Rand health quarterly最新文献

The Army Medical Corps comprises the physicians of the U.S. Army. In recent years, the Medical Corps' rate of recruitment has not been able to keep up with the pace of separations. Retention is down. A larger-than-expected proportion of Army physicians who have fulfilled their active-duty service obligation are separating rather than extending their careers and, possibly, serving until they are eligible for military retirement. This trend results in positions at military treatment facilities and other units being unfilled, compromising the Medical Corps' ability to fulfill its missions, whether in deployed operations or in caring for service members and other beneficiaries at home. In this study, the authors examine alternative strategies for the Army Medical Corps to ensure that it has access to the personnel it needs to support operational requirements. The authors consulted with subject-matter experts and gathered and analyzed data to help identify five courses of action (COAs) that could increase retention, increase accessions, or reduce the requirement for uniformed physicians.

Many veterans and their advocates are concerned that military service may cause impaired respiratory function resulting from occupational exposures to environmental hazards (e.g., Agent Orange in the Vietnam War, burn pits in the Global War on Terror) or infectious diseases (e.g., pneumonia). Such exposures occurring in service members' young adulthoods may not have immediately discernible effects on lung health; some symptoms may emerge in the immediate months or years after separation from the military, and diagnosable conditions may not manifest until decades later. Health care providers serving veteran populations must consider both the unique combat circumstances surrounding the time of veterans' service and the age-graded nature of health conditions that might result from military service. To characterize lung health across a broad age range of veterans, the authors analyzed data from two nationally representative surveys of health and well-being that include samples of veterans and their civilian peers. With these data, the authors compared respiratory health outcomes observed for the veteran and civilian populations who were of prime age for military service during different periods of national conflict: the Korean War, the Vietnam War, Operation Desert Shield/Storm, and the Global War on Terror. The authors estimated that differences in smoking behaviors-including differences prior to enlistment-account for at least half of the veteran-civilian disparities in respiratory outcomes. This suggests the need for military-based and post-transition smoking cessation efforts and further research into other factors that might contribute to these veteran and civilian disparities, such as environmental exposures during military service.

On-demand gene synthesis is a growing industry that has democratized access to customized synthetic deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) products used in biological research. However, the increasing availability and decreasing cost of custom synthetic nucleic acids presents a risk of misuse that could allow nefarious actors to obtain sequences of dangerous organisms or novel-engineered pathogens to construct a biological weapon. Securing nucleic acid synthesis is a policy priority for the U.S. government and the synthetic biology industry. But there is currently no legal requirement that gene synthesis providers screen their customers or their orders to ensure that the requested synthetic DNA and RNA constructs are not used for harmful purposes. Many providers screen orders voluntarily, but there is currently no universally accepted standard for screening customers or orders. In this study, the authors review government screening guidelines, industry consortium requirements, legislative proposals, and the scientific literature to assess the current state of commercial gene synthesis screening; summarize proposals for strengthening screening; and contribute recommendations for implementing comprehensive screening policies to secure commercial nucleic acid synthesis. These recommendations expand on and strengthen government communications, industry consortium rules and best practices, and proposals developed by researchers and provider organizations.

In this study, part of RAND's Gun Policy in America initiative, researchers seek objective information about what scientific literature reveals about the likely effects of various gun laws. In the fourth edition of this study, the authors incorporate more-recent research in their synthesis of the available scientific data regarding the effects of 18 state firearm policies on firearm injuries and deaths, violent crime, suicides, the gun industry, defensive gun use, and other outcomes. By highlighting where scientific evidence is accumulating, the authors hope to build consensus around a shared set of facts that have been established through a transparent, nonpartisan, and impartial review process. In so doing, they also illuminate areas in which more and better information could make important contributions to establishing fair and effective gun policies.

RAND researchers present findings from the qualitative arm of the America's Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows research project, sharing insights from interviews with U.S. military and veteran caregivers. Thirty-eight qualitative interviews were conducted between December 2023 and February 2024. In the interviewed caregivers' own words, they provided rich descriptions of their experiences, complementing the main study's survey findings with illustrative anecdotes that deepen our understanding of the challenges and joys of caregiving and elucidate opportunities to improve supportive services. Caregivers highlighted aiding care recipients with a broad array of activities of daily living and instrumental activities of daily living, often leveraging a variety of informal and formal supports. They often faced challenges, such as balancing caregiving with other priorities and commitments; managing care recipients' health-related conditions and needs; financial, emotional, and physical struggles; and difficulty accessing respite and navigating health care systems. Caregivers reflected on their identities, highlighting ways in which they are similar to and different from other caregivers; they generally said that they found caregiving to be rewarding. They also discussed the economic impacts of caregiving and pointed to opportunities for organizations to improve outreach and provision of services.

The devastating impact of the coronavirus disease 2019 (COVID-19) pandemic has led governments, health care institutions, and researchers to intensify their focus on developing improved means to detect, contain, and manage potential future outbreaks. As part of these efforts, policymakers and other nontechnical personnel need to understand available biosurveillance technologies. In this study, the authors summarize how current and emerging nucleic acid biosurveillance techniques work, describe their capabilities and limitations, and discuss the promise of emerging technologies. Biosurveillance systems are used to detect, monitor, and characterize health threats, or pathogens, in human and animal populations, food, wastewater, and the environment. Nucleic acid testing assesses nucleic acids, comprising deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), to determine the biologic agents present in clinical samples (i.e., a sample collected by a medical laboratory from a symptomatic human) or environmental samples (e.g., wastewater). The authors describe a scenario of testing for pathogens in wastewater that uses detection technology within a comprehensive and pathogen-agnostic biosurveillance system. Wastewater testing offers a method for collecting samples without needing symptomatic individuals to present at clinics for care. Such testing can, therefore, offer data prior to symptoms and from those who have less access to clinical care. The case study demonstrates the advancements needed to develop a truly pathogen-agnostic, cost-effective wastewater biosurveillance system. The authors conclude that policymakers interested in establishing a biosurveillance program should carefully evaluate their specific research questions and their resource limitations to determine which technology is best suited to their needs.

The authors produced new estimates of the number of adults caregiving in the United States today; investigated how those caring for wounded, ill, and injured service members and veterans compare with those caring for civilians and with non-caregivers; and share insights on the potential consequences of caregiving on caregiversapos health, their economic security, and their families' well-being. They also propose recommendations to strengthen caregiver support. The information in this study is derived from two sources. RAND researchers administered the 2023 RAND Caregiving Survey. The final analytic sample size was 2,946 respondents, including 513 military and veteran caregivers, and, for comparison, 1,205 civilian caregivers and 1,228 non-caregivers. RAND researchers also administered the 2022 RAND Veterans Survey, a survey of 1,100 veterans residing in the United States. There are 14.3 million military and veteran caregivers, representing 5.5 percent of the U.S. adult population. There are an additional 91.3 million civilian caregivers (35.0 percent of U.S. adults) caring for wounded, ill, or injured civilian adults. Across all caregivers, most (78 to 81 percent) spend between one and 30 hours per week providing care. Under 10 percent spend less than one hour per week, and 11 to 16 percent spend 31 hours or more per week caregiving. The estimated aggregate economic value generated by military/veteran caregiving activities, which are largely uncompensated, ranges from $119 billion to $485 billion per year. Military/veteran caregivers incur an estimated $8,583 in annual out-of-pocket costs associated with their caregiving responsibilities. Military/veteran caregivers forgo an estimated $4,522 in annual household income.

The Department of Defense (DoD) requires both current and projected estimates of the size of its workforce population with specific categories of disabilities. These estimates support the requirements under the Rehabilitation Act of 1973 as well as the goals outlined in multiple executive orders, including Executive Order 14035, directing DoD to hire employees with disabilities and provide them with reasonable accommodations. These estimates are necessary to determine the assistive technology (AT) required and its anticipated costs through 2031. AT also furthers DoD's goals in aiding the recovery and retention of injured service members, as well as the broader DoD and U.S. Department of Veteran Affairs (VA) community in aiding in the post-service employment of service members who are medically separating. Thus, the authors seek to estimate the potential demand for AT from these groups. The authors give projections of the DoD civilian employee population-and of injured and wounded service members-with specific disabilities categorized by DoD's centralized AT procurer (hearing, vision, cognitive, and dexterity disabilities), as well as the potential anticipated requests for AT by these populations and their costs between 2021 and 2031.

Emerging research suggests that Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share underlying pathology and may represent a single, biologically defined disease spectrum. Cognitive changes are among the most worrisome symptoms for patients with PD, and are the core feature of DLB. While the cognitive changes experienced by individuals with PD and mild cognitive impairment share some clinical characteristics with patients who have undiagnosed or prodromal DLB, these changes are distinct from other types of dementias, such as Alzheimer's disease. To spur the adaptation of existing cognition-focused measures and the development of new ones to underlie clinical trial endpoints in PD and DLB, the PD/DLB Cognition Roundtable was held on January 10 and 11, 2024, in Washington, D.C. The roundtable brought together representatives from academia and industry, as well as with representatives of regulatory agencies, community partners, patient advocates, and research funders, to build consensus and collaborate on the outcome assessment and trial design methods that will support the development of new treatments for early or mild cognitive changes in disorders on the PD/DLB spectrum. The authors of this document summarize the roundtable, discussing the state of the field for clinical trial design and cognition measures in PD and DLB, promising avenues of research, and perspectives of regulatory agencies.