Advances in spatial epidemiology and geographic information systems

The field of spatial epidemiology has evolved rapidly in the past 2 decades. This study serves as a brief introduction to spatial epidemiology and the use of geographic information systems in applied research in epidemiology. We highlight technical developments and highlight opportunities to apply spatial analytic methods in epidemiologic research, focusing on methodologies involving geocoding, distance estimation, residential mobility, record linkage and data integration, spatial and spatio-temporal clustering, small area estimation, and Bayesian applications to disease mapping. The articles included in this issue incorporate many of these methods into their study designs and analytical frameworks. It is our hope that these studies will spur further development and utilization of spatial analysis and geographic information systems in epidemiologic research.     

Advanced glossary on genetic epidemiology

This is the last of a series of glossaries on terms used in genetic epidemiology published by the journal. This glossary covers the most advanced genetic terms, most of which are related to new study designs and laboratory techniques. It provides the reader with examples and references of real studies that applied each of the study designs defined in the glossary. This should help the reader grasp the subtleties of each of these strategies and will allow the reader to research the literature according to their interest.     

Intervention research: Science,skills, and strategies

Despite a rich history of etiological research, the field of occupational safety and health does not a have a rigorous history of research on what works and does not work to prevent and control occupational diseases and injuries. National and global transformations of economies and workplaces with enhanced competitiveness require more attention to options for interventions. A three-pronged approach to building a body of knowledge on intervention research in occupational health and safety is identified in this paper. The approach focuses on the science, skills, and strategies that can be useful in intervention research. Scientifically, researches can draw on constructs and techniques from epidemiology, evaluation practice, and clinical trials. Experimental and nonexperimental approaches have value for occupational studies. The skills needed represent a range of disciplines beyond those traditional of health and safety; social scientists, economists, and organizational theorists often need to be part of research teams. Strategic approaches involve more labor-management partnerships, prospective study designs, and the use of intermediate and surrogate indicators. The strategic challenge will be to conduct intervention research against a backdrop of overriding political and economic pressures. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Teaching clinically experienced physicians communication skills. A review of evaluation studies

CONTEXT: Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. OBJECTIVE: This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. METHODS: CD-ROM searches were performed on MedLine and Psychlit, with a focus on effect-studies dating from 1985. RESULTS: Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate designs report the fewest positive training effects. CONCLUSION: Several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.     

Population–based family study designs: An interdisciplinary research framework for genetic epidemiology

Most complex traits such as cancer and coronary heart diseases are attributed either to heritable factors or to environmental factors or to both. Dissecting the genetic and environmental etiology of complex traits thus requires an interdisciplinary research strategy. Genetic studies generally involve families and investigate familial aggregations of traits, segregation of major disease genes, and locations of disease genes on the human genome, the latter of which can be identified via linkage analysis. Epidemiologic studies often use population-based case-control studies to establish the role of specific environmental factors. Integrating both objectives, genetic epidemiology is to assess the associations of environmental factors with disease status, to quantify the aggregation of cases within families, to characterize putative disease genes via segregation analysis, and to localize disease genes via linkage analysis with genetic markers. To accomplish these objectives through designed studies, we propose a class of population-based family study designs, which are formed by choosing among sampling designs at three stages. The objectives of sampling at these three stages are 1) combined aggregation and association analysis, 2) combined segregation, aggregation, and association analysis, and 3) combined linkage, segregation, aggregation, and association analysis. These designs form an interdisciplinary research framework for genetic epidemiology. Our preliminary exploration of this framework and related analytic methods indicates that population-based family study designs retain the efficiency of linkage analysis for localizing disease genes without losing the property of being population-based, and they will therefore allow an assessment of a joint contribution of genetic and environmental factors to complex traits. Genet. Epidemiol. 14:365–388,1997. © 1997 Wiley-Liss, Inc.     

Is there epidemiology in Russia?

OBJECTIVE: To examine the current state of epidemiology in Russia. DESIGN: The structure of clinical research and statistical methods was used to shed light on the epidemiology in Russia. The frequencies of specific study designs were evaluated using Medline data for 1970-1997. To determine the proportion of advanced design clinical studies the frequency of cohort, prospective, follow up, or longitudinal studies, and controlled trials was evaluated. All diagnosis related studies were found to determine the usage of advanced statistical technique (ROC analysis). The adequacy of Medline information was checked by hand search of journals. All dissertations in epidemiology defended in Russia in 1995 and 1996 were evaluated for their methodology. The curriculum recommended by Ministry of Health to Medical Universities was evaluated. Available literature and library indexing of epidemiological terms examined. MAIN RESULTS: Russian medical research uses less frequently advanced study designs and methods of data analysis. Medical students are taught epidemiology as a science of spread of infectious diseases. There is no department of epidemiology in Russian universities where epidemiology is taught in the modern sense and no epidemiological and biostatistical periodicals available in Russia. CONCLUSION: Epidemiology in Russia remains in an archaic state of science of the spread of infectious diseases and it is detrimental to methodology of medical research in Russia.     

Enteric infections due to Campylobacter, Yersinia, Salmonella, and Shigella

This report reviews the available information on the clinical features, pathogenesis, bacteriology, and epidemiology of Campylobacter jejuni and Yersinia enterocolitica, both of which have recently been recognized as important causes of enteric infection. In the fields of salmonellosis and shigellosis, important new epidemiological and related findings that have implications for the control of these infections are described. Priority research activities in each of these areas are outlined.     

Principles for planning the teaching of evidence-based medicine/clinical epidemiology for MPH and medical students

Medical decision-making requires increasing skills in communication, information retrieval, and formulating and answering focused clinical questions. Medical students need increasing exposure to the principles of evidence-based medicine and methodologic training in epidemiology and biostatistics in order to cope with the explosion of medical information and in order to appraise, interpret, and perform clinical research. This review summarizes the principles applied to teaching these subjects to medical students, as well as to students in Master's programs who will pursue careers in public health or clinical research.     

Social epidemiology: Directions for the future in academic and “shoe-leather” risk analysis

In the past, social epidemiology has been a field of interest to only a few professionals, notably sociologists and a select few epidemiologists. Expansion of the scope of epidemiology beyond infectious diseases and a few chronic diseases has made social epidemiology vitally important in the work of a host of professionals in public health and preventive medicine. These include persons doing risk analysis, persons working in environmental and occupational health, health educators, and persons working in institutions such as labor unions and schools which mediate the effects of risk factors upon population groups. With the expansion of the field, it is becoming apparent that the interrelationships among social risk factors are complex. Some social factors are both predictors of health status and outcome factors. This complexity will require new analytic methods, some of which are outside the present repertoire of most epidemiologists and biostatisticians. This paper examines the changing scope and impact of social epidemiology and suggests directions for the future of teaching and research in the field. If these new directions, guide research and teaching in the field, public health professionals will be able to bring a host of newly acquired skills to their shoe-leather epidemiology. Using those skills will require broad interdisciplinary cooperation in health promotion and disease prevention.John Christian Lane, M.D., Ph.D., M.P.H. is Adjunct Assistant Professor, Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine and Assistant Professor of Preventive and International Medicine, Adjunct Assistant Professor of Pediatrics, Oral Roberts University School of Medicine.     

Teaching epidemiologic methods

Advances in causal inference, study designs, and quantitative methods have led to new challenges for structuring a cohesive epidemiology methods course. This is particularly true for courses aimed at students who are training for a research career. Such students are expected to have a strong understanding of epidemiologic inference and modeling. They should grasp the principles of study design and analysis, and be able to interpret and report results effectively. This commentary discusses ways in which courses on epidemiologic methods can be made more effective, including: (1) a definition of the scope of epidemiologic methods; (2) a framework for defining a curriculum for heterogeneous student populations; (3) the need for computing and practical exercises; and (4) a call for increased attention to epidemiology education.     

Confounding in air pollution epidemiology: the broader context

Recent research appropriately suggests that caution is warranted when interpreting long-term trends of improving air quality and trends in reduced mortality rates as causal because of concerns about confounding. The use of long-term time trends as the primary source of exposure variability, however, has been avoided in most air pollution epidemiology studies. Multiple studies, using different study designs that exploit various temporal and spatial dimensions of exposure variability, have observed reasonably consistent and coherent associations between particulate air pollution and cardiopulmonary health. It's possible that these air pollution studies have experienced "epidemiological bad luck" with multiple confounders that are inadequately controlled for and coincidentally cause spurious correlations that are coherent across the different study designs. To be consistent with the overall epidemiologic results, these confounders must correlate with pollution across various dimensions of time and space and be stronger risk factors for cardiopulmonary disease than for other disease. The more likely explanation of recent air pollution epidemiology is that air pollution, especially fine particulate and related pollution, has measurable effects on cardiopulmonary health.     

Trends in employer postings for epidemiology jobs: an analysis of PublicHealthJobs.net data from 2003 to 2016

PurposeTo analyze public health job posting data to help objectively inform epidemiology faculty and students about skills sought by employers.MethodsRaw data from PublicHealthJobs.net database (January 2003–October 2016) was data-mined and analyzed (n = 25,308 job postings). There were 3985 jobs that were classified with an epidemiology designation, either as the only designation or co-occurring with another designation. Frequencies and percentages were calculated for job type, industry, location, degree requirements, CPH credential, and specialized skills.ResultsThe majority of recent postings (January 2014–October 2016) were for full-time positions (60.8%). The highest proportion of recent job industries was education/academic/research (44.3%), state government (17.5%), and nonprofit/NGO (16.3%). A masters-level degree was listed in 71.4% of postings, frequently co-occurring with other degree levels. Epidemiology as the only job class was listed in 1765 postings (45.3%). Most characteristics of epidemiology job postings did not appreciably change over the time period, but there were some specialized skill differences.ConclusionsThis analysis illustrates how employment sites can be used to identify employer preferences in epidemiology hires. There may be some skills that are beneficial additions to public health curricula or that job-seeking future epidemiologists may wish to enhance during their training.     

Training in survey and research methods within a Master of Public Health program

Sound decision-making and practice in public health, as in other disciplines, is contingent upon information that is properly collected, analyzed, and interpreted. We describe the content and teaching methods of a graduate course in investigative methods in public health taught within the framework of a Master of Public Health (MPH) program. Following the progressive steps of carrying out research, we highlight the main concepts and skills that a student of public health should be exposed to. This includes the formulation of the study purpose and objectives, basic study designs, definition and selection of the study population and study variables, issues related to the actual collection of data in the field including the reliability and validity of the information, and preparing the data for analysis. We describe the teaching methods that are employed including frontal lectures, individual and group-based exercises, and the use of simulated data to develop skills in the critical reading of published literature and data analysis. The integration of the learned concepts and tools into course workshops and dissertation work is also addressed. Together with training in epidemiology, statistics and other quantitative and qualitative methodologies, this course provides a solid basis for MPH graduates to tackle the public health challenges that await them.     

The present position in Brucella phage research: A review of the literature

It is only comparatively recently that efforts to isolate and purify stable Brucella phages have met with success. This success has important implications for the epidemiology and possibly the control of brucellosis, and the author has therefore thought it opportune to summarize and review the present state of research on Brucella phages.     

Ways to strengthen research capacity in developing countries: effectiveness of a research training workshop in Pakistan

BACKGROUND: Developing countries are currently facing the burden of both communicable and non-communicable diseases. Physician-scientists, trained in patient care and research skills, are crucial in performing cutting-edge clinical research in developing countries. A major, unmet challenge has been lack of local expertise and the increasing problem of 'brain drain'. OBJECTIVE: The objective of this study was to present and assess a model of research training for healthcare professionals in Pakistan in order to increase research skills. METHODS: A 9-day research training workshop was offered to healthcare professionals in Pakistan using face-to-face (F2F) and video-teleconferencing (VTC) methods. In total, 38 F2F and 18 VTC participants were included in the workshop, which was conducted by research faculty from the University of Pittsburgh. The study measured short- and long-term effectiveness of research training. The training included courses in basic epidemiology, biostatistics, genetic epidemiology and international health. RESULTS: A significant improvement in post-test scores was seen in both the F2F and VTC groups (P<0.001). In the F2F group, mean scores increased from 11.13 (pre-test) to 15.08 (post-test 1), and in the VTC group, mean scores increased from 10.67 (pre-test) to 13.22 (post-test 1). Two-sample t-tests indicated that these results were statistically significant (P<0.001). Two-way repeated measure analysis of variance in both groups showed significant changes in mean scores over time (P<0.001). CONCLUSION: This model for training physicians in public health by providing in-house research training can be used to strengthen local capacity and reduce increasing problems of 'brain drain'.     

大数据时代的药品安全主动监测:对照选择的挑战与机遇

电子医疗数据已成为大数据时代开展药品安全主动监测的重要资源。基于此确认药品与不良事件是否存在关联，要回归传统的流行病学研究设计，选取恰当的对照进行对比。本文主要阐述不同对照选取的原理、适用情形，介绍、评价并比较各种对照选取的思路与参数，引入对照选择批量化实现的进展性成果，以期为我国利用电子医疗数据开展上市后药品安全性监测提供方法学参考。     

Modern cancer epidemiological research: genetic polymorphisms and environment

Individual cancer susceptibility seems to be related to factors such as changes in oncogenes and tumor suppressor genes expression, and differences in the action of metabolic enzymes and DNA repair regulated by specific genes. Epidemiological studies on genetic polymorphisms of human xenobiotics metabolizing enzymes and cancer have revealed low relative risks. Research considering genetic polymorphisms prevalence jointly with environmental exposures could be relevant for a better understanding of cancer etiology and the mechanisms of carcinogenesis and also for new insights on cancer prognosis. This study reviews the approaches of molecular epidemiology in cancer research, stressing case-control and cohort designs involving genetic polymorphisms, and factors that could introduce bias and confounding in these studies. Similarly to classical epidemiological research, genetic polymorphisms requires considering aspects of precision and accuracy in the study design.     

Weak associations in environmental epidemiology

Several suggestions have been made to enhance study designs to strengthen weak associations. Among these are reduction of non-differential misclassification, and restriction of studies to populations with low underlying risk of disease, due to low exposures to other known determinants of the health effect under investigation. To some extent, these suggestions have been put to use in environmental epidemiology, and in this paper, some prospects and problems associated with these attempts are discussed using examples from our own research.     

Competencies for graduate curricula in health, medical and biomedical informatics: a framework

The rapid emergence of programmes in health informatics, medical informatics and biomedical informatics implies a need for core curricula in these diverse disciplines. This study investigated the recommended competencies for health and medical informatics, aiming to develop a framework for use in curricular development. Current health and medical programmes around the world were analysed to assess how these competencies are reflected in current curricula and to identify new competencies. Several preferred skills and knowledge sets were identified and 40 programs were analysed. Diverse curricular designs were found in these programmes. Competencies such as research skills, knowledge in health information systems and methods for informatics/computer science were the most frequently taught. Knowledge or skills in interpersonal communications, social impact of IT on health, and data mining may represent important skills for future informaticians. The suggested framework and the data analysed may be important for developing a competency-based modular curriculum.