierarchy of controls in preventing healthcare associated transmission of TB and other infectious agents potentially transmitted via the airborne route: administrative, environmental and PPEs. Need to determine the role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission.
04/05/2005 23:13 PU 175 I This will be very important in the years to come
04/05/2005 19:03 PU 173 I With the increasing number of vaccines available for children, it is becoming more important to examine the interactions between different vaccines given at the same time as well as the safety of the various combination vaccines
04/03/2005 21:43 PU 144 I research the supression of the immune system from alcohol use, marijuana use and other drug use, including the misuse of perscription drugs. does infectious diseases spread more quickly in the AOD using population?
04/01/2005 08:20 DC 142 I Complete a valid study on the need or not for fit-testing of N-95 respirators. Develop a controlled study of resistant organisms and antibiotic use in an environment that allows Pharmaceutical companies to educate physicians and one that requires medical professionals to do the research and education.
03/30/2005 10:37 DC 131 I Would aslo like focus on biologic terrorism Development of standards or guidelines that can be referred to when making policy.
03/30/2005 08:50 DC 123 I Development of new and more reliable testing for TB.
03/30/2005 08:48 OH 121 I A particular emphasis needs to be placed on maintaining quality HIV prevention programs in the face of political resistance. Effective, evidence-based programs are often undermined by a vocal minority that politicize public health issues. A recent example is elimination of the "Programs tha t Work" program supported by DASH. The research and service initiatives supports programs that work should be reinstated.
03/29/2005 14:18 OH 117 I Oral health has implications relevant to all the chronic disease programs established by the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), including cancer control, diabetes, healthy aging, healthy youth, heart disease and stroke, nutrition, safe motherhood, and tobacco. Additionally, several reports have provided evidence for the potential correlation between oral diseases such as periodontal diseases, and systemic disorders such as cardiovascular disease and adverse pregnancy outcomes. For these reasons, the topic of the role that oral health has on an individual’s overall health should be added to its research agenda. The feasibility, efficacy and cost-effectiveness of integrating rapid HIV –testing in dental clinics were highlighted in the CDC’s Division of Oral Health Research Opportunities. This should be expanded to include additional infectious diseases such as the hepatitis B and C viruses, oral diseases such as caries susceptibly, periodontal disease and oral cancer, and systemic disease such as diabetes and cancer. Thus, this topic should be expanded to include research on multiple forms of salivary diagnostics as well as potential applications, practice implications, economics, and liability issues. In line with this, research is needed regarding the role of dentistry in the screening of systemic disease and the development of guidelines for referral to medical specialties for corresponding diagnosis and treatment.
03/29/2005 10:57 DC 114 I TB....this is still a very hot topic. We need to priortize research on the relative role and effectiveness of respiratory protection and the need for fit-testing in the control of TB and other various infectious agents. With the continuing decrease in healthcare resources, both staffing and money, we need to determine how best to spend those resources. It is important to make the best decisions that will provide the best protection economically. All research needs to include scientific data that proves beyond a reasonable doubt that taking this action will provide higher quality of care to the patient and protect our staff at the same time. This would include issues such as documented proof that use of fit tested respirators provide less seroconversions that use of a surgical mask. I realize that the perception is that obviously a fit tested respirator will provide better protection but I have never seen data that has documented this fact.
03/29/2005 09:08 DC 106 I Need a meta analysis (or other study) of all nosocomial tuberculosis transmissions (ever) to help dispel the myth that fit testing a paper "respirator" is necessary. Since no transmission has ever occurred with a well fitting paper mask and other environmental controls in place, this would be a great efficiency booster for ICPs.
03/28/2005 13:29 DC 102 I We are also very concerned about influenza, RSV, and other respiratory diseases that pose a serious risk to some children (and sometimes to adults), in addition to some of the emerging conditions (e.g. avian influenza).
03/28/2005 13:20 DC 95 I Prioritize research on the relative role and effectiveness of respiratory protection and need for fit-testing in the control of transmission of various infectious agents, including Mycobacterium tuberculosis. Outcome research (transmission studies) to define the relative importance of the hierarchy of controls in preventing healthcare associated transmission of Mycobacterium tuberculosis and other infectious agents potentially transmitted via the airborne route: administrative, environmental and personal protective equipment. Health outcome and cost-benefit studies on the use of personal protective equipment: types of respiratory protection, frequency and utility of fit-testing. The relative role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission
03/28/2005 13:12 DC 94 I Prioritize research on the relative role and effectiveness of respiratory protection and need for fit-testing in the control of transmission of various infectious agents, including Mycobacterium tuberculosis. Outcome research (transmission studies) to define the relative importance of the hierarchy of controls in preventing healthcare associated transmission of Mycobacterium tuberculosis and other infectious agents potentially transmitted via the airborne route: administrative, environmental and personal protective equipment. Health outcome and cost-benefit studies on the use of personal protective equipment: types of respiratory protection, frequency and utility of fit-testing. The relative role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission The actual scientific rationale for using respirators for the control of transmission of disease needs to be elucidated- when concept was first introduced (for MTB) there was absoulutely no evidence to support using respirators. This one concept has caused a great deal of resources to be used that could have been directed towards activities that are scientifically valid & actually work.
03/28/2005 12:43 DC 92 I mycobacterium para tubreculosis & link to Crohns & IBS
03/28/2005 12:40 DC 90 I Would like to see more research and promotion of vaccine preventable diseases.
03/28/2005 11:33 DC 78 I Encourage colleges and universities to offer courses and degrees in Occupational Health, Infection Control and Epidemiology of new and emerging diseases.
03/28/2005 10:19 DC 71 I Research in to the effectiveness of mask fit-testing in the control of transmission of various infectious agents. Pulmonary tuberculosis being the most frequently referenced disease. Cost effectiveness use of personal protective equipment vs transmission.
03/28/2005 09:17 DC 65 I Outcome research (transmission studies) to define the relativeimportance of the hierarchy of controls in preventing healthcare associated transmission of Mycobacterium tuberculosis and other infectious agents potentially transmitted via the airborne route:administrative, environmental and personal protective equipment. The relative role of patient characteristics, procedure-related events and environmental sources of infectious agents in airborne disease transmission
03/28/2005 08:41 DC 61 I Research to show if pulmonary Mycobacterium tb is transmitted to care givers wearing a well fitted submicron (surgical, non-respirator) mask. Would like to decrease the time and money taken to fit test respirator use in healthcare givers in the hospital.....need the time and money for issues much more practical, especially since unable to find any good research showing surgical masks don't work. (Or at least research to show that disposable N-95 respirators do or don't protect healthcare givers from tb, if they are snug on the face without gaps (without being fit tested).
03/28/2005 08:10 DC 59 I Although it is extrememly important to understand the workings of pathogens on a molecular level, I think that more emphasis should be placed on prevention of transmission of infectious organisms and development of vaccines.
03/27/2005 16:24 DC 55 I How about more research on true primary prevention for non-sexually transmitted (respiratory and GI) diseases as they seem to be the largest cause of mortality and "cost" to the health care system. Also CDC should use Health Promotion targeting the public to disseminate the messages of the research they fund
03/25/2005 13:08 DC 51 I Vaccine development is of the upmost importance--along with chemoprophylaxis.
03/22/2005 13:52 WA 38 I Explain to the public why the CDC did not educate the public on the HCV epidemic after learning of it's wide spread potential and the largest population infected were the blood transfused. Also explain to the public why the CDC did not establish an early warning system after the HIV/AIDS epidemic was funded by congress so that this would never happen again or if it happened again, through the early warning system we could educate the public and slow the spread and/or identify the population potentially infected? Governments failure has cost lives and we still have no "honest" public education on this issue. Instead we do have a CDC integrated plan that would conveniently integrate HCV into HIV/AIDS programs therefore again, adding salt to the wound; misleading the public as to their real risk factors (either a drug abuser or MSM) and turn away any potential questioning of the governments role in the spread of this epidemic.
03/15/2005 13:55 WA 26 I Invited participant for this breakout group
03/15/2005 00:18 WA 25 I Vaccines should be developed to fight new epidemics as well as we need to look at distribution, cost, supply.
03/11/2005 07:02 GA 18 I Sexual behavior research
03/04/2005 23:04 GA 12 I I would like to encourage the expansion of topical microbicide research. It is imperative that we increase the funding for microbicide clinical trials until an effective and safe microbicide is available to the public. Specifically, women need options they can use to protect themselves when their partners don’t use condoms – options they can control and use without their partner’s participation, if necessary. Microbicides are being designed to fill that niche. A safe, effective microbicide will allow women to take action to protect themselves without having to rely on their partners for protection. The possibility of a gel or crème that gave women that power seems like a real cause for hope. Such a break-through could actually change the equation of risk and substantially reduce the numbers of women becoming infected with HIV. Microbicides aren’t cheap to develop and more public funding is urgently needed to keep the research to find a safe, effective microbicide moving as quickly as possible. Please give thoughtful consideration to this issue. Sincerely, Terri L. Wilder, LMSW Coordiantor Georgia Campaign for Microbicides
02/25/2005 08:43 GA 7 I Development of improved diagnostic tools for detection of latent TB infection and active TB disease. Development of antibiotics for drug resistant TB strains. Development of a TB vaccine.
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Date Time Type ID Group Comment
04/20/2005 10:33 PU 474 X 1. We need to combine all the health surveys and other information to see the entire picture of the Health Status of the US population. To accomplish this complex task, we can develpo Health Index of the US population by either modelling or weighted sum methods. 2. Analytical method for the complex sample survey data is needed because the conventional method is not suitable for the specific nature of CDC data sets Nonresponse is a serious problem for NCHS survey such as National Health and Nutrition Examination Survey (30-40 percent nonrespomnses). To do better analysis of the data, we need to understand non-responses and data analysis should incorporate them.
04/20/2005 07:18 PU 472 X CDC is committed to supporting and developing evidence-based public health interventions, yet many effective interventions implemented in communities do not have formal evaluations in the published literature. A promising area of CDC research investment is in supporting the formal evaluations of community-originated public health intervention efforts. That is, CDC would offer funding and technical assistance to programs already being implemented that feel they have promise and would like to undertake a formal evaluation that could be submitted for publication. By increasing the scope and range of evidence that is represented in the peer-reviewed literature, we increase our effectiveness as a public health agency engaged in evidence-based intervention. In support of this proposal, please see the following document that was developed by the CDC's Measures of Racism Working Group: 1. Provide a summary statement of your research idea or theme (1 sentence or phrase) Formal evaluation of community-originated interventions 2. Provide details/examples of idea (1-2 sentences) CDC will invite requests for funding and technical assistance from community-based organizations to evaluate intervention strategies that have originated and are already being implemented in communities. 3. Describe how this theme addresses or relates to the four criteria: a) Public health need/importance of problem In the 2004 pilot of the CDC Goals Management process, the goals management pilot teams were asked to evaluate intervention strategies and provide evidence-based guidance to CDC on best investments for public health impact. During that process, the limitations of published reviews such as the Community Guide to Preventive Services became clear: • Many promising public health interventions are never formally evaluated • Many evaluations that are conducted are never published • Formal reviews of published evaluations deal with dated intervention strategies because of the delays inherent in publication and then in the review process If CDC wants to invest its resources in the best available intervention strategies, it will need to broaden the pool of candidate strategies beyond those currently identified in formal reviews of published evaluations. Increasing the number and range of promising public health programs that are formally evaluated will improve CDC’s ability to make the best decisions about how to invest public health effort and dollars. b) Relevance to reducing health disparities The lack of formal evaluation of promising community-originated intervention strategies is especially true in the communities with the poorest health outcomes. These communities are often strapped for resources and access to evaluation expertise. Limited intervention resources are usually devoted entirely to program, with no reserve set aside for evaluation. Interactions with academic institutions are often limited or laden with a history of being disrespected, and evaluation expertise is often not nurtured within these communities. Strategies for addressing the causes and manifestations of health disparities are being tried everyday in affected communities, and CDC can help identify the best of these. c) Potential for broad impact CDC investment of resources and expertise for formal evaluation of ongoing community-originated interventions will allow the innovative strategies currently being implemented in these communities to be brought to the table and potentially taken to scale. d) Relevance to CDC mission and health protection goals CDC has a responsibility to make the best use of our public health dollars. Broadening the pool of formally-evaluated intervention strategies will improve CDC effectiveness in addressing all of our health protection goals.
04/20/2005 07:06 PU 471 X We need add a research priority to the Cross-Cutting Research agenda entitled "Social Determinants of Health". This area would include research efforts to identify and intervene on the fundamental causes of behavioral and health outcome disparities. In particular, research would: Examine differences in the distributions of exposures, opportunities, and outcomes by “race” and socioeconomic status. Include measures of racial climate in surveillance systems. Develop disparity impact assessments tools to enable disparity impact statements for all newly proposed policy and programs (at federal, state, and local levels). Mandate the collection of socioeconomic data with all federally-supported data collection. Develop measures of racial climate, institutionalized racism, personally-mediated racism, and internalized racism, including qualitative measures of structures, policies, practices, and norms. In support of adding "Social Determinants of Health" as a research priority, see the following language excerpted from the July 2004 final report of the Public Health Research Implementation Team chaired by Tanja Popovic as part of the CDC's Futures Initiative: Recommendations: Conduct surveillance to describe and monitor the health burden of SDOH • Assess CDC surveillance systems to evaluate how they currently capture social determinants of health, and recommend modifications or additional measures as needed • Conduct surveillance of neighborhood and community contexts, beginning in 5 major cities • Develop new measures of social context for use in surveillance • Review and develop social health indices to summarize population health across communities, states, and the nation and to track changes over time Conduct epidemiologic studies and advance methods to identify the health impacts of SDOH • Employ new methods, such as life course epidemiology and multilevel analysis, to elucidate the relationships between social determinants and health outcomes • Develop measures of assets and social support structures in communities to identify behavioral, cultural, and social factors that promote health • Train investigators to ask new questions about how racism, socioeconomic status, and other stress-inducing processes affect health, especially in vulnerable populations • Train CDC scientists on the health and human rights frameworks that have been adopted internationally; provide guidance for understanding how CDC research and programs fit into a larger health and human rights framework Conduct SDOH intervention and translational research • Review current intramural and extramural social determinants of health intervention research activities; identify gaps and make recommendations for future research • Identify current behavioral and biomedical interventions that could be expanded to address social determinants of health in order to increase effectiveness • Develop incentives to support cross-CDC and cross-Federal Agencies collaboration on social determinants of health research • Develop innovative evaluation and program tools that incorporate social determinants of health approaches • Develop new methods, such as Health Impact Assessment, to evaluate the public health impact of social interventions (for example, housing or job training programs) • Expand opportunities to work with communities to capture local knowledge and build capacity to address social factors that influence health Develop structures and partnerships to integrate SDOH into PH research and practice • Establish a central social determinants of health hub in the Office of Strategy and Innovation or the Office of the Chief of Science to guide CDC social determinants of health activities • Establish social determinants of health teams in 5-7 CIOs and/or Coordinating Centers, affiliated with the Associate Directors of Science and linked to the central social determinants of health hub • Collaborate with the NIH Office of Behavioral and Social Sciences Research to establish a continuum of social determinants of health etiologic and intervention research • Develop social determinants of health and multidisciplinary training opportunities and programs within the Office of Human Capital and Professional Development; explore potential collaboration with the NIH Office of Behavioral and Social Sciences Research • Establish extramural research programs that are consistent with intramural social determinants of health research goals and activities
04/19/2005 22:43 PU 470 X X11 - Important topic. I suggest defining "Public Health Workforce" broadly to include healthcare and public health practitioners with lower levels of training, i.e., medical assistants/techs, and other allied medical services and therapies who can inturn help to educate the public and impact public health.
04/19/2005 22:38 PU 469 X X5 - People with Disabilities are a population frequently overlooked by Public Healt. Although gaps in surveillance of people with disabilities are identified in Healthy People 2010 and other sources, CDC has an opportunity to lead the nation in adequately addressing the special access to public health, stigma and lack of adequate knowledge by health care providers and public health, which further compounds and compromises their health. Rates of disability are highest among Native Americans, and obesity rates are high among people with disabilities. CDC needs to do more research in this area.
04/19/2005 17:43 PU 465 X For the last two years I have explored published research related to strokes and discussed potential collaborations to address some of the issues associated with the increasing burden of stroke and its long-term consequences on the population. Based on my research and discussions with potential collaborators, there is a tremendous opportunity to develop a laboratory research focus on stroke. We have done some preliminary work to develop a proposal for a project to validate and implement quantitative methods for measuring and profiling proteins associated with strokes, identified methods and technology to be validated, and located sources of samples for a study. What we have not been able to identify is a relatively small amount of funding to support the project. My reason for including this suggestion under cross-cutting research is that the technology we propose is very sensitive and versatile. It has the capacity to identify, measure, and monitor proteins and peptides for applications related to chronic diseases and chemical and biological exposures. This technology provides a broader (lower resolution) view, rather than a narrow focus and is complementary to the higher resolution technologies that we are currently using. My concern is that we are passing up the opportunity to look at the forest because we are so focused on the trees. I would be delighted to discuss this in more detail. Mary K. Robinson, Ph.D. Health Scientist Division of Laboratory Sciences National Center for Environmental Health Centers for Disease Control and Prevention Voice: 770-488-4208 Fax: 770-488-4192 E-mail: mkr1@cdc.gov
04/19/2005 17:26 PU 463 X X17, Ethics in Public Health: this area is really important. Public health isn't very reflexive, and doesn't tend to recognize the ways in which it can conflict with the values of human rights and the principles of research ethics. Public health needs to think more carefully about when and how it is appropriate to engage in what might otherwise be called social control or paternalism, in the name of the public good. We need to be good stewards of our knowledge and methods, and their uses.
04/19/2005 16:13 PU 457 X Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:54 PU 455 X Comment 1: Suggested bullet for "Examples or research activities" for item X-12 (Economics and Public Health): "Developing models to value unintended consequences (positive or negative) that accompany large-scale public health interventions." Explanation: Some public health interventions are designed to prevent a disease with modest burden. The intervention may be cost-beneficial per se, but the almost inevitable unintended consequence could introduce costs that vastly outweigh that burden. Perhaps certain kinds of intervention should not be applied for diseases that have less than a threashold burden, esp. if the intervention is not voluntary for the population. Comment 2: Change first bullet in X-12: "Develop methods to produce currently unknown values for various economic measures of health burden and well-being, INCLUDING COSTS TO THE PUBLIC HEALTH SYSTEM" Explanation: we lack data on costs of outbreak control, etc. Comment 3: Also for X-12 (I have no suggested wording for this bullet): CDC should conduct research - and publish results - relating to the value of outbreak investigation and control to society. Explanation: The SARS epidemic cost the global economy $10s of billions, and CDC/WHO/Others identified risk factors to reassure commerce and ultimately helped control the scope of the epidemic. How much money did CDC save the global economy?
04/19/2005 15:43 PU 453 X We need better standards for developing estimates of cost of illness (COI) for various chronic and other diseases. Right now the field is a mess. Also, how about more research on how to reduce or eliminate sociodemographic disparities? Everyone trots out data documenting the disparities, but no one seems to take on the harder issue of how to reduce them. I believe the underlying problems are similar no matter what the disease, so an addvance in any one area may help everyone.
04/19/2005 15:31 PU 452 X Way too much information squeezed into this area. Who would want to read this? Cut it down, make it simple. Do we need this group along with all the others?
04/19/2005 14:21 PU 447 X New theme There is a need for an additional cross-cutting research theme specifically focused on development and validation of health-related quality of life methods. This theme is closely related to the CDC Mission "to promote health and quality of life..." as well as to the Healthy People 2010 goals to "increase the quality and years of healthy life" and "eliminate health disparities". This area of study is very important to the public as well as to state and community leaders and has considerable potential value to CDC research and intervention programs in all other research theme groups. Yet it has no clear funding stream and it is not adequately addressed or emphasized by the current research themes. A suggested Research Theme Title and Decsription and Examples of Research Activities are as follows... Health-Related Quality of Life-- Develop and evaluate survey-based methods for assessing health-related quality of life--defined as perceived physical and mental health over time--and for tracking these perceptions in state and community populations to identify potentially unmet health needs and disparities, evaluate the effects of health policies and programs, and guide the effective allocation of public health resources. Examples of Research Activities-- +Develop and validate brief sets of health-related quality of life measures for use in population surveys and prevention research. + Develop valid methods for assessing health-related quality of life in multiple settings (e.g., homeless shelters, clinics, and nursing homes) and populations (e.g., new immigrants and persons with limited reading skills) +Study factors relating to worsening and improving trends in national, state and community health-related quality of life. Conduct applied research on the use of population health-related quality of life data by states and communities in health decision-making and policy. Theme X14 In the description of X14 add "assess and" after "better" and add "in populations" after "mental health". Add the following example as well... +Develop and validate brief measures of depression, anxiety, and other common mental health conditions and symptoms (in collaboration with mental health agencies) for use in population surveys and prevention research.
04/19/2005 14:20 PU 445 X It appears that CDC is starting the recognize and bring to focus complimentary and alternative medicine practices. In a presentation scheduled for May 23rd, researchers will present how Yoga breathing exercises (technical term: Pranayama) are effective for multiple types of behavioral and health outcomes that are priority for CDC. Research that focuses on self-management of chronic diseases may benefit from learning about alternative practices from the East.
04/19/2005 13:25 PU 439 X X7. Identification of barriers to health promotion/disease prevention interventions to include mental illness (depression/anxiety, etc). X14. Mental Health Promotion and Illness Prevention are important both in their own right (which this goal addresses) but also with respect to many of our existing areas of focus. As written, the examples do not include ways that mental health promotion and mental illness prevention are important as part of overall health and well being. For example: Addressing the impact of depression on risk behaviors like smoking, physical inactivity and poor nutrition. Or the need to attend to mental health of people diagnosed with chronic diseases like HIV/AIDS, diabetes, heart disease etc. Also community resilience and terrorism (a psychological target of attack). Or how can you motivate someone who is depressed and obese to exercise which would have impact on both obesity and mood. Where will this research be done if not here? This cross cutting topic is VERY important but as currently framed is less cross cutting and more focused. I think we could have a role in both but believe our impact would be greater if we worked on this in MANY of our current areas of focus.
04/19/2005 12:27 PU 437 X theme X 12 - This is vitally important. We need to know what it is costing us to not promote health and to spend so much on medical care. What if we spent 50% on prevention and 50% on care.
04/19/2005 12:25 PU 436 X Theme X8 - What is impact on transportation system on access to health care and healthy food. What is impact of car dominated transportation on health of those who can't drive (blind, elderly, disabled, seizure disorder).
04/19/2005 11:56 PU 433 X A major area of needed research is in the financing of public health agencies. LOCAL capacity building is currently the prime imperative for the nation's public health infrastructure. Nevertheless, the local tax base in many places simply is not adequate to support necessary functions and essential serivces. Innovation is needed to properly allocate financing among local, state, and federal sources as well as to private-sector entities. Models need to be developed that provide government with tools to predict staffing levels, operating costs, and capital investments.
04/19/2005 11:18 PU 430 X I would think that these areas could be better coordinated with IOM recommendations for public health prevention. CDC should also have a better balance between risk, prevalence, and funding in its activities. Things that NIH is already doing should be left to the bigger pockets of NIH. All of the moves to make CDC more like NIH should be re-examined. We used to be looked at as innovators within public health. Now we are maintainers of the status quo, generators of more bureaucracy, and supportive of a political administration that continually undermines the public health. Lastly, I think CDC should have a serious examination of using this business model of re-organization. The business model has destroyed effective health care in the US - people are sicker and care is more expensive and less personal. This model is also starting to take down public health. CDC is a worse place to work and we are less responsive to the wholistic aspects of population health because of it.
04/19/2005 10:23 PU 423 X I recommend that the research activities for X.7 include: Identify risk/benefit perceptions and barriers to behavior change of population segments as the basis for salient messages. I recommend that Theme X.10 be rewritten to state "... to disseminate, implement, and maintain effective interventions and programs." I recommend that the first research activity for X.10 include "implementation, adaptation, and maintenance" of effective interventions. I oppose research theme X.15 on the grounds of privacy violation, stigma creation, and negative impact on persons' insurability.
04/19/2005 09:46 PU 421 X Thanks for this list; lots of important topics that don't always have a clear "home". Particularly pleased to see and want to emphasize the importance of research related to workforce and career development issues. Although HRSA has a role in this arena, it is primarily clinical, rather than public health, in nature. Another topic to add relates to (public) health systems research -- for example, how do organizational structures, relationships, etc., influence public health impact? Thanks for the opportunity to comment.
04/19/2005 06:48 PU 417 X Theme ID X19 Research theme title and description Determinants of demand for preventive services Identify socio-economic, organizational and institutional factors that effect individual demand for preventive services Examples of research activities • Investigate variations in individual demand for preventive services by the type of health insurance coverage, exposure to worksite health promotion programs, health risk knowledge and attitudes about health • Investigate the effects of consumer-oriented approaches to management of health care costs (high-deductible health savings accounts) on availability and use of preventive services
04/18/2005 16:26 PU 414 X Comprehensive program evaluation: if state health programs are making a difference. Doing more work with states, communities-"trench-work" to find out what is really happening, what is working, etc.
04/18/2005 15:37 PU 411 X This area relates better to gaps in the health promotion area. However more is needed in research related to: the need for more research in social ecological models, implementation of transdisciplinary intervention, methods for engaging communities, advisory boards, and tribal leadership, trans-disease/risk factor intervention strategies for policy and systems change, and rapid translation/dissemination of research to practice. The bottom line suggestion is we need research to solve problems (the "how to") rather than just describing problems.
04/18/2005 15:18 PU 409 X I believe the title "Cross-cutting research" should be revisited. Rather, the important issues that are addressed here are more reflective of "Foundational Research". I also believe that the public health systems research concepts included here - such as exploring the public health infrastructure and state and local public health agency structures and roles, public health workforce, etc. - are so critical that they should be included in their own category. Without the strong organizational and workforce components required to actually undertake public health, the programmatic activities reflected in the other research categories would suffer.
04/18/2005 14:09 PU 405 X I think it is essential to have a robust cross-cutting research agenda to address such issues as the public health workforce. With the looming crisis of the aging and changing workforce in all the public health institutions throughout the country, we will be challenged to maintain a state of preparedness in any category, regardless of the level of the science. We must do research in the basic infrastructure issues and have the real hard data for the difficult competition for scarce resources. Additionally, all funding sources now want to know the impact of their training dollars. Without good evaluation, it will be difficult to show the impact of those training dollars which will make it more difficult for legislators to advocate for essential training.
04/18/2005 13:47 PU 402 X Once again, there appears to be redundancy in some of the goals from this area that have been covered in other areas - Disease, Injury, Disability, and Exposure surveillance; Eliminating Health Disparities; Health Education, Communication and Marketing. Despite the "Cross-cutting" in the title of this theme, it appears to once again focus of items that are covered in other groups.
04/18/2005 13:14 PU 397 X The starter list is completely inadequate with regards to including foundational research of systems-wide infrastructure or capacity for local and state public health. CDC has placed considerable emphasis on accountability, yet no mention of performance standards, accreditation, or other standards setting processes are listed. This area of research should be the highest priority at CDC, simply because without adequate knowledge of what's out there and how to organize, structure and finance the PH system in order to maximize it's impact, then all the research dollars spent on other areas is wasted. You need a separate category just for systems research - particularly the local and state agency component. Some suggested areas of research should include: 1) learning about accreditation and how it would function within the public health system; 2) evaluating the implementation of a national agency accreditation system; 3) long-term follow-up on whether having an accreditation system has lead to improvements; 4) How have local and state PH systems used the performance standards to make system improvements; 5) has the use of the performance standards lead to measureable impacts on systems functions; 6) has the use of the performance standards lead to measureable change in the community's health status; 7) what is the optimal structure, organization, workforce, etc that best provides public health services to the community? This is just a starter list and could easily be rapidly expanded. Serious consideration of having a robust systems research component should be your top priority.
04/18/2005 12:19 PU 393 X X12 Economics and Public Health- In addition to the economic aspects outlined here regarding cost and efficacy, it is very important that we also examine the broader, macro-level economic patterns and how they influence the infrastructure for creating healthy communities - communities which foster, encourage and enable healthy living. X13 Social and Behavioral Sciences in Public Health. I agree that understanding the social determinants of health is a critical part of the CDC research agenda and a huge cross cutting issue. By 'looking upstream' we will be much better able to design and implement health prevention policies and programs that implove the health and well being of entire populations. An element lacking in the research agenda is the issue of geographic disparities. More attention should be placed on understanding the geographic disparities in health patterns, and the varying geographic patterns that exist for different racial/ethnic groups. Identifying and monitoring geographic disparities in health enables health professionals to tailor intervention to the needs of specific communities and provides insights into new or previosly unidentified risk factors and risk conditions. It is also important to underscore the need to address racial/ethnic disparities in health. Longstanding historical conditions of discrimination and racism underlie many of the health disparities observed today. We must better understand and work to eliminate the racial/ethnic disparities observed in the United States.
04/18/2005 11:15 PU 389 X Facilitate formal resolutions to allow for the the access of educational records for public health activities with appropriate safeguards.
04/18/2005 08:36 PU 382 X This may be in there, but...seems esential to focus effort on combining data collection efforts across chronic diseases to give a more comprehensive picture of their interrelationships and to reduce the cost of these activities, increase efficiency and accuracy of comparaison across programs and diseases areas, to better understand common risk factors...
04/18/2005 07:27 PU 376 X A reasonable and comprehensive strategy to disseminate research findings to parents of the children who could benefit from the results of research should be a prominent component of this agenda. Educating families to use this information in advocating for health servcies for their children should
04/18/2005 06:24 PU 374 X As with many of the other topics, agenda sounds like a vacuum rather than you want to do the same research that a large number of research organizations have been doing for years. On survey response rate, population could be used generically. If not, CDC surveys target some variety of "populations" and some of those (e.g., MD's, nursing homes) may have special issues.
04/17/2005 17:54 PU 371 X A study of the health and wellbeing of prisoners in the US -- According to a Human Rights Report over two million U.S. persons are in prison, a higher percentage of its people than any other country. Even more troubling is the extent to which these persons are African American. While only 12% of the population is black, 44% of all prisoners in the U.S. are Black. Hispanics are approximately 13% of the population but 18% of the prisoners. In the majority of states the ratio of the Black percent of the incarcerated population to the Black percent of state residents is more than 4. Nearly 5% of black men compared to .6% of white men are incarcerated. We should study the effect on families, children and the community when such a high proportion of the population is in prison. We should study the conditions that these prisoners live in. A recent report by Human Rights Watch, Ill-Equipped: U. S. Prisons and Offenders with Mental Illness states that one in six U.S prisoners is mentally ill, many from very serious illnesses such as schizophrenia, bipolar disorder, and major depression. (If they are not ill when they go in, they probably are before they leave). Unfortunately, the woefully deficient health services in many, if not most prisons leave prisoners untreated or inadequately treated. This is especially true for the mentally ill. From January, 1995 until March, 2002, 83 people had committed suicide while prisoners in New York State alone. A recent article in the New York Times (Private Health Care in Jails Can Be a Death Sentence, February 27, 2005) describes the deplorable state of health care, including patients dying without any medical attention, medical staffs trimmed to the bone, underqualified or out of reach, prescription drugs not ordered or withheld, unread patient charts, etc. In New York, a physician from DC, overseeing care in different jails overruled doctors in the jails, refused to allow them to give drugs and treatments to prisoners when he never saw the patients and was not even licensed to practice there. Medical care in prisons is often woefully inadequate. In some prisons untrained correctional officers with no medical background are responsible for dispensing medications. This is a problem for many reasons, e.g., medications are allowed to run out, privacy concerns, untrained staff may unknowingly distribute the wrong medication or the dosage, or distribute it at the wrong time. In others, as described in the NY Times article, they simply don't care. Other concerns are lock downs for 23 hours a day for prisoners (In Illinois, for months or even years. This is torture.), the lack of a adequate and healthy diet, abuse by guards, lack of exercise, and lack of educational materials, training and courses that would help them make the transition back into the community. Patients who have medical problems need to be properly diagnosed and treated. Patients with TB or AIDs or any number of other infectious diseases will spread the disease to others not only in prison but to family and community when they get out. Thus, we should look at the following: number of deaths, whether patients have medical care available at all times, whether doctors and nurses are qualified, whether drugs and treatments are available and correctly dispensed to the right patients, whether the conditions the patients live in are fit for human habitation, whether the food is nutritious, whether prisoners are challenged and given the opportunity to take classes so that they will be able to survive when they leave prison, etc.
04/17/2005 14:00 PU 370 X The World Health Organization famously said several years ago that there can be no health without mental health. Mental health, perhaps more than any other area relates to many of the major research priorities; affecting the obesity epidemic, violence, injury, cardiovascular disease, and HIV/AIDS, among others. Mental health is a across-cutting research area and should be included in the starter list. Second only to heart disease, depression, is predicted to be the leading cause of death by the year 2020. CDC would be well-positioned ahead of the curve by adressing mental in the work across CIOs and Coordinating Centers.
04/17/2005 12:20 PU 369 X Each of the items in this starter list seem to apply to worker health issues as well as to general public health issues. If this is not the intent, it should be and the language should make that clear.
04/15/2005 16:18 PU 366 X Changing patterns of adult antibiotic use after implementation of Medicare Part D (my hypothesis is that adults will be using more antibiotics, especially more expensive broad spectrum ones)
04/15/2005 15:30 PU 365 X Just to re-iterate the importance of workforce development (making it broadly available to health staff and not limiting to upper management), and also Systems approach to design, development, implementation and evaluation of disease control.
04/15/2005 14:15 PU 362 X To Theme X14, "Mental Health and Substance Abuse", under "Examples of Research Activities" would suggest adding: "Evaluate the influence of mental health/mental illness on engagement in health protection activities and/or risk behaviors". Although it has not traditionally been CDC's role to assess or treat mental health, it is difficult to ignore the important interactive role it plays in the presence or absence of health protective behaviors.
04/15/2005 14:13 PU 361 X The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 09:06 PU 348 X Funding to support research which evaluates the effect of laws and regulations upon the public's health is greatly needed. In addition, funding is needed to support evaluation of the structural and functional variability of the public health system state to state. Research is needed which demonstrates the impact of public health services.
04/14/2005 14:18 PU 337 X It is good that genomics is listed here as Dr. Muin Khoury has rightly been advocating this for a LONG time! Some of the other areas are less cross-cutting but I guess CDC needs to pay lip service for these.
04/14/2005 13:26 PU 332 X Important for these ideas to not be developed and implemented in isolation from relevant program area. Under burden of disease, develop methods to capture benefits of mature programs - if we really want diphtheria back as a major cause of death in the United States, we can get it back.
04/14/2005 12:38 PU 328 X One area I would really like to see developed is the use of paraprofessional health workers in rural areas. Alaska's Community Health Aid Program has done wonders for rural Alaska, but there are resources still untapped. I'd like to see more community-based reserach that trains members of communities (especially rural communities) in basic health education, needs assessment, prevention/health promotion, community development, and program evaluation skills.
04/14/2005 12:30 PU 326 X GIS systems have been sorely under utilized in PH. Spatial relationships abound in all population sciences. Our connection to the earth, its weather, its terrain are unquestionable, yet we as PH experts continue to overlook this very important relationship. CDC needs to expand its expertise in using spatial methods and statistics, interpretting the results, and translating the information into PH practice.
04/14/2005 12:13 PU 322 X This is good and appropriately placed.
04/14/2005 11:43 PU 318 X There is surprisingly little methodological research in here-- i.e., research that pertains to the quality of information we obtain from surveys and surveillance systems. This could include a wide variety of initiatives on measurement error in surveys-- for example, experimentation and other social science investigation related to how questionnaire design decisions affect the quality of data; improving methods for evaluating the validity of statistical survey data; research into the cognitive aspects of survey methodology, and so on. Beyond work on questionnaires and response errors, there are wide areas of survey methodology related to mode of data collection, sampling, imputation, and interviewer effects that are ripe for additional research, as they are all fundamental issues related to data quality.
04/14/2005 11:05 PU 315 X Develop tools to help people prioritize the necessary lifestyle and healthstyle issues they need to change.
04/13/2005 15:59 PU 287 X We are currently unable to obtain some of the tools we need to manage and analyze data. This is apparently due to both budget constraints and to inefficiency in decision-making with regard to software to meet scientific research and evaluation needs. It is inconceivable to me that scientists in an agency like CDC are in this predicament.
04/13/2005 14:17 PU 280 X The starter list is thin on what I believe is the research area that could bring the biggest payoff in improving the health of the public. I'm speaking of research into how to improve the public health system itself--the governmental system in particular, but the entire system too. Items X8 and X11 seem to get us part way there, but much more needs doing in this area. We need to know, for example, what type of state-level system is best, what kind of state/local interaction pays off, what kind of funding arrangements for state and local PH are optimal, how much funding is the right amount. Do boards of health work? Should health officials report to boards, rather than to governors or county executives? What is the impact of the very fast turnover of senior state and local health officials on the quality of public health services. Etc., etc. There is much to be done. CDC has long given this category of research short shrift. And no one else but CDC can really do it adequately.
04/13/2005 11:00 PU 274 X It would be very helpful to have research conducted at the Public Health Office level to asertain what their information and education needs really are, and what equipment they have available on site to receive information and education communications from the CDC. Equipment such as Satellite receiving equipment, web streaming receiving equipment, telephone bridges and/or speaker phones, VCR, DVD and CD players, etc. Also are they planning to upgrade to HD Television related receiving and playback equipment, and if so, when do they expect to do so.
04/13/2005 10:22 PU 272 X Development of short scales for assessing alchohol, inhalant and/or drug abuse among use.
04/13/2005 09:55 PU 270 X I see three issues which should be addressed: 1) Broader economic analyses; 2) More sophisticated economic measurements; 3) Standards for determining social value and/or value from stakeholders' perspectives 1) Economic evaluation (cost-effectiveness, cost-benefit) and structured analyses such as business cases are extremely useful in determining policies regarding individual interventions. HOWEVER, there is a need to move beyond microeconomic analyses to broader economic investigation of markets that provide vaccines, drugs, and health care. For example, the recent Institute of Medicine report on vaccine finance that recommends replacement of Vaccines for Children is based on one-sided, and in some cases just plain faulty, economic analysis of the vaccine markets. As with MDs, economists specialize in different areas. There are a number of economists already working at CDC who have the ability to examine market fundamentals and provide advice on policies that will protect the provision of goods and services necessary to promoting public health. There is already some work underway examining the fundamentals of vaccine markets to make recommendations about policies to protect vaccine supplies. This work should be expanded and begin to incorporate other areas of public health. 2) There is a tendency to latch on to economic measurements without thinking them through in the context within which they are used, or examining how they were developed. In particular, QALYs and DALYs are often perceived as objective measures. Unfortunately, they are not and both come with significant methodological and ethical issues. CDC should sponsor a series of conferences to determine standards for these measures and their use. 3) There are standards for economic evaluations but they are not well advertised and, more often than not, are not followed. In fact, most societal perspectives are really government perspectives and rarely include the difficult to quantify -- lost time in a career for caregiving as an example. In addition, when making policy, it would be important to look at most studies from a variety of perspectives -- individual, supplier, provider, etc. CDC should hold a series of professional seminars about existing standards and hold debates about the appropriateness of these standards, developing new ones where necessary.
04/13/2005 07:49 PU 266 X Research Agenda : National Vision Program (NVP) /CDC/ Division of Diabetes Translation (DDT) X 2 Data Science and Information Systems Identify and develop the best methods to identify, obtain, link, and analyze new and emerging sources of data, and integrate and manage information systems in support of 1. Identify the most effective ways to integrate different health information systems, such as EMR, through the development of data standards, new technology, and innovative software tools and data bases. 2. Continue to work with the OCHIT in the design of a comprehensive HIT architecture that assures data quality and access to surveillance information. 3. Explore the potential for real time surveillance systems. X 3 Disease, Injury, Disability and Exposure Surveillance Develop new health surveillance methods and improve health surveillance systems for better detection, analysis, evaluation and control of diseases, injuries, disabilities and harmful exposures to protect the health of communities. 1. Evaluate different components of eye / health surveillance systems o improve performance. 2. Improve coordination among all involved eye/ health providers and institutions. 3. Improve rapid detection and reporting of emerging infectious diseases and harmful exposures. 4. Explore links of eye/ health to areas of homeland security. X 4 Burden of Disease Develop methods to measure and compare the relative burdens of specific diseases, injuries, and other adverse health conditions in order to implement the mix of public health interventions which will reduce or prevent the greatest amount of total health burden. 1. Develop new and improved methods to assess current and predict future trends for eye/ health burdens. 2. Burden assessment will be comprehensive including; acute, chronic illnesses, death, quality of life and well being, and economic and social costs. 3. Estimate preventable burden of eye/ health disease for appropriate allocation of resources. Cost to benefit ratio. X 5 Eliminating Health Disparities Develop and promote Develop and promote the use of effective methods, including interventions, in disadvantaged populations to characterize and reduce or eliminate modifiable health disparities based on gender, age or life-stage, race, ethnicity, nationality, geographic location, disability, income, wealth, education, and other social determinants of health. 1. Investigate health disparities amongst people with eye/ health disabilities, especially in minority populations. 2. Evaluate fundamental causes of ill-eye/ health and disparities in disadvantaged populations. 3. Investigate access issues related to eye/ health. X 7 Health Education , Communication and Marketing Develop effective health education, communication and marketing strategies and tools to inform and motivate people to make behavior changes to maintain healthy lifestyles, improve their health status, and prevent or minimize the impact of disease, injury and disability. 1. Evaluate new methods to improve eye/health literacy, especially among disadvantaged or poorly educated populations. 2. Investigate methods of encouraging populations to advance from being aware of eye/health issues to taking actions to promote their eye/health and prevent or reduce illness, injury or disability related to eye/ health. X 9 Public Health Impact Evaluation Improve evaluation methods and conduct evaluations on the public health impact of interventions, programs, and policies. 1. Evaluate the relationship between health insurance coverage, access to eye care and compare the costs to the benefits of the use of non used coverage and the impact of expanded coverage. 2. Evaluate how public eye/health programs can be structured to efficiently deliver the best services, improve health and build capacity. X 10 Translation and Dissemination of Effective Interventions Conduct research on effective methods to translate research findings into interventions and programs, and to disseminate effective interventions and programs. 1. Improve the dissemination, adoption and effectiveness of interventions that have been shown to be efficacious in prior research. 2. Develop systems of eye/ health care that enhance delivery and surveillance efforts that promote HP 2010 objectives as outlined in focus area 28.1, 28.2, 28.5 and 28.6. X 12 Economics and Public Health Develop and apply economic theories and methods to examine the supply and demand for public health, to estimate the monetary and social costs of diseases and injuries, and to improve the delivery of health care prevention, treatment and rehabilitation services. 1. Develop models on how public health agencies and health care providers can most efficiently optimize resources to provide the best mix of eye/health interventions. 2. Develop models that describe optimum communication strategies between health care providers and provide the economic justification for the use of these models. X 16 Public Health Law and Policy Determine the impact and effectiveness of legally-mandated public health interventions and programs in different community settings, and improve the translation of research findings into appropriate and effective legal strategies designed to protect public health. 1. Determine the impact and effectiveness of legally- mandated vision testing conducted by the Department of Motor Vehicles (DMV), Military Entrance Exams, Flight Physicals and others within various community settings including the low income or working poor, urban, rural, brown areas, green areas, insured community and uninsured community. 2. Determine if enhancements to this system would be an appropriate legal tool to improve the translation of eye/ health research findings into effective strategies designed to protect public health. 3. Determine if other appropriate legal strategies exist in the areas of legislative (State, Local and Federal), administrative (rulemaking), and legal challenges vs. impediments to protect the public eye/health. 4. Develop template for comparing the effectiveness and efficiency of laws and mandatory regulations in addressing chronic public health problems in achieving health impacts.
04/12/2005 14:51 PU 264 X • Cross-cutting Research: Under Health Education, consider dentistry’s potential role in nutritional counseling as one way to bring additional resources to bear on the obesity epidemic.
04/11/2005 15:51 PU 258 X These are excellent ideas. The challenge will be to manage these projects as they really ARE cross cutting.
04/11/2005 09:59 OH 251 X see general discussion comment below
04/11/2005 09:26 PU 242 X Under the Health Systems Research topic, please include factors affecting demand for health (access to care, insurance, income, stigma, KAB), as well as factors affecting the supply of health care
04/11/2005 07:49 PU 238 X To do cross cutting you need to set priorities. The found solutions meet the combined needs of all but don't fully meet the needs of any. I think that is a problem or a lot of programs.....What are the programs willing to give up categorically in order to have a better overall outcome.....a holistic solution rather than a categorial one....Can the immunization program give up 3 to 5% of their current coverage rates in return for a combined program that increases exercise, decreases tobacco use in kids, and promotes an 8th grade Dr. visit for adolescents around sexual health....
04/08/2005 08:45 PU 232 X This category does not seem entirely clear in its parameters.
04/08/2005 07:39 PU 230 X X4 is a solid idea
04/07/2005 19:03 PU 227 X This looks like a very interesting research agenda.
04/07/2005 16:14 PU 226 X Explore and develop analytic protocols for evaluationg community as the unit of analysis in constrast to the indiviual. Explore the determinants of community, including race/ethnicity, such as history, culture, context and geography and their role in addressing barriers and determining solutions related to behavior change, policy development, and environmental change. The development of new methodology, based on quantitative and qualitative methods, will be necessary.
04/07/2005 15:59 PU 224 X X5 - Assess and develop literature that expands on the utility of using acculturation scales for population identification as well as tailoring of public health messages and strategies to new Americans. X10 - Assess and develop analytical methods to respond to culturally-embedded public health concepts of at-risk populations.
04/07/2005 14:32 PU 219 X To assist both "Community preparadness and response" and "Enviroinmental and Ocupational Health research", CDC could support developmental and evaluative research on the application of advanced imaging methods for early detection and improved evaluation of active disease. A century ago, X-ray radiology revolutionized medical diagnostics. A similar event is occuring now with new imaging technologies, e.g., magnetic resonance imaging (MRI) and positron emission tomography (PRT-scan). While these are now becoming routine elements of clinical practice for cancer detection and staging, their further development and testing could be speeded for other than cancer environmental/occupational problems, e.g., early detection of lung fibrosis from occupational exposures (for instsnce, to better determine the nature of pulmonary problems currently manifest in WTC 9-11 responders as seen in the recent Mt. Sinai study /MMWR report) (J Nuc Med 2002;43:413); or to provide objective measures of occupational injury. In some cases these might shorten time to diagnosis from decades to prompt identification by non-invasive detection of active disease process, e.g., for lung fibrosis). That in turn might profoundly affect the standard paradigm for medical surveillance of some special populations at risk. CDC could do this by (1) applications research on advanced imaging methods for specific environmental/occupational disease or injury; and by (2) support for limited clinical evaluation/application at a small number of selected clinics where bellweather cases could be addressed, e.g., selected WTC responders in NYC, surface coal miners in western Pennsylvania.
04/07/2005 13:47 PU 218 X workforce research, community-based participatory research, pedagogical research
04/07/2005 13:47 PU 217 X public health systems research
04/07/2005 10:40 PU 213 X One of the basic tools that many programs at CDC employ is the controlled clinical trial (CCT). Two aspects of CCTs are particularly relevant to CDC. First, some CCTs are needed because the outcome of the trial may have significant public health impact or implications (e.g., the ongoing Tenofovir HIV prevention trials). Second, some types of CCTs can best (or only) be implemented in or through the public health sector (e.g., trials of new therapies in tuberculosis treatment; e.g., trials of new regimens for treatment of gonorrhea). In some instances, it is difficult to conceive that CCTs in an area important to CDC would be conducted if the activity is not supported by CDC. Inclusion of the methodologic aspects as well as specific applications of the CCT in the public health setting thus merit a significant place on the CDC research agenda.
04/07/2005 10:20 PU 210 X Researcher should make a focused effort to determine "what works' in disenfranchised communities (promotoras or community health workers for example) and submit those mechanisms to rigorous research to add credibility to these effective community strategies.
04/07/2005 10:09 PU 209 X Analyze the cost/benefit impact of increasing percentages of contractors at the federal public health level. Analyze public health law and ethics in relation to the technology transfer process, public/private collaborations, and CDC/NIH interfaces.
04/07/2005 09:39 PU 203 X Conspicuously absent from the health disparities research priority is sexual orientation.
04/07/2005 09:24 PU 202 X validation of items in existing surveillance systems is needed. Addressing surveillance gaps for children 6-12 for chronic disease prevention is urgently needed.
04/07/2005 09:19 PU 201 X automate sequence retrieval, alignment, and phylogenetic tree creation.
04/07/2005 08:53 PU 199 X Not sure where these fit, but having prevention research centers across the country funded by CDC (currently housed in the chronic center) for reasearchers to translate public health applicable interventions and also implement demonstration projects ssems a good idea that each of the centers/offices could take advantage of.
04/07/2005 06:45 PU 190 X Analytical methods and equipment with which to develop them are important for continued improvement in all areas from environmental to infectious diseases and terrorism. Ethics...I'm not convinced of the ethics of many ethicists. Seems like a waste unless there is a legitimate moral basis for such ethics.
04/06/2005 17:43 PU 186 X I'm concerned to see "Ethics in Public Health" at the bottom of this unalphabetized list.
04/06/2005 17:17 PU 184 X One of CDC's research priorities should be directed towards better understanding the secular trend in the United States and many other countries towards fewer autopsies; studies to better understand the consequences of fewer autopsies with regard to physician education, quality of medical care, public health surveillance, identification of emerging and established infectious diseases, and accurate diagnoses of chronic diseases, including neoplasms and rare neurological diseases.
04/04/2005 11:05 PU 147 X I also suggest some research into policy development and implementation processes.
04/04/2005 10:53 PU 146 X I believe that we need to increase our efforts in motor vehicle automatic crash notification systems. Specifically formulating mathematical models that will improve our ability to predict those with significant injuries and automatically notify prehospital personnel of the crash event and the likelihood of severe injury based upon the crash kinematics.
04/03/2005 21:43 PU 144 X X4. AOD addiction is a diesea that needs more study as to its burdens on society and individuals and all the public systems the government pays for as well as the costs to private family systems and child development X5. alcohol abuse is a perfect example of a disease that causes disparities in the response to its behavorial manifestations between sexes, ages, and cultures X7-8. be sure to inculde AOD addiction in this study of strategies to change behavior. this would be a good place to evaluate community anti drug coaltions and their effectiveness in health promotion. also study the effect of advertising on unhealthy life style choices and pick up where CAMY left off in tracking the impact of advertising on adloescent decisions to use alcohol. X9-14. these are all very important to better outcomes for the health of thegeneral population as well as those at high risk. X15. more work needs to be done in this area in relation to addictions. X16. many of the most cost effective strategies may come frm this area of investigation, especiall in the areas of alcohol, tobacco, andother addicitions like gambling, misuse of perscription drugs, regulation of meth ingredients, legal drinking age, etc.
04/01/2005 08:20 DC 142 X CDC should develop one tool for surveillance, including syndromic, to be used nationally. Info can be reported once and access can be limited to those who need it.
03/30/2005 10:37 DC 131 X Dissemniate info in a format (ie: workshops/seminars) for local hospitals to use to improve communication and report sharing
03/28/2005 17:33 OH 105 X As I understand it this section will focus on themes that combine ideas from any of the six target areas identified above as well as other innovative ideas. If that is the case I will like to see more emphasis of CDC on public health workforce development and training in developing countries; research into globalization, poverty reduction and public health; and investments in information technology and impacts on public health.
03/28/2005 13:29 DC 102 X Centralized data bases are needed by state or region to support f/u of major communicable diseases, vaccine preventable diseases, etc.
03/28/2005 12:25 WA 85 X X6-Community-Based Participatory Research, X5-Eliminating Health Disparities, and X9-Public Health Impact Evaluation should all be linked to E4 in the list from the Environmental and Occupational Health and Injury Prevention Workgroup. These 3 cross-cutting topics are desperately needed in Environmental Health and must be applied there. I work as an Outreach Educational Specialist for toxic sites with the Washington State Dept. of Health, a 1043 cooperative agreement partner with ATSDR (Superfund), and a vast majority of the communities impacted from toxic sites are either low-income, people of color, or new immigrants who don't speak English well. Community-Based Participatory research is badly needed in this area, particularly because of the hugely disconnected communication gap between technical health professionals and the communities they are supposed to serve. Effective, community-piloted evaluations are also desperately needed and we currently do not have the funding or the guidance to do them, although we are mandated to do them through OMB. Please help!
03/28/2005 09:17 DC 65 X Health outcome and cost-benefit studies on the use of personal protective equipment: types of respiratory protection, frequency and utility of fit-testing.
03/28/2005 08:10 DC 59 X The public health workforce is certainly dwindling because of lack of support at the state and local level.
03/22/2005 12:08 WA 37 X A cross-cutting research area of unique importance is that of the American Indian public health research. American Indians, Native Americans and Alaska Natives are like no other racial or ethnic group in the United States in terms of public health needs or research needs. It is critical that cuturally sensitive research and research training be launched to deal with the special public health issues surrounding American Indian people, their communities, their public health programs, clinics and hospitals. Disparities in public health research to address their particular issues need to be addressed. -- Carol Korenbrot, Research Advisor, California Rural Indian Health Board
03/15/2005 15:09 WA 29 X The CDC Research agenda should include: - an emphasis on community participatory research - Academic or other institutional based research conducted at a community level must involve the jurisdictional local public health authority - an emphasis on practice based research from the field - The practice based field research needs to address questions of organizational and structural effectiveness in the delivery of public health services.
03/09/2005 11:47 WA 14 X Can you tell me what is expected in terms of the format or public comment at these meetings? How long will each speaker have? Will powerpoint and multimedia presentations be allowed? Does one have to stay for the breakout sessions? Do you allow testimonials? Thank you, Monica Randall
02/25/2005 08:43 GA 7 X Health disparities research.
02/22/2005 09:17 OH 2 X Would be very useful if CDC were to develop more indicators of the quality of care and the severity of patient safety problems, as part of its ongoing efforts to assess public health.
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Date Time Type ID Group Comment
04/20/2005 09:53 PU 473 D Internet trials to be soon held against those guilty of crimes against humanity by inoculation with disease on www.againstthegrain.info INTERNET RADIO BROADCASTS 11P-1AM MON-FRI EST
04/19/2005 21:38 PU 468 D Given the importance of this, perhaps we should have all-hands meetings for each area and some discussion of how these were devised and what seems to be the ongoing issues. You might get better feedback from group discussions.
04/19/2005 17:26 PU 463 D Try to distinguish this effort from the Futures Initiative-- I realize they are related, but since alot of people feel left out of the Futures implementation, to the extent they associate research agenda development with it, they may not engage in agenda setting activities. Updates once or twice a month, or after major steps completed, by e-mail and on the website, would be welcome. Providing a timeline of the agenda development process, and charting progress on it, would also be helpful. Thanks for listening.
04/19/2005 16:13 PU 457 D Currently much of CDC's research is limited to cooperative agreements available to members of three organizations: Association of American Medical Colleges (AAMA), Association of Schools of Public Health (ASPH) and the Association of Teachers of Preventive Medicine (ATPM). There are respectable and qualified researchers in state and private universities who do not have a medical school or a school of public health associated with the university. The CDC reseach agenda should be open to competition to established researchers who are not members of these three organizations that are the receipients of umbrella cooperative agreements.
04/19/2005 15:52 PU 454 D One major area that gets little new research attention is the possible connection between birth control pills and breast cancer as well as abortion and breast cancer. Although much has been published, much of the epidemiological work appears to be very poor resulting in contradictory findings.
04/19/2005 15:31 PU 452 D It doesn't seem like the ADSs were very involved in this effort. I did not see the Center ADS meeting with the Division ADSs and asking them to meet with their respective divisions, get feedback and return to the Center ADS meeting with findings. We have this structure all set up but it is underutilized. An e-mail saying to submit comments does not have the same effect as having the ADS meet with the scientists to discuss the issue.....especially something as important as our research agenda. Because of the short turn-around time and the "futures initiative fatigue factor", I sense an attitude of "Who cares, they will do what they want to do" with they being the people on the top of the management structure. What is the definition of research? The whole set is much too long. We should be able to come up with 10 or fewer priority research areas for our research agenda. As is, this will not be absorbed by the research community both internal and external to CDC. All the Centers developed their own research agendas back in 2000. These could be revised to fit into a simple overall CDC research agenda in which the center or coordinating center specific areas would be available when needed but not included in the overall CDC agenda. Thank you for giving us the chance to give feedback!
04/19/2005 14:21 PU 447 D In it's present form, the CDC research agenda lacks structure. It could benefit from some rationale on how it relates to the accomplishment of the CDC Mission "to promote health and quality of life by preventing and controlling disease, injury , and disability."
04/19/2005 13:42 PU 442 D It is certainly frustrating that the public comment period on our new agency-wide research agenda was opened, to much fanfare, more than 6 weeks ago, but we received a request for comments within the agency 24 hours before the comment period was to close. It doesn't inspire much confidence in the importance of our opinions to either the process or content of this agenda. Overall, it's a nice laundry list, mostly of pet projects, but it is not clear why we need such an agenda. Who is setting the priorities? It is not clear what impact "measuring the frequency of important gene types" will have on public health, or how we are to measure the "impact of common language on emergency response teams" when we don't even have the trained personnel needed to serve on those teams.
04/19/2005 13:27 PU 440 D Where does developing community level interventions to improve resilience come in? People face tremendous stress nowadays and are responding to that stress in maladaptive ways. We need to be leaders and innovators in developing a public health approach to managing stress.
04/19/2005 13:25 PU 439 D Where does developing community level interventions to improve resilience come in? People face tremendous stress nowadays and are responding to that stress in maladaptive ways. We need to be leaders and innovators in developing a public health approach to managing stress.
04/19/2005 12:03 PU 434 D Where will the issues of oral health be addressed?
04/19/2005 11:19 PU 431 D I think it is sad that CDC does not have a research priority on "Eliminating Disparities" or on "Minority Health".
04/19/2005 11:08 PU 429 D Regardless of what management says about developing a research agenda, many laboratory researchers believe that our days are numbered here at CDC. Laboratorians are being told to stop work on innovative basic research projects. We are being told that our role is to only support epi studies. Research will be done by the NIH. In light of the dismal state of HIV vaccines, it is obvious that we need to encourage thinking outside the box to solve this problem as well as the problem of emerging infectious diseases.When you stop allowing the labs to do cutting edge research, you will loose the abiltity to respond to new threats. We must keep our labs up to date with the newest technologies and encourage basic research ideas. I think it is great to develop specific priorites and goals for research but we must remain open to new ideas as they come along. This developing agenda must continue to evolve over time. It is hard to believe that management is serious about supporting "research agendas" in light of the day to day decisions that are being made.
04/19/2005 10:59 PU 428 D no focus in maternal and child health either as a topic area or within specific content areas - this seems short sighted
04/19/2005 10:36 PU 427 D From the perspective of NCHS, this is not at all satisfactory. We operate a wide variety of data collection systems, and vital statistics and our survey programs are the priority. Enhancing the integrity and stability of these key programs is critical to addressing any research priorities. If vital statistics and the surveys are not nurtured and fully supported, then the research flowing from them will be tainted and flawed. A key strength of vital statistics for example is the extensive detail for racial and ethnic subpopulations as well as small geographic units. The research agenda calls for addressing disparities, but without serious and substantial investments in the vital statistics program, this research cannot happen. Similarly, the cross cutting agenda in theme ID# X13, Social and Behavioral Sciences in Public Health refers to devising new qualitative and quantitative methods for surveillance of behavioral risks associated with adverse health outcomes. Why not instead put resources into the exisiting surveys, for example the NSFG, NHANES, NHIS, to enhance the utility of these tried and true and very highly regarded surveys to address these research issues, instead of advocating new data collection systems?The real danger is that we will see whatever [limited] resources there are go into these new ideas and this will come at a big cost for the core programs at NCHS. We're already seeing first hand that the alleged new money for NCHS is not translating into needed support for enhancing the existing systems.
04/19/2005 10:33 PU 426 D I have spent over half an hour now looking thru this "starter list of research priorities," and the fact sheets that go with them. I am puzzled. First, I'm not sure what their definition of "research" is. The most important example of this is that I don't see one mention of Vital Statistics as a mission or priority for CDC. If we don't have vital statistics, we have nothing. Vital statistics is more important than anything I saw listed here. Second, I also don't see one mention of population-based surveys like the NHIS, NSFG, and NHANES. This is very strange. Third, the list appears to be just a list of what CDC is already doing, in order to justify what it's doing. In some cases, it lists things that someone would LIKE to be doing if they had more money. Is that what our "agenda" is--a wish list from those who spoke up? Fourth, it isn't clear what the process is going to be to decide what CDC's priorities are. From the contents of this wish list, it seems pretty clear that people in Atlanta are going to get priority over Hyattsville. If they use this list to make budget decisions, that would be downright scary. Someone prominent needs to tell them that vital statistics and basic population surveys are the foundation of their priority setting. They need to be supported. The targeted research that's emphasized in these lists is a waste of time without the basic data provided by vital statistics and population-based surveys--those data tell you what you should be doing targeted research ON.
04/19/2005 10:29 PU 424 D I think that CDC should have initially involved our partners in public health---those in CSTE. Ignoring these long-standing, intelligent partners in the outreach stage of this current reorganization was an enormous mistake, in my opinion. It has weakened our relationship with them and was short-sighted. I would like to see that corrected.
04/19/2005 10:23 PU 423 D Part of the intent of the CDC Health Protection Research Guide, 2006-2015 is to prioritize research; however, I did not see anything about how the priorities in the above seven areas were established nor how the research themes will be prioritized relative to each other. Will CDC pursue all themes equally?
04/18/2005 16:26 PU 414 D I think we have critical knowledge gaps when it comes to program evaluation-and creating a bigger prescense in the field. I think we need to colloborate more with national experts (ie: Michael Quinn Patton) and do alot more program evaluation here at CDC. There's alot more to it than simply looking at surveillance type data and indicators.
04/18/2005 16:18 PU 413 D I was curious on how genetics would fit into the research agenda. It is cross cutting but specific enough to be a separate discipline.
04/18/2005 15:18 PU 409 D The categories and starter lists, in general, seem very siloed and program-oriented. I think much would be gained by CDC leading the charge for a public health systems research category (listed first to emphasize its role in building the foundation upon which programmatic activities are undertaken). We know very little about public health infrastructure and how we can improve the public health agencies and workforce that are at the front line of public health. This is an important area that could have great impact for all areas of CDC, as well as for our national stakeholders.
04/18/2005 13:14 PU 397 D The process that CDC used to establish the seven focus areas, and their attendent starter lists, appears to have failed by not recognizing the extreme importance of having good, basic research done on what kind of public health system we have and how we can make sure it's functional and accountable. Forget all those precious research dollars spent on infectious disease, chronic disease, injury, etc if none of those interventions or programs operate in an effective manner within communities. This obvious mistake needs to be addressed, otherwise we (CDC) risk wasting resources as well as alienating the supporting public policy makers in cities, counties and states across the Nation.
04/18/2005 11:15 PU 389 D A very nice start at developing the research agenda. Please make sure issues of cumulative exposures are addressed and their impact on disability. Also, an effort to develop methods to evaluated complicated genetic and environmental interactions resulting in disease and disability are needed.
04/18/2005 09:23 PU 384 D I am leary of the need for an "agenda". Current research at CDC is excellent. My greatest concern is CDC staff taking on too much (the equivalent of Congress mandating but not funding).
04/18/2005 08:36 PU 382 D More research and program development focus on addressing mental health issues related to chronic disease (e.g., physiological impact of stress and learned helplessness). This might include tracer studies that follow patients over time and track stressors related to their ineractions with the healthcare system----what innovative practices seem most related to the reduction of these factors that reduce quality of life by increasing debilitating complications and costs associated with chronic disease.
04/18/2005 08:09 PU 379 D I would like to see some connection to the private sector, where, in PA, 85% of immunizations are given. I would like to see more research on what distinguishes high-performing practices from the average ones. I would like to see training and resources to help the average start to act more like the high performers. See Wishner A et al. Best Practices: applying management analysis of excellence to immunization. J Med Practice Management, March/April 2005, Vol. 20, No. 5, pp. 275-278. This was a pilot project with a small sample -we could really use more research in this area!
04/18/2005 07:29 PU 377 D After a very quick read, I did not get the impression much is included on vectorborne diseases in the U.S. or elsehere. Is that true?
04/18/2005 06:24 PU 374 D Too little attention given to data quality issues and infrastructure needs that come before one can do all this ambitious research.
04/15/2005 14:13 PU 361 D The greatest contribution CDC could make to the safety and health of the public is to begin a dialogue on the delivery of health care in our communities in a non-partisan, non-ideological, open discussion. Promote objective reviews and educational forums to educate the public on both the short-comings and the advantages of our current approach to health care delivery. Leave no stones unturned. Review the AMA, the health insurance companies, our legal system, the educational system, and federal funding. Present alternative approaches that other countries have employed to avoid our deficiencies and report objectively their failures and successes. If the American public had the objective information they need to evaluate our health care system, we would not have the system we now have and millions of lives would be saved annually. This is an annual loss greater than any plaque or war our country has endured. This could be the number one accomplishment of CDC in this century.
04/15/2005 13:36 PU 360 D I suggest that CDC fund Evidence-based best practice community-wide social ecological primary prevention interventions to address physical inactivity, poor diet and other lifestyle patterns, instead of fragmenting communities into less meaningful pieces. We must address lifestyle problems within the context of where people live.
04/15/2005 13:16 PU 357 D As before (and seems always) these strategies are exclusively “REactive” and seem to address only the known/notifiable/occurring diseases in areas where human population is already exposed and “suffering” . This is good, necessary, extremely important, but as before leaves us totally unprepared for any upcoming events and changes. What we need is a PROactive strategy that would tell us what to expect and where before humans are actually start falling sick. New lands are being developed; urban sprawl puts people ever closer to the nature (I love leaving in suburbs); large areas are being deforested or reforested; vector and reservoir species compositions are changing ... I could go on and on. If we new 20 years ago what we know today about natural cycle and foci of Lyme disease, would it have such an impact on the nation as it have had? Or would we be able to prepare for the effects of reforestation and = prevent the “pandemic” at least partially? Well, currently Amblyomma americanum is on the move and spreading allover and very quickly, exceeding in abundance the existing ticks in many areas. Do we know what these ticks carry, what they can transmit, how they affect the existing vertebrate, vector and pathogen communities? Are we prepared for a “pandemic” of STARI (or like) allover the Country? Exotic ticks (and files I am sure) are being imported into the Country, and some of those are getting a firm footing here. Are we/public/doctors prepared to prevent, recognize, and treat hartwater, African tick fever, CCHF, or is it going to be another thunder from a seemingly blue sky? And these are just the most apparent threats. In short, we need a strategy and a system (something like a network of perpetual monitoring stations) to monitor the natural foci regardless of the presence or absence of an already suffering human population.
04/15/2005 12:22 PU 354 D A question, for up thru year 2010 how does the CDC research agenda support and advance national health goals specifed in HHS Heatlhy People 2010 and recent reports of the USPHS Office of the Surgeon General? Thank you.
04/15/2005 09:25 PU 349 D This is a very comprehensive and fairly exhaustive list of potential research topics. The shear size of the list covering so many topics raises several questions: 1) How will the agenda be used? That should be prominently featured at the start of future documents. 2) How will priorities be set? Will the priorities be based on the categories currently listed in the agenda or will some other process be used to deal with diseases that have the greatest health burden. For example, while HIV is mentioned in the document in multiple areas, many of the goals could encompass research on HIV. It would be important to spell out the process the agency will use to set priorities among the many potential research projects. It would be helpful if that priority setting process was transparent and allowed for public input. 3) How will the agenda influence CDC's budget allocations for research? 4) How will the agenda be administered within CDC?
04/15/2005 09:06 PU 348 D Thank you for this opportunity.
04/14/2005 19:00 PU 342 D Would surveillance go here?
04/14/2005 14:18 PU 337 D Thank you for giving us an opportunity to comment and provide input!
04/14/2005 13:57 PU 335 D Resist methodologically inane projects and projects that are driven by politics, not science.
04/14/2005 13:49 PU 333 D Overall I was sorry to see so little specific attention to women (aside from their role as mothers) and recommend including women's health with a focus on gender and health care, contraception (access and new technologies), domestic violence, abortion and infertility.
04/14/2005 13:26 PU 332 D While this is an interesting compendium, I find it difficult to envision how it will actually be used - without prioritization it is simply a wish list. Who will prioritize it, and how will they do it? Those are key questions that are unclear to me from the materials provided.
04/14/2005 12:30 PU 326 D CDC has a unique position as a national and world PH authority. We own or have access to more PH information than any other PH entity. We need to take advantage of modern technology to organize and disseminate this wealth. Most PH events are local and the value of easily obtained pre-event baseline data via a variety of access methods can be invaluable both in an emergency and for routine management and administration issues.
04/14/2005 11:33 PU 316 D A lot of what CDC does is research, but not everything is research. For example, a lot of what we do is program oriented that has little or no research component. Some of the items in the starter list seem more program than research oriented. For example, its not clear what the research componant is of developing systems. There may well be a research componant, but its not clear from the starter list. I worry that the methods used to gather information for the starter list got a little off focus and began to inventory CDC activities, independent of whether or not they included a research component. The text seems somewhat distant from what I imagine to be actual research questions that would ultimately drive the agenda. Alot of pruning and drilling down will be needed. Currently the list appears to be organized by content area. I would suggest possibly organizing the starter list or actual agenda by types of research, rather than by content area. Researchers skill sets may be more readilly characterized my the kind of research they do, rather than a particular content area, though certainly they can often be distinguished by content area as well. Examples of types of research might include: Evaluation research, Basic science or laboratory research, Behavioral research, Methods development research, Population public heatlh research, Clinical research, Informatics or IT systems research, Economic and cost effectiveness research. Those are just some possible examples, but you can see that within a content area such as Infectious diseases, there are several different kinds of researchers and research activities. These researchers might identify more with the type of research they do rather than the particular subject area they apply it toward. Organizing in this way may help facilitate construction of the actual research questions that drive the agenda. Within these broader categories, there may be subcategories that help organize the agenda. For example within population research, one subcategory could be risk factor research, etc. Perhaps what would be helpful is to work on a hierarchical classification of research types to assist with organizing the agenda. .
04/14/2005 10:39 PU 310 D This list of research areas looks good to me. I think the research agenda should be reviewed and updated only every 2-3 years unless there is a major change in our population's health or in our health care system that warrants immediate study and addition to the CDC Health Protection Research Guide, 2006-2015.
04/14/2005 10:35 PU 309 D It looks like the right people are not involved in the process.
04/14/2005 10:31 PU 308 D Though under "cross-cutting" perhaps Health Disparities in the US should be a separate and expansive research agenda. We remain a country that refuses to address these issues in the medical and health systems, and it is our responsibility to address them? Segregation in hospital care and access? Physician and emergency technical care and outcomes? Minority health issues? (Dekalb Counties infant mortality rates?) Obesity and education? This is an issue which hits us here in our own backyard hardest of all?
04/13/2005 16:06 PU 288 D It is unclear how cross-cutting activities will be implemented across many CIOs and coordinating centers and how evaluation and impact factors will be incorporated into specific projects. Although we have asked for copies of our CIO strategic plan (much less coordinating center), management has not shown us how our project impact measures fit into our CIO or division strategic plans. It would be useful to have it written in the final plan to explain all this to the folks and stakeholders at the bottom of the food-chain, those of us who have to actually do the work and come up with the research proposals.
04/13/2005 13:49 PU 278 D Your priorities are on target but very sweeping. Will your budget sustain meaningful research in all of these areas? If not, it would probably be better to limit and be more specific so that your outcomes are discernible.
04/13/2005 10:22 PU 272 D Appreciate this process.
04/13/2005 09:59 PU 271 D It is critical for the CDC to place more emphasis upon training future laboratory research leaders. We need better communication between laboratory scientists and epidemiologists through more crosscutting laboratory training. We should pattern a Laboratory Research Investigation Service after the model of the EIS. This will be critical to meet present and future challenges to public health.
04/13/2005 09:10 PU 268 D I believe health disparities should be included as a distinct category if we are committed to bridge that gap.
04/13/2005 08:22 PU 267 D All of the women's health goals seem focused on conception, pregnancy, and childbirth. More maternal health than women's health. I would encourage the CDC to think of women's health more broadly, including an emphasis on gender-based differences in presentation and treatment of chronic diseases. Other important areas in women's health: aging, other reproductive health areas (birth control, abortion, STDs), and violence against women.
04/13/2005 07:49 PU 266 D The National Vision Program (NVP) CDC Division of Diabetes Translation (DDT) NCCDPHP was pleased to participate in this exercise. This process should be repeated every 3-5 years and should be considered an essential component for all CDC programs.The information should be complied in a manner that would contribute to the further development of collaborative approaches within CDC/A
04/12/2005 17:58 PU 265 D Of the universe of possible research activities, our priorities should be research that informs CDC's programmatic activities. Some of the research themes here are so broad that there is little to comment on, and many of the examples of research activity are not specific enough to serve as examples (see my specific comments on #4 above). Moreover, a number of these examples are badly in need of editing for clarity and consistency with basic research principles. CDC should seek the advice of people like Dr. Judith Auerbach, formerly of NIH, who has actually succeeded in getting a large Federal agency to create a detailed plan for its prevention research, to adopt a process for updating the plan annually, and, over a 5-year period, to fund what was stated in the plan. She is now at AMFAR in Washington, D.C. I know we aren't NIH, but we don't have start from scratch.
04/12/2005 14:51 PU 264 D CDC Health Protection Research Guide, 2006-2015 Written Statement of the American Association for Dental Research (AADR) Introduction: The AADR, a fully incorporated non-profit organization and the largest Division of the International Association for Dental Research, represents nearly 5,000 dental researchers in the US. The AADR commends the Centers for Disease Control & Prevention for its decision to develop a CDC-wide, comprehensive research agenda, and we appreciate the opportunity to participate in the process of developing this agenda. Research in the oral health arena spans many areas of science from the more traditional dental materials, cariology, and periodontal research to behavioral sciences & health services research, neuroscience, pharmacology and salivary research. In fact, there are 21 distinct scientific research groups within IADR/AADR covering the above areas and many others. Through a Memorandum of Understanding , the AADR is a full partner with the US Department of Health & Human Services in promoting the oral health objectives of Healthy People 2010 and the National Call to Action to Promote Oral Health of the US Surgeon General . Through IADR/AADR professional meetings and publications, we have sought to bring wider attention to the disparities in oral health that exist and the need to build the science base and accelerate science transfer. In the latter vein, the AADR supports broad dissemination and consideration of the research agenda developed by the American Dental Association to address issues of importance to the practicing dentist [ADA Council on Scientific Affairs, November 2004]. In recent years, the AADR has promoted, through its Congressional testimony and fact sheets, the need to recognize the potential of saliva-based diagnostics; the value of practice-based research networks involving dental clinicians; the growing evidence of a connection between periodontal diseases and systemic conditions, such as heart disease, diabetes and low birth weight babies; and the need to address the most common affliction of childhood, i.e., dental caries. The AADR believes fervently that oral health research can make significant contributions to human health and that, wherever possible, should be a key collaborative partner with the overall medical research enterprise. In addition to supporting biomedical and clinical research, the AADR also believes that support for science transfer, epidemiology, and prevention research are critical. Thus, we have supported funding for the continued inclusion of oral health in the ongoing NHANES and for the CDC’s Division of Oral Health to “put science into action by developing and testing interventions to prevent oral diseases … including work(ing) with states to extend sound public health policies and programs ...” The dental research community stands ready to contribute to the CDC Health Protection Research Guide, 2006-2015 and to help pursue the types of research that have been, and will be, identified by this agenda. Additional comments are arranged and submitted in the categories outlined on the CDC web site.
04/11/2005 15:51 PU 258 D Overall I think it is very important to have a research agenda. This is an ambitious task. I worry a little about having Congress edit the agenda with its red funds-cutting pen. Still, we need to MANAGE the research here as well as conduct it. Looking to the future, I think it is critical for the "younger generation" to be part of the picture in planning this so that there is a group of people at CDC ready to keep this going--a group who understands the Big Picture the research agenda represents. Good luck.
04/11/2005 11:11 PU 254 D Although these topics for the research agenda seem fine at first glance, they are so broad, that there is little if any current research which is not included in these categories. Therefore, I would say it's difficult to provide useful comment on the topics. Although this broad scope may be intentional at this point, it would seem more helpful to have specific topics which are the main focus for this fiscal year. I'm not sure what good it will do us to have broad topics for a research agenda that encompass what CDC is already doing.
04/11/2005 09:59 OH 251 D Promotion, prevention, and reduction of mental health morbidity and related economic and human capital effects should be central, integrated, and prominent in the agenda of CDC. It is important this not be neglected as a cause of morbidity as well as mortality, nor that it be relegated to an afterthought or ancillary problem.
04/11/2005 07:49 PU 238 D this needs to be bottom up instead of top down.......We have already seen duplicative projects funded at significantly higher cost our of the OCSO. Specifically we are conducting two projects at 100K each that OCSO funded a third at 1.5 million that overlaps both and duplicates some previous work.
04/08/2005 15:52 DC 235 D I was deeply troubled by both what CDC presented in the Centers for Disease Control and Prevention Research Agenda Development Public Participation Meeting as well as the information provided during the meeting by the representatives of the Research Agenda Development Workgroup (RADW). The leadership of this effort provided a wholly inadequate discussion of the purpose or underlying objective of the process or about public health is, as I understand it. I want to comment on two critical areas where the information provided did not suggest that the planners had a clear understanding of the need for the agenda-setting process or the principles that underlay the effort. For my part, I believe the CDC process would be best served if their target of this effort was to propose or set research priorities for public health not just for CDC. When the possible distinction was raised in the public meeting between a) identifying CDC's research priorities and b) the broader concern of identifying public health research priorities, the response was something like, "Thank you for your comment we will take this back with us." It was hard to hear this as anything but a “brush-off”. Quite to the contrary, those facilitating the meeting from the RADW should either have known the answer and shared it or engaged the audience in a discussion of this critical consideration. We still do not know which agenda is of greatest concern to CDC and what leadership role, if any, CDC is prepared to take concerning a research agenda for public health. Secondly, in several different ways and at several different times audience members raised a concern with the RADW objective asking whether the task was a) to consider which ones of the various division-specific research priorities (NORA is the one familiar to me but we were told of many equivalents for other units) should become the highest priorities for CDC (or public health), or b) to consider how best to integrate the specific research priorities already identified with CDC units into an overarching vision of research priorities. Again, the response was "thank you for your comment we will take this back with us." I was dismayed that the facilitators didn't know (or share with us) which was the target or at least entertain a discussion of which it should be.
04/08/2005 08:45 PU 232 D Following up on my comments in response to category 2, it seems that child maltreatment, domestic violence & family violence doesn't clearly fit into any of these categories. Also, where would adolescent sexual health fit?
04/08/2005 08:41 PU 231 D The list is too vague to be meaningful. It reads like a wish list with subjects but no content. What is the time period? What is the budget? What is the priority? What is the purpose? How does this "agenda" differ from what CDC has done in the past? Who is this for?
04/07/2005 19:03 PU 227 D No comment
04/07/2005 15:59 PU 224 D Development of a plan to capitalize on research that is generated in other federal agencies/disciplines for use in specific CDC projects. For example, the analysis of the utility of mental health and substance use research on behavioral science specific to sexually-transmitted illnesses and risk taking.
04/07/2005 14:59 PU 221 D Please make UNDERAGE DRINKING AND DRUG USE one of your main topics. This focus area would need to incorporate media messages, families, and colleges.
04/07/2005 14:46 PU 220 D In several places, example research activities include "promote widespread use of proven interventions..." How is "proven" defined in this context? Does evaluating the "bang-for-the-buck" (e.g., cost-effectiveness) of the intervention come into play also?
04/07/2005 10:20 PU 210 D I fell as though CDC is imposing what they think is best on communities rather that acknowledging that effective strategies for disease prevention and health promotion already exist but they need to be submitted to rigorous scientific research in order to establish validity. More attention to existing community strategies (social networks for example) should be integrated into the overall CDC Health Protection Research Guide, 2006-2015. In addition, there should be a concerted effort to identify Centers that have already conducted this research and take steps establish a resource center and/or conduct research on adapting and tailoring existing protocols for different diseases and/or populations
04/07/2005 10:09 PU 209 D I do not see any agenda items here related specifically to access to appropriate medical services, one of the core functions of public health. There is a desperate need for research related to the care of people with chronic conditions in this country -- availabilty of family-centered palliative care, for example, when clients do not meet the eligibility criteria for either skilled home health care or hospice. The economic and social burden on families of providing care to seniors, and the lack of training of those family members to provide that care.
04/07/2005 09:19 PU 201 D If we are going to be a shrinking organization, should I get out now? Is the capital builty by CDC scientists being spent? Do we have group think problems as were experienced by Intelligence? How do we spot biased statistics? How do we remove bias at the top, as has embarassed us with the smoking-obesity issue?
04/07/2005 09:11 PU 200 D There is no attention to disparities?..?? I would suggest that it should be at the heart of public health and service delivery. “Social Inequality May Be Harmful To Your Health. It Increases The Burden Of Disability And Disease In Communities And Cuts Short Lives. Economic Deprivation, Discrimination, Lack Of Access To Health Services, And Violation Or Neglect Of Human Rights All Play A Part In Shaping Population Health.” as cited on http://Www.Hsph.Harvard.Edu/Disparities Health disparities research should be cross-cutting and should be based on a goal of addressing and eliminating disparities; particulalry, as it relates to policy, data & responsibility.
04/07/2005 08:45 PU 198 D Provide an intellectually stimulating environment for infectious disease research, which includes an appriciation for sustained rigorous scientific programs and professional development. Do not assume that a small number of administrators have a better idea of the strengths of the institution than do the combined intellect of the public health scientists that have thought about this for most of their professional lives. The undeniable core component of the CDC remains understanding and control of infectious disease. The 'disease control' role and goal is completely understood and supported by the US public...many of the other "priorities" listed in the document frequently don't merit the term "research".
04/07/2005 08:26 PU 197 D Because this is the first time someone has solicited my input, I am concerned about your desire to have employee input. If you want everyone to buy into something like this, they needed to be involved from the start; otherwise, all you get is a rubber stamp on these extermely general statements that seem to be all inclusive but really say very little.
04/07/2005 07:53 PU 192 D Where is the worksite health promotion agenda? I see worker safety, but not worksite health promotion.
04/07/2005 06:45 PU 190 D Branch Chiefs and Division Directors are low enough in the chain to be aware of priorities in their subject areas, yet should be aware of priorities. Thesee should be consulted as well as those higher up the chain who may be more aware of political priorities.
04/07/2005 00:45 PU 188 D Where is the recognition that epidemiology is the key science that informs CDC's decisions and research agenda? At one time, an entire CIO was devoted to leadership and coordination of epidemiology agency-wide. Where do we now turn for leadership in epidemiology?
04/06/2005 08:53 DC 179 D Much needed guidelines, on prevention of transmission of infectious agents, need to be backed by scientific evidence. Without that evidence (ie. need for N95 respirators to prevent transmission of TB) other agencies will pass regulations on a "feel good" basis giving false information/security to the public and causing increased cost and burden to the healthcare industry having to comply.
04/05/2005 15:12 PU 171 D Trauma Centers serve to protect the nation’s health and need adequate funding. Additional government funds must be allocated to save these vital resources
04/05/2005 14:18 PU 165 D One glaring gap in this agenda is the almost complete absence of items addressing the role of social determinents of health in the etiology and prevention of public health probrlems and of their promotion. This has been widely recognized as an important frontier in wider public health cricles and has been fostered within CDC. It is not addressed within CDC's environmental health arena where attention is devoted primarily to various aspects of the physical environment. Focussing research attention on social determinents will help CDC devise interventions that will have borader and longer lasting impact then those that focus on individual behavior change.
04/05/2005 13:45 PU 164 D Trauma Center Preparedness
04/04/2005 12:33 PU 155 D I believe that CDC is considering what its position should be on developing standardized measures of clinical quality (in private institutions; it is understood that it has a role in developing such measures in public institutions) I believe that CDC can play a role by helping promote evidence-informed measurement, and discourage regulators, accrediting bodies, and others from adding to the expensive and burdensome measurement demands by adding measures that are not evidence-informed.
04/04/2005 11:05 PU 147 D I like this web site and appreciate the opportunity to submit comments. One overall comment I would like to make for the research agenda is that each grant opportunity needs to focus on Community-Based Participatory Research and Community Capacity Building. They're key components for successful future research and not as prevalent as I would like to see from govenment grant opportunities.
04/04/2005 10:48 PU 145 D Hello. A research priority that is noticeably absent but a major health issue is racial/ethnic disparities in health and health care. I would urge the CDC to add this to the list and consider designing RFAs to address this issue. Another priority that is missing but that would capitalize on CDC strengths is community-based research. I would be happy to discuss these issues further with a CDC project officer. Thank you. -Glenn Flores, MD Director, Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, WI
04/03/2005 21:43 PU 144 D i found connections tot he problems individuals and society deals with on a daily basis caused by the epedimic use of alcohol, tobacco and other drugs. If babies dont' come into the world healthy but are affected by FASD or other drug exposure, societies bill will mount dramatically as the child ages. if the child becomes involved with alcohol under the age of 14, the developmental delays and impairment will again cause expense to the community and lost potential in the child. please do not forget the role alcohol plays in many other diseases and public health concerns.
03/30/2005 10:37 DC 131 D Frequent updates on where each of the 6 areas are in the process
03/29/2005 14:18 OH 117 D The CDC Division of Oral Health (DOH), a component of the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), has shared its list of Research Opportunities with the American Dental Association. The Association regards oral health as an important area for CDC-sponsored research, and is in full support of the topics identified by the DOH.
03/28/2005 14:56 DC 104 D Recommend strongly: the need for a National Healthcare-associated infection reporting system that all states utilize, and a system whereby consumers can understand the risk adjusted data generated from such a system. This should be a National initiative, and not an individual state initiative, in my opinion.
03/28/2005 12:45 DC 93 D I would like to know, as a newly appointed Infection Control nurse, what are the standards for staffing the Infection Control and Employee Health Departments? I work in a 62 bed acute care facility and tackle both the Infection Control and Employee Health jobs. Is this recommended?
03/28/2005 12:40 DC 90 D Would like to see Dr. Maki reconvene the HICPAC group to update CR-BSI . Much good data on this was published only after the HICPAC group published their guidelines. Please revise and update this guideline.
03/28/2005 12:25 WA 85 D I was very impressed with your process. I attended the meeting on March 24th in Seattle. I think a list serve of public meeting participants would be useful to you and a great vehicle to address updates. The facilitator, Susan Veit, in the Environmental and Occupational Health breakout session was superb.
03/28/2005 11:48 DC 82 D I recommend CDC research agenda be evaluated no less frequently than every 4-5 years.
03/28/2005 11:05 DC 75 D I think that there are so many different approaches to decreasing healthcare acquired infections from so many different agencies that we are just chasing our tails to meet all these different agency requirements. It seems everyone is looking at the same issues, but just a little differently. This leads to great frustration when we look at pneumonia 4 different ways and try to meet 4 different agency expectations. This leads to poor interventions. We need the CDC to lead the way on best practice and if we meet CDC requirements, we meet JCAHO, CMS, etc.
03/22/2005 20:50 OH 39 D The CDC web site states "CDC remains committed to supporting the Healthy People 2010 goals. We think that those goals will play a vital role as we move forward with agencywide goals management at CDC. In many instances, the Healthy People 2010 goals clearly define particular strategies and interventions that can be used to drive CDC’s health impact goals which are framed in terms of life stages, healthy communities, and community preparedness." However, several key areas from HP 2010 are missing - infant health, and cancer. I do not understand how CDC will support HP 2010 goals if they are not listed.
03/16/2005 11:19 WA 31 D I'd like to register but this is the only page that comes up. Please let me know how to register for the Seattle meeting. Katrina.Simmons@doh.wa.gov
03/11/2005 16:04 WA 20 D Please secure a larger room for the session on Environmental Health
03/11/2005 07:02 GA 18 D Utilize community participatory reserarch Publicize research priorities
02/23/2005 18:08 GA 4 D I cannot comment without knowing more about the directions for research in these broad areas. The areas themselves seem to be a reasonable breakdown of the whole, though I am concerned that the area of health promotion research appears to have little space for such behavioral and lifestyle issues as tobacco use, poor nutrition and physical inactivity. I trust the conference will offer greater insight on the directions in these broad areas. In addition, I am interested to know how these CDC research initiatives intersect with the larger research agendas at NIH, AHRQ and other federal agencies.
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