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Studying the prevalence of Acquired Immune Deficiency Syndrome (AIDS) among American Indians and Alaskan Native populations reveals a low 1990 case rate but a rapid increase in diagnosed cases, at a rate higher than any other racial/ethnic group. Culturally sensitive prevention programs are required. (SLD)

Biological questions about Acquired Immune Deficiency Syndrome (AIDS) are minor compared with political and ethical problems related to the AIDS epidemic in the United States. Lack of public confidence in the work of public health officials and the controversy surrounding New York City's syringe exchange program are two examples. (SLD)

Objectives. This study examined the quality of recent reviews in epidemiology. Methods. All 1995 issues of 7 widely read epidemiology journals were searched to identify reviews. Results. Twenty-nine reviews were identified. Methodology was not specified or incomplete for literature searches in 79% of reviews; the same was true for inclusion criteria in 83% and for combining studies in 62%. More than 60% of the reviews were not methodologically systematic. Conclusions. There is a need to improve the quality of review papers in epidemiology. If systematic methodology were followed more frequently, epidemiologic science and its application could be improved. (Am J Public Health. 1998;88:475-477) [ABSTRACT FROM AUTHOR]

Objectives. We conducted 2 studies to determine the impact of text message immunization reminder-recalls in an urban, low-income population. Methods. In 1 study, text message immunization reminders were sent to a random sample of parents (n=195) whose children aged 11 to 18 years needed either or both meningococcal (MCV4) and tetanus-diphtheria-acellular pertussis (Tdap) immunizations. We compared receipt of MCV4 or Tdap at 4, 12, and 24 weeks with age- and gender-matched controls. In the other study, we compared attendance at a postshortage Haemophilus influenzae B (Hib) immunization recall session between parents who received text message and paper-mailed reminders (n=87) and those who only received paper-mailed reminders (n=87). Results. Significantly more adolescents with intervention parents received either or both MCV4 and Tdap at weeks 4 (15.4% vs 4.2%; P<.001), 12 (26.7% vs 13.9%; P<.005), and 24 (36.4% vs 18.1%; P<.001). Significantly more parents who received both Hib reminders attended a recall session compared with parents who only received a mailed reminder (21.8% vs 9.2%; P<.05). After controlling for age, gender, race/ethnicity, insurance status, and language, text messaging was still significantly associated with both studies' outcomes. Conclusions. Text messaging for reminder-recalls improved immunization coverage in a low-income, urban population. [ABSTRACT FROM AUTHOR]

In the epidemiological imagination, the Framingham Heart Study has attained iconic status, both as the prototype of the cohort study and as a result of its scientific success. When the Public Health Service launched the study in 1947, epidemiological knowledge of coronary heart disease was poor, and epidemiology primarily involved the study of infectious disease. In constructing their investigation, Framingham's initiators had to invent new approaches to epidemiological research. These scientific goals were heavily influenced by the contending institutional and personal interests buffeting the study. The study passed through vicissitudes and stages during its earliest years as its organizers grappled to define its relationship to medicine, epidemiology, and the local community. (Am J Public Health. 2005;95:602-610.doi10.2105/AJPH.2003.026419). [ABSTRACT FROM AUTHOR]

Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemioiogy in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization-molecular and societal as well as individual-this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline. [ABSTRACT FROM AUTHOR]

Predictions that measles would be eradicated through vaccination have not been fulfilled. The reasons for this failure are analyzed in this paper, and the possibilities for successful action against measles are outlined. [ABSTRACT FROM AUTHOR]

The development of modern epidemiology, particularly cancer epidemiology, is often seen as a post-World War II phenomenon. However, the First National Cancer Survey, conducted from 1937 to 1939 as part of the newly formed National Cancer Institute's initial activities, provided the first data on the occurrence of cancer in the United States. This project was directed by a young sociologist, Harold Fred Dom. Through Dom, many of the methodological innovations in sociology, such as the use of surveys and observational study designs, were incorporated into modern epidemiology. I examine Dorn's training and early career in the content of the First National Cancer Survey as a means of investigating the beginnings of modem epidemiology. (Am J Public Health. 2008;98:2150-2158. doi:10.2105/AJPH.2007.1l7440) [ABSTRACT FROM AUTHOR]

This article attempts to contribute to the debate on the future of epidemiology by combining Thomas Kuhn's ideas on scientific paradigms with the author's observations on some epidemiology textbooks. The author's interpretations were based on his readings of Kuhn's The Structure of Scientific Revolutions, epidemiology textbooks, and papers on the future of epidemiology. Thomas Kuhn's view is that sciences mostly work with a single paradigm driven by exemplars of successful work, and that proposals for paradigm change are resisted. Sciences that are maturing or changing do not have a dominant paradigm. Epidemiology textbooks showed diversity in their concepts, content, and approach. Most exemplars related to etiologic research rather than public health practice. One key focus of the recent controversy regarding the role of epidemiology has been the increasing inability of epidemiology to solve socially based public health problems. Kuhn's views help explain the polarization of views expressed. Kuhn's philosophy of science offers insights into controversies such as whether a paradigm shift is needed or imminent and the gap between epidemiology and public health practice. Interaction between science philosophers, epidemiologists, and public health practitioners may be valuable. [ABSTRACT FROM AUTHOR]

This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach. [ABSTRACT FROM AUTHOR]

Ecological studies have been evaluated in epidemiological contexts in terms of the "ecological fallacy." Although the empirical evidence for a lack of comparability between correlations derived from ecological- and individual-level analyses is compelling, the conceptual meaning of the ecological fallacy remains problematic. This paper argues that issues in cross-level inference can be usefully conceptualized as validity problems, problems not peculiar to ecological-level analyses. Such an approach increases the recognition of both potential inference problems in individual-level studies and the unique contributions of ecological variables. This, in turn, expands the terrain for the location of causes for disease and interventions to improve the public's health. [ABSTRACT FROM AUTHOR]

This paper reports the findings from an epidemiological survey conducted in California using the Health Opinion Survey (HOS). a measure of psychoneuroticism, as well as other scales and inventories. Uncontrolled results indicate That Mexican Americans have higher symptom and case levels, but that these differences are found primarily among marginally acculturated and immigrant respondents, HOS caseness levels were 15.4 for Spanish speaking Mexican Americans. 6.6 for English-speaking Mexican Americans. and 5.5 for other Whites. Joint effects of ethnicity for sex, age, education, and marital Muftis were substantial however there were differences in caseness between Spanish-speaking Mexican Americans. English-speaking Mexican Americans. and other Whites on four measures of psychological distress. The results indicate the importance of acculturation-related factors, including educational attainment, language preference, and nativity for predicting symptomatology among Mexican Americans. (Am J Public Health 1985; 75:523-527.) [ABSTRACT FROM AUTHOR]

The identification in February 1976 of a new strain of influenza virus led to the enactment of unprecedented federal legislation to minimize the impact of a potential outbreak of pandemic influenza in the fall and winter of 1976-1977. This legislative program does not, however, represent a commitment of federal resources to deal with the more general, longstanding problem of epidemic influenza. This paper presents a series of estimates of the impact and economic consequences of influenza. By including periods of interpandemic as well as pandemic disease, the estimates offer a broadened perspective of the magnitude of the influenza problem. The estimates show that while the proportions of pandemic influenza can be singularly impressive, the cumulative effects of interpandemic outbreaks are generally of greater consequence. The paper discusses the implications of these estimates and the 1976 legislation for the support and implementation of federal policy on the use of influenza vaccine. While the commitment of resources in support of public policy cannot alone guarantee successful implementation, it must be considered an essential prerequisite for dealing with both interpandemic and pandemic influenza. [ABSTRACT FROM AUTHOR]

Objectives. We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. Methods. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Results. Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Conclusions. Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers. [ABSTRACT FROM AUTHOR]

Objectives. We characterized smokers who are likely to use electronic or "e-"cigarettes to quit smoking. Methods. We obtained cross-sectional data in 2010-2012 from 1567 adult daily smokers in Hawaii using a paper-and-pencil survey. Analyses were conducted using logistic regression. Results. Of the participants, 13% reported having ever used e-cigarettes to quit smoking. Smokers who had used them reported higher motivation to quit, higher quitting self-efficacy, and longer recent quit duration than did other smokers. Age (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97, 0.99) and Native Hawaiian ethnicity (OR = 0.68; 95% CI = 0.45, 0.99) were inversely associated with increased likelihood of ever using e-cigarettes for cessation. Other significant correlates were higher motivation to quit (OR = 1.14; 95% CI = 1.08, 1.21), quitting self-efficacy (OR = 1.18; 95% CI = 1.06, 1.36), and ever using US Food and Drug Administration (FDA)-approved cessation aids such as nicotine gum (OR = 3.72; 95% CI = 2.67, 5.19). Conclusions. Smokers who try e-cigarettes to quit smoking appear to be serious about wanting to quit. Despite lack of evidence regarding efficacy, smokers treat e-cigarettes as valid alternatives to FDA-approved cessation aids. Research is needed to test the safety and efficacy of e-cigarettes as cessation aids. [ABSTRACT FROM AUTHOR]

The article talks about research papers on the epidemiology of disablement published within the issue. Researchers have found a pattern for the distribution of disability or the restrictions in activity that is consistent with previous research on correlates of mortality and other health status indicators. The papers addresses the continued need for conceptual clarity among the triad of concepts of impairment, disability and handicap that arose from earlier distinctions among disease, illness and sickness.

Abstract: Dr. Salk's comments on our paper fall into four major categories: our use of the techniques of decision analysis, the assumptions we used, the fact that we did not include individual and social values in the model, and the way in which vaccine policies are developed in the United States. We believe that the methods were used correctly, that the assumptions we used are defensible, and that our conclusions were both appropriate and appropriately worded. We explicitly did not include individual and social values since we were addressing the scientific and epidemiologic issues rather than ethical and moral issues. Vaccine policy development in the United States is carried out in public forums with opportunity for presentation of all sides of an issue. INSET: AAP Urges Removing Religious Exemption Clauses in Child Abuse.... [ABSTRACT FROM AUTHOR]

Conclusions. Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community. (Am d Public Health. 2001;91: 907-914) [ABSTRACT FROM AUTHOR]

The article presents various research papers on epidemiology and discusses public health of the aged in the United States. The history of epidemiology and public health is replete with examples of ingenious and brilliant use of available data that were used to answer important questions and that yielded major public health advances. The Davis report on living arrangements is a sophisticated analysis that reveals the limitations of secondary data, albeit more subtle ones, when one are asking complex questions. If the data reflects a national sample, having national data becomes strength of the study. It is important to note that "secondary data" is an imprecise label that covers a great diversity of types and sources of data. The data set has information on some additional variables not previously examined. It becomes important to look at these variables as possible controls or as risk factors.

Today, our understanding of and approach to the exogenous causes of cancer are dominated by epidemiological practices that came into widespread use after World War II. This paper examines the forces, considerations, and controversies that shaped postwar risk factor epidemiology in the United States. It is argued that, for all of the new capabilities it brought, this risk factor epidemiology has left us with less of a clinical eye for unrecognized cancer hazards, especially from limited and localized exposures in the work-place. The focus here is on Wilhelm Hueper, author of the first textbook on occupational cancer (1942). Hueper became the foremost spokesman for earlier identification practices centering on occupational exposures. The new epidemiological methods and associated institutions that arose in the 1940s and 1950s bore an unsettled relation to earlier claims and methods that some, Hueper among them, interpreted as a challenge. Hueper's critique of the new epidemiology identified some of its limitations and potentially debilitating consequences that remain with us today.

A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multilevel analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations. [ABSTRACT FROM AUTHOR]

Objectives. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. Methods. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. Results. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. conclusions. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to non infectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended. [ABSTRACT FROM AUTHOR]

Quantitative risk assessment provides formalized scientific input to regulatory agencies that set occupational and environmental standards for potentially toxic exposures. Current practice relies heavily on statistical extrapolation from high-dose animal studies. Human data obviate the need for interspecies extrapolation and reduce the range of high-to-low dose extrapolation. This paper proposes a framework for classifying individual epidemiologic studies as to their adequacy for use in dose-response extrapolation. The framework considers five criteria: (1) a stable positive association with an adverse health outcome; (2) high overall study quality; (3) no substantial confounding; (4) quantitative exposure assessment for individuals; (5) evidence of a dose-response relationship. With these criteria, studies can be categorized as (1) suitable to serve as a basis for extrapolation; (2) inadequate to be the basis for direct extrapolation but appropriate to use for evaluating but appropriate to use for evaluating the plausibility of animal-derived risk estimates; or (3) useful only for hazard identification, not for dose-response assessment. Methods for using studies in the first two categories are briefly described. The emphasis is not on establishing rigid rules, but rather on ensuring a consistent, reliable process that makes optimum use of available data. [ABSTRACT FROM AUTHOR]

Objectives. The current primary federal dust standard for US underground coal miners of 2 mg/m³ respirable dust is based on British epidemiological information on exposure-response derived in 1969. Since then, much new information has become available. This paper reviews and compares the available information as it relates to the US mining situation. methods. Recent exposure-response information on pneumoconiosis and dust exposure derived by British researchers was employed to estimate working-life risks of pneumoconiosis for miners exposed to 2 mg/m³. Results. It is estimated that close to 9% of underground coal miners who work for 40 years in a 2 mg/m³ environment would develop pneumoconiosis (category 1 or greater). Progressive massive fibrosis would develop in 0.7%. Conclusions. There are unresolved questions relating to the validity of extrapolating findings on British mines and miners to the US and also in predicting disease levels at the low end of the dust exposure spectrum. Given the data available, current information suggests miners who are employed for a working life-time at the current federal dust limit of 2 mg/m³ are still at risk of developing pneumoconiosis. [ABSTRACT FROM AUTHOR]

Abstract: This paper provides an overview of problems in multivariate modeling of epidemiologic data, and examines some proposed solutions. Special attention is given to the task of model selection, which involves selection of the model form, selection of the variables to enter the model, and selection of the form of these variables in the model. Several conclusions are drawn, among them: a) model and variable forms should be selected based on regression diagnostic procedures, in addition to goodness-of-fit tests; b) variable-selection algorithms in current packaged programs, such as conventional stepwise regression, can easily lead to invalid estimates and tests of effect; and c) variable selection is better approached by direct estimation of the ° of confounding produced by each variable than by significance-testing algorithms. As a general rule. before using a model to estimate effects, one should evaluate the assumptions implied by the model against both the data and prior information. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses methodology in developing exposure data for the water supply contaminant dibromocholoropropane (DBCP) in Fresno County, California. There are 532 drinking water systems (49 large and 483 small) within Fresno County plus 14,000 private wells. We determined the number of wells per system, the output per well, and the population served by each system. The task of deriving water quality estimates for each census tract was complicated by the fact that a single census tract can be served by more than one system; each system usually has more than one well; and a single well can have several episodes of testing for various contaminants. We calculated a series of weighted averages for concentrations of DBCP, arsenic, and nitrates for each census tract, using water production figures for each well as the weighting factor. Water quality data were derived from a total of 14,861 laboratory reports, although the majority did not report on all contaminants. Mean DBCP levels ranged from 0.0041 ppb to 5.7543 ppb among the census tracts. We found no correlation between DBCP levels per census tract compared to either arsenic or nitrates. We believe that we made as complete an exposure assessment as practically feasible. [ABSTRACT FROM AUTHOR]

Abstract: Despite the widespread use of ecologic analysis in epidemiologic research and health planning, little attention has been given by health scientists and practitioners to the methodological aspects of this approach. This paper reviews the major types of ecologic study designs, the analytic methods appropriate for each, the limitations of ecologic data for making causal inferences and what can be done to minimize these problems, and the relative advantages of ecologic analysis. Numerous examples are provided to illustrate the important principles and methods. A careful distinction is made between ecologic studies that generate or test etiologic hypotheses and those that evaluate the impact of intervention programs or policies (given adequate knowledge of disease etiology). Failure to recognize this difference in the conduct of ecologic studies can lead to results that are not very informative or that are misinterpreted by others. (Am J Public Health 1982: 72:1336-1344.) [ABSTRACT FROM AUTHOR]

Concern about water quality today involves chemicals where the epidemiologic significance of exposure to low level concentrations is not well understood. This includes also various inorganic and organic additives. This paper discusses these aspects in ecologic terms. [ABSTRACT FROM AUTHOR]

The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to determine the frequency and character of policy statements in epidemiologic reports. Methods. The first author followed a standardized protocol and reviewed a random sample of articles selected from the American Journal of Epidemiology, Annals of Epidemiology, and Epidemiology. The second author reviewed all articles with policy statements and a 10% sample without such statements. Results. Overall, 23.8% of the articles contained policy statements. Annals of Epidemiology and the American Journal of Epidemiology had similar frequencies of articles with policy statements (30% and 26.7%, respectively), while Epidemiology evidenced the lowest frequency (8.3%). The majority of policy statements (55%) pertained to public health practice; 27.5% involved clinical practice, and the remainder (17.5%) focused on corporate policies, regulatory actions, or undefined arenas. The frequency of policy statements differed according to first author's affiliation, type of publication, area of research, research design, and study population. Conclusions. Although a minority of publications included policy statements, the inclusion of a statement seemed to be influenced by specific study characteristics. [ABSTRACT FROM AUTHOR]

We used Medicare data bases and U.S. Census data to address two questions critical to the use of Medicare files for epidemiologic research. First, we examined the degree to which the population enrolled in the Medicare program is similar to the elderly resident population of the United States, as estimated by the US Census. We found small differences in the total population estimates hut substantial differences by age and race. Second, we found that among Medicare enrollees, physician claims identify a small proportion of hip fracture cases which are not documented in the hospital discharge files. This proportion varies by age region, and state within the United States. Calculation of rates based on Medicare hospital discharge data, and probably other hospital discharge data sets as well, must take these limitations into account. Use of all available Medicare data files can overcome these limitations. [ABSTRACT FROM AUTHOR]

Abstract: Over the fast decade there has been a marked increase in information on the epidemiology of psychiatric disorders, particularly major depression, in adults living in the community and in families. The ability to conduct large epidemiologic studies of psychiatric disorders is due to improvements in diagnostic precision and reliability in psychiatry and to the development of systematic methods for collecting information on signs and symptoms to make diagnoses. Results from a recently completed epidemiologic survey of psychiatric disorders in five urban communities in the United States and from several large-scale family genetic studies suggest that major depression is a highly prevalent disorder. It occurs in adults and children, and there in evidence for an increased rate in younger people. The average age of first onset is in young adulthood. Most depressions are untreated. The firm risk factors for major depression include being female: young (born after World War lib separated/divorced or in an unhappy marriage: and having a family history of major depression. There is a two-to-threefold increased risk for major depression if there is a family history of the disorder. The relevance of these findings to clinical practice and public health is discussed. (Am J Public Health 1987:77:445-451.) [ABSTRACT FROM AUTHOR]

Abstract: Records of 642 outbreaks of acute gastroenteritis were reviewed to determine the proportion of outbreaks that were clinically and epidemiologically consistent with Norwalk-like virus infection. Using as our criteria stool cultures negative for bacterial pathogens. mean (or median) duration of illness 12-60 hours, vomiting in is ≥ 50 per ¢ of cases, and, if known, mean (or median) incubation period of 24-48 hours, we found that 23 per ¢ of waterborne outbreaks. 4 per ¢ of foodborne outbreaks, and 67 per ¢, 60 per ¢, and 28 per ¢ of outbreaks in nursing homes, in summer camps, and on cruise ships. respectively, satisfied the criteria for Norwalk-like pattern. Of 54 outbreaks that satisfied the criteria for Norwalk-like pattern, 14 were investigated for virus etiology. Ten of these (71 per ¢) yielded serologic evidence of Norwalk-like virus infection. Norwalk-like viruses are probably an important cause of outbreaks of acute gastroenteritis, investigation for Norwalk virus antibody in outbreaks that are clinically and epidemiologically consistent with Norwalk-like virus infection ix likely to yield diagnostically useful results. (Am J Public Health 1982; 72: 1329-1332.) [ABSTRACT FROM AUTHOR]

The author discusses the study "Surveillance in Environmental Public Health: Issues, Systems, Sources," by S. B. Thacker and colleagues. He asserts that Thacker and colleagues' paper represents an important advance in the application of surveillance to environmental public health. He cites some of the successful elements in occupational health surveillance. He examines a holistic approach to public health surveillance.

For New York City from 1978 to 1990, plotting the 3-year running averages of citywide new tuberculosis cases against the middle year yielded and S-shaped curve, with the inflection point at 1983 between early slow and late rapid rise. The inflection in the S curve appears to be associated with hierarchical establishment of secondary epicenters, and the phase of rapid rise in new cases seems to be associated with spatial diffusion from both the primary and secondary epicenters. [ABSTRACT FROM AUTHOR]

Abstract: Health department epidemiologists in 50 states. New York City, and the District of Columbia were surveyed in 1985 about seven potential data sources for occupational disease surveillance. Reported sources of occupational disease data were: automated workers' compensation claims (63 per ¢ of the 52 respondents): provider reports (62 per ¢): death certificates with occupation or industry (60 per ¢): cancer registries with occupational histories (3.5 per ¢): birth certificates with parent's occupation (27 per ¢): non-cancer disease registries (13 per ¢): and hospital or insurance records (8 per ¢). [ABSTRACT FROM AUTHOR]

Abstract: We examined the costs of a typhoid fever outbreak caused by exposures to contaminated food over a 47-day period at a restaurant. For the 49 respondents, the patient-related costs ($215.5481 were primarily medical expenses ($183.902) and lost income or productivity ($28,603). The estimated patient-related costs for all 80 outbreak-associated cases was $351,920. Had contaminated food continued to be served, the prevention-related costs ($36,500) would have been offset by patient-related costs ($7,488/day) within 5 days. [ABSTRACT FROM AUTHOR]

Comparative studies of health conditions and medical problems involving various nations and cultures may cast light on a frequently complex and difficult scientific problem and at the same time, have highly practical significance for the populations involved. Examples include large scale multinational research projects on nutrition and heart diseases and international comparisons of cancer epidemiological. These projects have made important theoretical and applied contributions and promise still more exciting results in the future. The political dispute over whether the government in Peking or that in Taipei was entitled to represent the huge population of China kept the People's Republic out of the World health Organization until 1912.

The article presents a study on the problem of construct validity in the assessment of the usefulness of child maltreatment report data. While report data continue to be collected and organized, little is done with these data to estimate the incidence and prevalence of child abuse and neglect. Greater attention to epidemiology is required, and ultimately the issue of etiology must be addressed. Child maltreatment may usefully be thought of as a social indicator of the quality of life for families. The analysis examines child maltreatment reports for 58 New York State Counties.

Ensuring the conditions for all people to be healthy, though always the core mission of public health, has evolved in approaches in response to the changing epidemiology and challenges. In the Public Health 3.0 era, multisectorial efforts are essential in addressing not only infectious or noncommunicable diseases but also upstream social determinants of health. In this article, we argue that actionable, geographically granular, and timely intelligence is an essential infrastructure for the protection of our health today. Even though local and state efforts are key, there are substantial federal roles in accelerating data access, connecting existing data systems, providing guidance, incentivizing nonproprietary analytic tools, and coordinating measures that mattermost. [ABSTRACT FROM AUTHOR]

Epidemiology instruction has expanded at the undergraduate level in part because it increases student critical thinking and scientific literacy, promotes students' perception of public health as both practical and relevant, and empowers students as independent, lifelong learners. Why then are more high schools not adopting epidemiology as a course requirement for students? Although prior iterations of high school epidemiology courses are noteworthy for incorporating active and participatory learning, embedding them into existing and continually shifting curricula is challenging and time-consuming, especially for teachers not trained in the field. It also may be argued that currently available epidemiology teaching resources emphasize content rather than thinking skills and therefore do not optimally promote students' personal engagement with, and in-depth understanding of, the mission and goals of public health. I propose a new framework for high school epidemiology that draws from progressive education ideology, including three critical elements: empowerment, authenticity, and transfer. I provide multiple examples to show how this framework has been used across a wide array of settings to hone epidemiology thinking skills in high school students. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of training in epidemiology and public health to the improvement of global public health leadership. The Field Epidemiology Training Programs and Public Health Schools Without Walls established the Training Programs in epidemiology and Public Health Interventions Network (TEPHINET). The programs are increasingly popular as catalysts for strengthening the scientific basis of policymaking through the continuous examination of data available from surveillance systems. The TEPHINET programs will improve surveillance, disease prevention and health promotion programs.

Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM. [ABSTRACT FROM AUTHOR]

The author offers observation on epidemiology and its role in public health and society. He describes the first textbook of epidemiology, "Epidemics and Crowd-Diseases: An Introduction to the Study of Epidemiology," by Major Greenwood. He analyzes the article "Choosing a Future for Epidemiology: I. Eras and Paradigms," by M. Susser and E. Susser. He also examines the article "Traditional Epidemiology, Modern Epidemiology, and Public Health," by N. Pearce.

The article discusses several opinions from clinicians and epidemiologists concerning the relation of psychiatric epidemiology to clinical psychiatry. During the 1949 Milbank Memorial Fund conference on the Epidemiology of Mental Disorders, several practicing psychiatrists questioned the relevance of clinical psychiatry including epidemiologist John Gordon, who emphasized that the study of the clinical case of mental disease is an artificial grouping of many morbid entities. Thomas Francis points that epidemiology is dependent on the accuracy of diagnosis and aims to draw psychiatrists into the epidemiological viewpoint.

Graduate students and postdoctoral fellows—including those at the Harvard School of Public Health (HSPH)— have somewhat limited opportunities outside of traditional coursework to learn holistically about public health. Because this lack of familiarity could be a barrier to fruitful collaboration across disciplines, HSPH postdocs sought to address this challenge. In response, the Public Health 101 Nanocourse was developed to provide an overview of five core areas of public health (biostatistics, environmental health sciences, epidemiology, health policy and management, and social and behavioral sciences) in a two half-day course format. We present our experiences with developing and launching this novel approach to acquainting wider multidisciplinary audiences with the field of public health. [ABSTRACT FROM AUTHOR]

Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure. INSET: Key Disaster Epidemiology Terms. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the extent to which early life conditions and adverse life events impact chewing ability in middle and later adulthood. Methods. Secondary analyses were conducted based on data from waves 2 and 3 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in the years 2006 to 2009 and encompassing information on current chewing ability and the life history of persons aged 50 years or older from 13 European countries. Logistic regression models were estimated with sequential inclusion of explanatory variables representing living conditions in childhood and adverse life events. Results. After controlling for current determinants of chewing ability at age 50 years or older, certain childhood and later life course socioeconomic, behavioral, and cognitive factors became evident as correlates of chewing ability at age 50 years or older. Specifically, childhood financial hardship was identified as an early life predictor of chewing ability at age 50 years or older (odds ratio = 1.58; 95% confidence interval = 1.22, 2.06). Conclusions. Findings suggest a potential enduring impact of early life conditions and adverse life events on oral health in middle and later adulthood and are relevant for public health decision-makers who design strategies for optimal oral health. [ABSTRACT FROM AUTHOR]