Biomedical subjects

Kimberly M Thompson

Publications and source records attributed to Kimberly M Thompson.

36 records · Page 2Linked to original sources

PubMed2004

Changes in children's exposure as a function of age and the relevance of age definitions for exposure and health risk assessment.

OBJECTIVE: The objective of this study was to review and synthesize the existing exposure information available to support the characterization and estimation of children's environmental health risks as a function of age. METHOD: This includes a review of the existing peer-reviewed literature and reports from the US Environmental Protection Agency (EPA) up through January 1, 2003 for information about exposure data for American children with a focus on identifying the age categories used and data gaps that limit our ability to estimate children's risks from exposure to environmental hazards. RESULTS: On the basis of this synthesis, several key data gaps emerge that suggest some areas in which exposure assessors may want to focus attention, including current breast milk consumption by infants and breastfeeding information for children over age 1 year; children's food-handling practices and how these lead to exposure (eg, by eating with dirty hands or by eating food that has dropped onto a contaminated surface); fish-intake rates for young children and for children whose families include sport fishers or whose families rely on self-caught fish for sustenance; incidental and intentional soil intake by children; soil adherence for dermal exposure; relationships between various microactivities, macroactivities, and microenvironments where children spend time; and a correlation between exposure factors and growth (ie, how children's exposure behaviors change over time). In contrast, relatively good exposure information exists for characterizing children's growth and water ingestion, and at least some exposure information exists for the wide ranges of exposures of regulatory interest. CONCLUSION: Given the currently available data, exposure assessors can estimate children's potential health risks from a number of different types of exposure, but longitudinal data are needed to reduce the significant uncertainties that arise from reliance on currently available data, and a number of dose-response challenges remain.

Aging↗

PubMed2004

Violence, sex and profanity in films: correlation of movie ratings with content.

CONTEXT: Children's exposure to violence, sexual themes, profanity, and the depiction of substances in movies remains a source of parental and public health concern. However, limited research quantifies the correlations between movie content, ratings, and economics or addresses the issue of ratings "creep." OBJECTIVES: To characterize available information about violence, sex, and profanity content of movies as a function of rating; quantitatively explore the relationships between content, ratings, and economic information; compare the amount of violence in animated and non-animated G-rated films; and test for a trend of decreased stringency of rating criteria (ie, "ratings creep") as a function of time. DESIGN: We developed a complete database of movie ratings available from the Motion Picture Association of America (MPAA) to characterize the content information (including any indicated reasons noted for ratings) for all movies released between January 1, 1992 and December 31, 2003. We then added to the database the three Kids-in-Mind content-based scores for: (1) violence and gore, (2) sex and nudity, and (3) profanity; and the 15 categories of information from Screen It!, which began providing information in mid-1996. Finally, we obtained information on gross revenues and movie budgets from the IMDbPro. We performed statistical analyses to correlate the content-based scores with the overall rating and rating reasons assigned by the MPAA; to test the hypothesis that age-based ratings became less stringent over time; to explore correlations between film content, ratings, and available economic information; to compare the amount of violence in animated and non-animated G-rated films; and to characterize the available information about the depiction of substances in films. MAIN OUTCOME OF MEASURES: Description of movie ratings, correlation of content with rating, and statistical results. RESULTS: Comparing the content-based scores for different movie ratings, we find large variability exists in the types of content that receive different MPAA ratings, and good correlation between the content-based scores assigned by Kids-in-Mind and Screen It! The MPAA rating reasons correlate with higher scores assigned to content-based ratings, and the number of reasons indicated increases with the age-based rating category. We found significantly higher rated content in movies as a function of time, suggesting that the MPAA applied less stringency in its age-based ratings over time for the period of 1992-2003. Animated films rated G by the MPAA received a significantly higher content-based score for violence on average than non-animated films rated G (P < .05). With respect to information about the depiction of substances, the MPAA mentioned alcohol or drugs in its rating reason for 226 films (18%), while Screen It! identified depiction or use of tobacco, alcohol, and/or drugs in 1211 films (95%), including 26 of the 51 G-rated films (51%). We found significantly higher gross revenues for PG-13- and R-rated films when comparing films that received an MPAA rating reason for violence compared with those films that did not (P < .001 based on 2-sided t-tests with unequal variances for both of the separate tests of PG-13- and R-rated films). CONCLUSIONS: Parents and physicians should be aware that movies with the same rating can differ significantly in the amount and types of potentially objectionable content. Age-based ratings alone do not provide good information about the depiction of violence, sex, profanity, and other content, and the criteria for rating movies became less stringent over the last decade. The MPAA rating reasons provide important information about content, but they do not identify all types of content found in films and they may particularly miss the depiction of substances.

Child↗

PubMed2004

Violence in teen-rated video games.

CONTEXT: Children's exposure to violence in the media remains a source of public health concern; however, violence in video games rated T (for "Teen") by the Entertainment Software Rating Board (ESRB) has not been quantified. OBJECTIVE: To quantify and characterize the depiction of violence and blood in T-rated video games. According to the ESRB, T-rated video games may be suitable for persons aged 13 years and older and may contain violence, mild or strong language, and/or suggestive themes. DESIGN: We created a database of all 396 T-rated video game titles released on the major video game consoles in the United States by April 1, 2001 to identify the distribution of games by genre and to characterize the distribution of content descriptors for violence and blood assigned to these games. We randomly sampled 80 game titles (which included 81 games because 1 title included 2 separate games), played each game for at least 1 hour, and quantitatively assessed the content. Given the release of 2 new video game consoles, Microsoft Xbox and Nintendo GameCube, and a significant number of T-rated video games released after we drew our random sample, we played and assessed 9 additional games for these consoles. Finally, we assessed the content of 2 R-rated films, The Matrix and The Matrix: Reloaded, associated with the T-rated video game Enter the Matrix. MAIN OUTCOME MEASURES: Game genre; percentage of game play depicting violence; depiction of injury; depiction of blood; number of human and nonhuman fatalities; types of weapons used; whether injuring characters, killing characters, or destroying objects is rewarded or is required to advance in the game; and content that may raise concerns about marketing T-rated video games to children. RESULTS: Based on analysis of the 396 T-rated video game titles, 93 game titles (23%) received content descriptors for both violence and blood, 280 game titles (71%) received only a content descriptor for violence, 9 game titles (2%) received only a content descriptor for blood, and 14 game titles (4%) received no content descriptors for violence or blood. In the random sample of 81 T-rated video games we played, 79 games (98%) involved intentional violence for an average of 36% of game play time, and 34 games (42%) contained blood. More than half of the games (51%) depicted 5 or more types of weapons, with players able to select weapons in 48 games (59%). We observed 37 games (46%) that rewarded or required the player to destroy objects, 73 games (90%) that rewarded or required the player to injure characters, and 56 games (69%) that rewarded or required the player to kill. We observed a total of 11,499 character deaths in the 81 games, occurring at an average rate of 122 deaths per hour of game play (range 0 to 1310). This included 5689 human deaths, occurring at an average rate of 61 human deaths per hour of game play (range 0 to 1291). Overall, we identified 44 games (54%) that depicted deaths to nonhuman characters and 51 games (63%) that depicted deaths to human characters, including the player. CONCLUSIONS: Content analysis suggests a significant amount of violence, injury, and death in T-rated video games. Given the large amount of violence involving guns and knives, the relative lack of blood suggests that many T-rated video games do not realistically portray the consequences of violence. Physicians and parents should appreciate that T-rated video games may be a source of exposure to violence and some unexpected content for children and adolescents, and that the majority of T-rated video games provide incentives to the players to commit simulated acts of violence.

Adolescent↗

PubMed2004

Content and ratings of teen-rated video games.

CONTEXT: Children's exposure to violence, blood, sexual themes, profanity, substances, and gambling in the media remains a source of public health concern. However, content in video games played by older children and adolescents has not been quantified or compared with the rating information provided to consumers by the Entertainment Software Rating Board (ESRB). OBJECTIVES: To quantify and characterize the content in video games rated T (for "Teen") and to measure the agreement between the content observed in game play and the ESRB-assigned content descriptors displayed on the game box. DESIGN AND SETTING: We created a database of all 396 T-rated video game titles released on the major video game consoles in the United States by April 1, 2001, to identify the distribution of games by genre and to characterize the distribution of ESRB-assigned content descriptors. We randomly sampled 80 video game titles (which included 81 games because 1 title included 2 separate games), played each game for at least 1 hour, quantitatively assessed the content, and compared the content we observed with the content descriptors assigned by the ESRB. MAIN OUTCOME MEASURES: Depictions of violence, blood, sexual themes, gambling, and alcohol, tobacco, or other drugs; whether injuring or killing characters is rewarded or is required to advance in the game; characterization of gender associated with sexual themes; and use of profanity in dialogue, lyrics, or gestures. RESULTS: Analysis of all content descriptors assigned to the 396 T-rated video game titles showed 373 (94%) received content descriptors for violence, 102 (26%) for blood, 60 (15%) for sexual themes, 57 (14%) for profanity, 26 (7%) for comic mischief, 6 (2%) for substances, and none for gambling. In the random sample of 81 games we played, we found that 79 (98%) involved intentional violence for an average of 36% of game play, 73 (90%) rewarded or required the player to injure characters, 56 (69%) rewarded or required the player to kill, 34 (42%) depicted blood, 22 (27%) depicted sexual themes, 22 (27%) contained profanity, 12 (15%) depicted substances, and 1 (1%) involved gambling. Our observations of 81 games match the ESRB content descriptors for violence in 77 games (95%), for blood in 22 (27%), for sexual themes in 16 (20%), for profanity in 14 (17%), and for substances in 1 (1%). Games were significantly more likely to depict females partially nude or engaged in sexual behaviors than males. Overall, we identified 51 observations of content that could warrant a content descriptor in 39 games (48%) in which the ESRB had not assigned a content descriptor. We found that the ESRB assigned 7 content descriptors for 7 games (9%) in which we did not observe the content indicated within 1 hour of game play. CONCLUSIONS: Content analysis suggests a significant amount of content in T-rated video games that might surprise adolescent players and their parents given the presence of this content in games without ESRB content descriptors. Physicians and parents should be aware that popular T-rated video games may be a source of exposure to a wide range of unexpected content.

Adolescent↗

PubMed2004

Use of passive samplers to mimic uptake of polycyclic aromatic hydrocarbons by benthic polychaetes.

Experiments were conducted to test whether passive samplers made of low-density polyethylene (polyethylene devices, or PEDs) can estimate the extent of uptake of polycyclic aromatic hydrocarbons (PAHs) by benthic polychaetes (Nereis virens) in contaminated marine sediments. For a variety of PAHs, PEDs reached 90% equilibrium with sediment PAHs in 60 days or less. Using 60-day sediment bioaccumulation tests, we have demonstrated a significant relationship between PAH concentrations in the polychaetes and the PEDs (R2 = 0.67, p = 0.002), with the PEDs taking up less PAHs than the polychaetes. Because of this relationship, PEDs can potentially be used in a regulatory context to simulate uptake of bioavailable PAHs in contaminated marine sediments. The PED PAH concentrations were also used to calculate porewater PAH concentrations that allowed for the estimation of a linear free-energy relationship between the lipid-water distribution coefficient (Klip) and the octanol-water distribution coefficient (KOW) for PAH uptake in marine polychaetes (R2 = 0.94, p < 0.0001).

Animals↗

PubMed2004

Estimation of tuberculosis risk on a commercial airliner.

This article estimates the risk of tuberculosis (TB) transmission on a typical commercial airliner using a simple one box model (OBM) and a sequential box model (SBM). We used input data derived from an actual TB exposure on an airliner, and we assumed a hypothetical scenario that a highly infectious TB source case (i.e., 108 infectious quanta per hour) travels as a passenger on an 8.7-hour flight. We estimate an average risk of TB transmission on the order of 1 chance in 1,000 for all passengers using the OBM. Applying the more realistic SBM, we show that the risk and incidence decrease sharply in a stepwise fashion in cabins downstream from the cabin containing the source case assuming some potential for airflow from more contaminated to less contaminated cabins. We further characterized spatial variability in the risk within the cabin by modeling a previously reported TB outbreak in an airplane to demonstrate that the TB cases occur most likely within close proximity of the source TB patient.

Aerospace Medicine↗

PubMed2004

Value of information analysis in environmental health risk management decisions: past, present, and future.

Experts agree that value of information (VOI) analyses provide useful insights in risk management decisions. However, applications in environmental health risk management (EHRM) remain largely demonstrative thus far because of the complexity in modeling and solving VOI problems. Based on this comprehensive review of all VOI applications published in the peer-reviewed literature of such applications, the complexity of solving VOI problems with continuous probability distributions as inputs in models emerges as the main barrier to greater use of VOI although simulation allows analysts to solve more complex and realistic problems. Several analytical challenges that inhibit greater use of VOI techniques include issues related to modeling decisions, valuing outcomes, and characterizing uncertain and variable model inputs appropriately. This comprehensive review of methods for modeling and solving VOI problems for applications related to EHRM provides the first synthesis of important methodological advances in the field. The insights provide risk analysts and decision scientists with some guidance on how to structure and solve VOI problems focused on evaluating opportunities to collect better information to improve EHRM decisions. They further suggest the need for some efforts to standardize approaches and develop some prescriptive guidance for VOI analysts similar to existing guidelines for conducting cost-effectiveness analyses.

Decision Making↗

PubMed2004

Integrated analysis: combining risk and economic assessments while preserving the separation of powers.

This article presents a process for an integrated policy analysis that combines risk assessment and benefit-cost analysis. This concept, which explicitly combines the two types of related analyses, seems to contradict the long-accepted risk analysis paradigm of separating risk assessment and risk management since benefit-cost analysis is generally considered to be a part of risk management. Yet that separation has become a problem because benefit-cost analysis uses risk assessment results as a starting point and considerable debate over the last several years focused on the incompatibility of the use of upper bounds or "safe" point estimates in many risk assessments with benefit-cost analysis. The problem with these risk assessments is that they ignore probabilistic information. As advanced probabilistic techniques for risk assessment emerge and economic analysts receive distributions of risks instead of point estimates, the artificial separation between risk analysts and the economic/decision analysts complicates the overall analysis. In addition, recent developments in countervailing risk theory suggest that combining the risk and benefit-cost analyses is required to fully understand the complexity of choices and tradeoffs faced by the decisionmaker. This article also argues that the separation of analysis and management is important, but that benefit-cost analysis has been wrongly classified into the risk management category and that the analytical effort associated with understanding the economic impacts of risk reduction actions need to be part of a broader risk assessment process.

Journal Article↗

PubMed2004

Tiered chemical testing: a value of information approach.

In December 2000 the EPA initiated the Voluntary Children's Chemical Evaluation Program (VCCEP) by asking manufacturers to voluntarily sponsor toxicological testing in a tiered process for 23 chemicals selected for the pilot phase. The tiered nature of the VCCEP pilot program creates the need for clearly defined criteria for determining when information is sufficient to assess the potential risks to children. This raises questions about how to determine the "adequacy" of the existing information and assess the need to undertake efforts to reduce uncertainty (through further testing). This article applies a value of information analysis approach to determine adequacy by modeling how toxicological and exposure data collected through the VCCEP may be used to inform risk management decisions. The analysis demonstrates the importance of information about the exposure level and control costs in making decisions regarding further toxicological testing. This article accounts for the cost of delaying control action and identifies the optimal testing strategy for a constrained decisionmaker who, absent applicable human data, cannot regulate without bioassay data on a specific chemical. It also quantifies the differences in optimal testing strategy for three decision criteria: maximizing societal net benefits, ensuring maximum exposure control while net benefits are positive (i.e., benefits outweigh costs), and controlling to the maximum extent technologically feasible while the lifetime risk of cancer exceeds a specific level of risk. Finally, this article shows the large differences that exist in net benefits between the three criteria for the range of exposure levels where the optimal actions differ.

Animals↗

PubMed2004

Importance of black carbon in distribution and bioaccumulation models of polycyclic aromatic hydrocarbons in contaminated marine sediments.

The roles and relative importance of nonpyrogenic organic carbon (NPOC) and black carbon (BC) as binding phases of polycyclic aromatic hydrocarbons (PAHs) were assessed by their ability to estimate pore water concentrations and biological uptake in various marine sediments. Sediment bioaccumulation tests were performed with the marine polychaete Nereis virens, using a polyethylene device to estimate pore water concentrations of PAHs. Using existing partitioning data for pyrene and phenanthrene, it was found that the traditional Equilibrium Partitioning model, which assumes all organic carbon is NPOC (EqP(OC)), overestimated the measured pore water concentrations in the test sediments by one to three orders of magnitude. Instead, the measured pore water concentrations were better predicted from a distribution scenario that uses both BC and NPOC (EqP(NPOc,BC)) When comparing actual worm body burdens of pyrene and phenanthrene with the two model estimates of worm tissue concentrations, the EqP(OC) model tended to overestimate actual body burdens by three orders of magnitude, while the EqP(NPOC,BC) model came much closer to the true body burden values. The observed distribution of PAHs in the test sediments was used to calculate BC partition coefficients for five PAHs, which were one to two orders of magnitude higher than their corresponding organic carbon-normalized distribution coefficients, or K(OC)s. Together, these results suggest that, in certain situations, adding black carbon to distribution models may be necessary to predict accurately the bioavailability of PAHs.

Animals↗

PubMed2003

Policy decision options during the first 5 years following certification of polio eradication.

Policy makers face a number of difficult choices as they develop policies to ensure maintenance of a polio-free world following global eradication and certification. These policy decisions include choices about immunization, outbreak response (including whether to create a vaccine stockpile), surveillance, containment, management of chronic excretors, and investment in future research. This paper focuses on identifying the categories of decisions and characterizing the actual factors that country-level policy makers must weigh to manage polio risks during the first 5 years after certification. Building on a comprehensive literature review, we report the results of the first qualitative analysis to: (1) systematically characterize each type of decision and the relevant options during the first 5 years after certification, (2) clearly identify critical factors that influence the choices, and (3) specifically demonstrate the interdependence among the decisions to produce a reduced set of decision options. This paper explicitly focuses on the different perspectives of developed and developing countries in characterizing the options. While the management of polio risk in the postcertification period presents important challenges, this comprehensive approach helps simplify the process by focusing on critical decisions.

Developed Countries↗

PubMed2003

The role of bath seats in unintentional infant bathtub drowning deaths.

OBJECTIVE: The objective of this study was to quantify and characterize the role of bath seats in infant mortality from bathtub drowning. METHOD: Risk analysis of bathtub drowning deaths for infants aged 6-10 months was performed using data available from the US Consumer Product Safety Commission (CPSC), birth and mortality data from the National Center for Health Statistics (NCHS) for US resident infants from 1990-1998, and bath seat ownership from the American Baby Group and industry sales data compiled by NPD to estimate bath seat use. The analysis computes the relative risks of infant drowning based on estimates of bath seat use with a cohort design and explores the potential confounding by a range of factors. RESULTS: In-depth analysis of the unintentional bathtub drowning deaths of American infants aged 6-10 months for the years 1994 through 1998 revealed 40 infant drowning deaths associated with bath seats and 78 deaths not associated with bath seats. Based on available data on sales and use that suggest approximately 45% of infants in this age group use bath seats, the existing data do not support a hypothesis that bath seats increase the risk of bathtub drowning for infants. Bath seats are not intended or marketed as safety devices, and analysis of the existing, albeit limited, data suggests that they either have no effect or they may provide some slight unexplained protection against unintentional bathtub drowning risks (with an odds ratio for the risk of drowning with a bath seat vs without a bath seat of approximately 0.6 [95% confidence interval (CI) 0.4-0.9]). Although all potential confounders cannot be fully explored due to incomplete data and large uncertainties remain, this analysis suggests that the US CPSC made the appropriate decision not to ban bath seats in response to petitions it received in 1994 and 2001. CONCLUSIONS: Increasing market sales and surveys of reported bath seat use were associated with decreasing unintentional infant bathtub drowning risks. Rigorous risk analyses should be conducted when considering regulating products to ensure that regulation does not inadvertently increase injury risks. Analysis of the factors associated with these deaths suggests that additional efforts are needed to ensure that caregivers do not leave infants unattended in the bathtub and to collect data that will further improve our understanding and management of these risks.

Age Factors↗

PubMed2003

How much do kids count in corporate board rooms? Results from the first survey of Fortune 1000 companies.

OBJECTIVE: The objective of this study was to characterize the extent of the business community's commitment to children, particularly with respect to understanding its role in assuring children's health and development, by conducting a survey of the largest US companies. METHODS: A survey of year 2001 Fortune 1000 companies was performed to determine whether their mission statements, vision statements, or guiding principles include a commitment to children; whether they employ people under the age of 18 years in the United States; whether they encourage their employees to mentor children under the age of 18 years; whether they have an affiliated philanthropic foundation; whether their company's philanthropy focuses specifically on children; and whether they participate in any activities that particularly help disadvantaged children. The survey consisted of 2 mailings followed by phone calls to companies to obtain answers to the questions listed above and answers to additional questions that asked specifically about the company's financial expenditures for parental leave, child care, and healthcare for children of employees and about the company's specific philanthropic giving aimed at helping children. Descriptive information about some of the ways that companies impact the lives of children was also obtained to provide context for the responses. RESULTS: Data were obtained from 333 year 2001 Fortune 1000 companies (33%) between March 20, 2002 and March 20, 2003, with a good representation of all industry sectors. These data suggest that approximately 33% of the companies that responded have mission statements, vision statements, or guiding principles that specifically include a commitment to children. Employment opportunities for children under the age of 18 years in the United States exist at approximately 41% of these companies. These companies clearly see mentoring as a major theme, with 77% of them encouraging their employees to mentor children under the age of 18 years. Approximately 60% of the companies that responded support affiliated, independent philanthropic foundations, and approximately 55% of companies indicated that they focus their philanthropy specifically (although not exclusively) on children. Approximately 80% of these companies indicated that they participate in at least one activity that helps disadvantaged children. Many companies faced challenges in estimating their overall investments in children, particularly given their large and decentralized nature, but they were able to provide an overall sense of their commitment and they indicated that they could provide quantitative data prospectively if they knew it would be requested. CONCLUSION: Many companies that responded play a major role in supporting children's health and development in the United States both directly and indirectly. Further efforts to better quantify the business community's aggregate commitments to improving children's health and development should be sought to allow better estimation of the amount of resources expended and the impact of these investments on children.

Adolescent↗

PubMed2002

Genetic testing for lung cancer risk: if physicians can do it, should they?

Advances in genetics have increased our ability to assess an individual's genetic risk for disease. There is a hypothesis that genetic test results will motivate high-risk individuals to reduce harmful exposures, to increase their surveillance for disease, or to seek preventive treatments. However, genetic testing for genes associated with an increased risk of lung cancer would not change physicians' recommendations regarding smoking cessation. Limited studies suggest that test results that demonstrate an increased risk of lung cancer do not improve smoking cessation success. These test results may even distort an individual's risk perceptions. Before recommending genetic testing to assess risk for disease, physicians need to consider whether knowledge about genetic susceptibility will alter patient management.

Health Behavior↗

PubMed2002

Variability and uncertainty meet risk management and risk communication.

In the past decade, the use of probabilistic risk analysis techniques to quantitatively address variability and uncertainty in risks increased in popularity as recommended by the 1994 National Research Council that wrote Science and Judgment in Risk Assessment. Under the 1996 Food Quality Protection Act, for example, the U.S. EPA supported the development of tools that produce distributions of risk demonstrating the variability and/or uncertainty in the results. This paradigm shift away from the use of point estimates creates new challenges for risk managers, who now struggle with decisions about how to use distributions in decision making. The challenges for risk communication, however, have only been minimally explored. This presentation uses the case studies of variability in the risks of dying on the ground from a crashing airplane and from the deployment of motor vehicle airbags to demonstrate how better characterization of variability and uncertainty in the risk assessment lead to better risk communication. Analogies to food safety and environmental risks are also discussed. This presentation demonstrates that probabilistic risk assessment has an impact on both risk management and risk communication, and highlights remaining research issues associated with using improved sensitivity and uncertainty analyses in risk assessment.

Communication↗

PubMed2002

Validating benefit and cost estimates: the case of airbag regulation.

Preregulation estimates of benefits and costs are rarely validated after regulations are implemented. This article performs such a validation for the mandatory automobile airbag requirement. We found that the original 1984 model used to estimate benefits became invalid when 1997 values were input into that 1984 model. However, using a published 1997 cost-effectiveness model, we demonstrate, by replacing the model inputs with the values from 1984, that the 1997 cost-effectiveness ratios, based on real-world crash data and tear-down cost data, are less attractive than what would have been originally anticipated. The three most important errors in the 1984 input values are identified: the overestimation of airbag effectiveness, the overestimation of baseline fatality/injury rates, and the underestimation of manual safety belt use. This case study, which suggests that airbags are a reasonable investment in safety, shows that the regulatory analysis tools do not always produce findings that are biased against health, safety, and environmental regulation. Future validation studies of health, safety, and environmental regulation should focus on validation of benefit and risk estimates, areas where we found significant error, as well as on cost estimates.

Air Bags↗

PubMed2002

Emerging issues in vaccine economics: perspectives from the USA.

Economic studies of vaccines, including vaccine development and delivery issues, are increasingly needed to inform policy recommendations and programmatic decisions in the USA. This need arises from the increasing costs of vaccines, the complexity of the US healthcare system and the limited number of vaccine manufacturers in the market. We have developed a national research agenda in domestic and global vaccine economics by conducting key informant interviews with 42 experts and inviting ideas from an additional 128 experts. To assess priorities among the 129 ideas that were generated, we asked 15 experts representing a broad range of perspectives to rank the ideas and we analyzed their votes. The highest-ranking domestic research ideas included evaluating: the costs of vaccine shortages, the cost-effectiveness of potential human papillomavirus vaccination and adult and adolescent pertussis vaccination programs and the cost-effectiveness of universal vaccine purchase programs for adults as well as children. The highest-ranking globally-oriented ideas included developing a resource allocation model to support the best vaccination program decisions with limited funds and assessing the cost-effectiveness of HIV, rotavirus, meningococcal and malaria vaccines in developing countries. To optimize the usefulness of vaccine economics research, conceptual issues, such as how to set values for the prevention of illness and how to maximize social equity through investments in vaccines, must be addressed.

Adult↗

PubMedDate not supplied

Value of information literature analysis: a review of applications in health risk management.

This article provides the first comprehensive review of value of information (VOI) analyses related to health risk management published in English in peer-reviewed journals by the end of 2001. VOI analysis represents a decision analytic technique that explicitly evaluates the benefit of collecting additional information to reduce or eliminate uncertainty. Through a content analysis of VOI applications, this article characterizes various attributes of VOI applications, shows the evolution of the methodology and advances in computing tools that allow analysis of increasingly complex problems, and suggests the need for some standardization of reporting methods and results. The authors' analysis shows a lack of cross-fertilization across topic areas and the tendency of articles to focus on demonstrating the usefulness of the VOI approach rather than applications to actual management decisions. This article provides important insights for VOI applications in medical decision making.

Bayes Theorem↗