The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholdersâ€"the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved.

This report, prepared by an expert committee of the Institute of Medicine, identifies gaps and strengths in past and current research relating to the health and performance of military women, and provides guidance on establishing research finding priorities. Overarching recommendations deal with basic funding considerations for awards; important health questions related to racial or ethnic group membership; peer review; the promotion of information exchange; and the promotion of strong collaborative partnerships involving Department of Defense intramural efforts, established academic institutions, federal research programs, and civilian research programs. The committee recommends long-term commitment to research focused on the health of military women and the development and maintenance of databases to support this research, including longitudinal research. The committee's recommendations of specific topics for research fall into four broad areas: Major factors affecting the health and work performance of military women; psychological and health issues resulting from integration of women into a hierarchical male environment, or related to women and men living and working together in close quarters; health promotion and disease prevention; and access to and delivery of health care.

This study compared the unplanned pregnancy rate in soldiers against wives and daughters of soldiers. In addition, this investigation evaluated the relationships between a soldier's job, classified into specific job categories, as well as, some of the more common military occupational specialties and spontaneous abortion, small for gestational age, and preterm birth. This investigation found that pregnant soldiers who reside in the barracks demonstrated an unplanned pregnancy rate of 77.9 percent. The odds ratio for unplanned pregnancy in barracks residents was 4.32(3.24-5.78) and the odds ratio for pregnant barracks residents and never previously utilizing oral contraceptives was 2.55(1.87-3.48). These results may suggest access barriers to health care. Soldiers in the logistics job category demonstrated an increased risk of spontaneous abortion, the odds ratio was 1.87(1.20-2.93), within the logistics job category soldiers in MOS 92A demonstrated an odds ratio of 2.55(1.48-4.37). No other occupations were found to be at risk for spontaneous abortion. Soldiers were not, and no soldier job categories were identified at increased risk of S% or preterm birth. The most important predictors of SGA were Asian race 1.75(1.06-2.88), Black race 2.32(1.72-3.13), cigarette use 1/2 to 1 pack per day 2.17(1.45-3.26), and cigarette use more than 1 pack per day 2.71(1.17-6.29). The most important predictors of preterm birth were Black race 2.32(1.72-3.13) and cigarette use less than 1/2 per day 1.59(1.05-2.39).

According to current statistical data, one in eight women will be diagnosed with breast cancer. The five-year survival rate for breast cancer patients has improved in recent years, but the overall mortality rates have changed little. In 1993 Congress allocated $210 million for breast cancer research as part of the Department of Defense budget. An Institute of Medicine (IOM) committee was convened at that time to advise the U.S. Army Medical Research and Development Command on strategies for managing a breast cancer research program. This book evaluates the program's management and achievements to date. Although it is too early to evaluate the program in terms of breakthrough results and new insights produced by the funded projects or investigators, this book documents the process used to select research proposals for funding and analyzes the portfolio of funded projects in terms of their responsiveness to the recommendations and fundamental questions articulated in the 1993 IOM report.

The cause of iron deficiency anemia (IDA) in premenopausal women is often presumed to be due to menstrual losses. The purpose of this study was to investigate the diagnostic value of a comprehensive gynecologic and gastrointestinal evaluation among premenopausal women with IDA. Nineteen premenopausal non-pregnant women over 18 yrs of age with IDA defined by a HGB