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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.  相似文献   

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The present review is aimed to introduce an new occupational lung disease, Indium Lung.  相似文献   

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The changing epidemiology of Staphylococcus aureus?   总被引:24,自引:0,他引:24  
Strains of methicillin-resistant Staphylococcus aureus (MRSA), which had been largely confined to hospitals and long-term care facilities, are emerging in the community. The changing epidemiology of MRSA bears striking similarity to the emergence of penicillinase-mediated resistance in S. aureus decades ago. Even though the origin (hospital or the community) of the emerging MRSA strains is not known, the prevalence of these strains in the community seems likely to increase substantially.  相似文献   

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Choosing a future for epidemiology: I. Eras and paradigms.   总被引:29,自引:13,他引:16       下载免费PDF全文
To inform choices about the future of epidemiology, the present condition of epidemiology is examined, in terms of its evolution through three eras, each demarcated by its own paradigm: (1) the era of sanitary statistics with its paradigm, miasma; (2) the era of infectious disease epidemiology with its paradigm, the germ theory; and (3) the era of chronic disease epidemiology with its paradigm, the black box. The historical context in which these eras arose is briefly described. In each era, the public health was at the center of the concerns of the founders and early protagonists of the prevailing paradigm. Around this intellectual development we weave a further theme. We argue that in the present era, the public health has become less central a concern. At the same time, in epidemiology today the dominant black box paradigm is of declining utility and is likely soon to be superseded.  相似文献   

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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.  相似文献   

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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-epidemiology 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.  相似文献   

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Perspectives of clinical epidemiology in Germany   总被引:1,自引:0,他引:1  
The aim of this article is to discuss the perspective of clinical epidemiology in Germany. The following statements are discussed: (1) There is some confusion about the definition of clinical epidemiology. (2) There is a latent and growing need for clinical epidemiology in Germany. (3) Clinical epidemiology is an interdisciplinary field and not simply clinical medicine, epidemiology, biometry, or medical informatics. (4) We must continue with the education of clinicians and nonclinical methodologists in clinical epidemiology to develop the field of clinical epidemiology in Germany, Biometry, medical informatics, and epidemiology will play an essential role for this purpose. (5) The German scientific community urgently needs clinicians and scientists with experience in methodological research to specialize in the methods of clinical epidemiology. (6) The starting point for the development of clinical epidemiology in Germany, clear deficits in the past notwithstanding, is promising. However, we will only be able to develop the field if the egoism of the different disciplines can be tamed.  相似文献   

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This essay explores an alternative paradigm for epidemiology, one which is explicitly informed by a feminist perspective. We intend to expand upon recent critiques and debates within the emergent fields of "critical", "popular", and "alternative" epidemiology to examine how epidemiology's conceptual models--which are meant to contribute to the prevention of social inequalities in health, but may instead reinforce social hierarchies based on gender, race, and class--constrain our understanding of health and disease. Specifically, we examine persistent antifeminist biases in contemporary epidemiological research on women's health. Issues highlighted include: problem definition and knowledge production in women's health: biological essentialization of women as reproducers; and decontextualization and depoliticization of women's health risks. As part of this critique, we include suggestions for an emancipatory epidemiology that incorporates an alternative feminist framework.  相似文献   

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Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field.  相似文献   

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Social epidemiology is a branch of epidemiology that focuses particularly on the effects of social-structural factors on states of health. Social epidemiology assumes that the distribution of advantages and disadvantages in a society reflects the distribution of health and disease. It proposes to identify societal characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms. The central and initial question of social epidemiology to be answered is what effect do social factors have on individual and population health. However, the new focus on this theme using current epidemiological methods is a relatively recent phenomenon. There are several significant concepts in the field of social epidemiology: 1) the bio-psychosocial paradigm, 2) the population perspective, 3) use of new statistical approaches such as multilevel analysis, and 4) significance of theory. The relationship between social class and health has been a major research field since the beginning of public health history. Many studies have identified the disparities in health among social classes and developed several theories, such as social selection theory and socio-biological translation theory. However, despite the long history of this research field, the effect of social class on health is not yet fully understood. Income distribution and health is a relatively new field within social epidemiology. Three possible mechanisms for the consequences of income distribution on health are 1) disinvestment of human capital, 2) disinvestment of social capital, and 3) psychological process. Refining theories of income distribution is a major challenge in research on income distribution.  相似文献   

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Although the predominant paradigm of epidemiological investigation continues to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epidemiological models. In this paper we illustrate the need for a more comprehensive epidemiological approach towards understanding the risks for diabetes, by exploring the lived experiences of diabetes and lay meanings of risk among Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victoria over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a life out of balance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding diabetes that is derived from the narratives of Melbourne Aborigines, consists of three levels of connectedness important in determining an individual's susceptibility not only to diabetes but to all disease--(1) family, (2) community and (3) society. This structure of interactive systems at successive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidemiology is that it has the capacity to discover previously unknown components of a system at several different levels, and to build models to explain how these components interact. This framework, developed using an ethno-epidemiological approach, has application in other indigenous populations who have been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challenges presented by rapid global socio-cultural and environmental change that are impacting negatively on population health.  相似文献   

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The innovation of epidemiology plays a crucial role in the development of the health sciences. The authors emphasize the importance of epistemological analysis related to scientific and technical production. They focus on the theoretical and methodological contributions of the principal Latin American groups in the field of epidemiology, stating their main accomplishments, issues and potentials. When reviewing those conceptual and practical innovations, the authors analyse the effects of broader historical conditions on scientific work. To them, Latin American contemporary innovative epidemiological research and production have developed clearly differentiated principles, methods and technical projections which have led to a movement of critical or 'social' epidemiology. The functionalist approach of conventional epidemiology, characterized by an empiricist viewpoint, is being overcome by a more rigorous and analytical approach. This new epidemiological approach, in which the authors as members of CEAS (Health Research and Advisory Center) are working, has selectively incorporated some of the technical instruments of conventional epidemiology, subordinating them to a different theoretical and logical paradigm. The new framework of this group explains the need to consider the people's objective situation and necessities, when constructing scientific interpretations and planning technical action. In order to accomplish this goal, epidemiological reasoning has to reflect the unity of external epidemiological facts and associations, the so-called phenomenological aspect of health, with the underlying determinants and conditioning processes or internal relations, which are the essence of the health-disease production and distribution process. Epidemiological analysis is considered not only as a problem of empirical observation but as a process of theoretical construction, in which there is a dynamic fusion of deductive and inductive reasoning.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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This statement summarizes the key points of discussion among a group of nutritional epidemiologists who met in Washington, DC, for 2 d in October of 1997 to reflect on the role of nutritional epidemiology in the development of dietary recommendations for the public. Although imprecision in the measurement of diet places limits on nutritional epidemiology, no other field of nutritional science can provide direct information on relations between nutrition and health in free-living human populations. Among the nutritional sciences, therefore, epidemiology was regarded as being critically important. Nutritional epidemiology can be improved in the future by the development of more precise measures of long-term dietary exposures, both by improved methods of self-reporting of diet and by the development of more useful biomarkers of long-term nutritional status. There is a need as well to reconsider the applicability of causal criteria as applied to nutritional epidemiology, because many of the important associations between dietary behaviors and chronic diseases cannot necessarily be expected to be either strong or to manifest linear dose-response relations. In the future, scientific evidence from the rapidly growing field of nutritional epidemiology will likely play an increasingly important role in developing nutrition policy and advice for the public.  相似文献   

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