Feinstein and study design

Dr. Alvan Feinstein saw himself as the father of “clinical epidemiology” in the modern meaning of this term, of this “new intellectual domain of modern medical science.” In this role, he saw himself as drawing from his “clinical sophistication” and from “the rigorous scientific demands” to which “clinicians are accustomed,” while “public health” epidemiologists “often use a more arbitrary set of standards.” His conception of the scope of clinical epidemiology was remarkably Catholic and the same was the case in respect to cause-effect research in it. In the latter, he was firmly committed to the randomized-trial paradigm, including in his teachings on study design in etiologic research. Characteristically original, many of Dr. Feinstein's study-design ideas remain controversial.     

医院临床流行病学机构服务需求调查

目的 了解某医院中各类人员对临床流行病学技术服务的需求和临床流行病机构提供技术服务的能力。方法采用工作总结,档案资料整理、工作记录资料统计分析等方法收集临床研究技术服务信息,分析总结该医院2008年各类人员对临床流行病学技术服务的需求和临床流行病学机构提供技术服务的现状。结果该服务机构在编职工3人,研究生3人。2008年共完成咨询272人次,咨询者中医生最多（147人次,54．0％）研究生次之（90人次,33．1％）,其他人员咨询较少（35人次,12．9％）。咨询内容包括统计方法（106人次,39．0％）,课题设计（96人次,35．3％）,论文撰写（36人次,13．2％）和其他内容（24人次,8．8％）。具有高级技术职称的咨询服务者提供研究设计技术服务（71／139,51．1％）多于助理研究员（22／151,19．1％）和研究生（3／18,16．7％）,差异有统计学意义（P〈0．01）。助理研究员（66／151,57．4％）与研究生（10／18,55．6％）提供统计方法技术服务的比例高于高级技术职称的咨询服务者（30／139,21．6％）,差异有统计学意义（P〈0．01）。结论医院中的医生和研究生需要临床研究各阶段的临床流行病学技术服务。在医院设立临床流行病学机构有必要性和可行性。技术服务不收费的“暗补”政策有利于提高医院内临床流行病学技术服务的可及性和服务对象的满意程度。     

空间流行病学与分子流行病学结合分析在结核病研究中的应用进展

空间流行病学和分子流行病学方法在结核病研究中已广泛使用,但二者均具有各自的局限性,而二者的结合则为结核病研究提供了新的思路和方法。文中所有引用文章均来自中国知网、万方数据知识服务平台、PubMed和Web of Science四个数据库。空间流行病学和分子流行病结合的方法在国外的结核病研究中已广泛使用,在确定区域地方性的流行菌株基因型、结核病传播方式及危险因素分析、耐药结核病、结核病防控措施等方面均具有重要意义,值得国内该领域的研究学者和疾病防控工作者进行借鉴和学习。     

“Omics” research,monetization of intellectual property and fragmentation of knowledge: can clinical epidemiology strengthen integrative research?

An analysis of the contributions of “omics technologies” to human health and clinical care needs to address the relationships between internal issues (e.g., methodological shortcomings in “omics” research and clinical biology) and external influences. Among the latter, monetization of intellectual property (IP) appears to be a powerful force favoring methodological limitations and an excessive reductionism and fragmentation of biological knowledge. Following economic successes in other industries (semiconductors, software, and “dot-coms”), monetization of IP tries to market small fragments of big research “puzzles”; the strategy seems partly responsible for the biotech industry having underperformed methodological, clinical, and economic expectations. Hence, internal, purely scientific reasons can hardly explain failures in the application of long-proven principles of clinical epidemiology to the discovery and validation of diagnostic and prognostic tests. Nevertheless, this paper also sketches methodological proposals that may help integrate microbiological, clinical, and environmental evidence. Clinical and epidemiological reasoning, knowledge, and methods need to be applied on a much wider scale than until now by “omics” studies that aim at making inferences relevant for human beings. Rather than adopting the values and norms of “science business,” “omics research” could apply a diversity of clinicoepidemiological models favoring integrative research.     

Time-weighted averages, peaks, and other indices of exposure in occupational epidemiology.

Dose surrogates commonly used in occupational epidemiology are exposure intensity, exposure duration, and cumulative exposure. The appropriateness of any of these measures as dose indicators depends on the nature of the induction process for the disease under consideration. Peak exposure intensity is often associated with acute health outcomes, whereas cumulative exposure is generally more relevant for diseases with long induction times, i.e., "chronic" diseases. However, there may be situations where peak exposure is etiologically relevant in chronic disease induction, such as might occur with nonlinear rates of damage during brief intervals of very high exposure. An approach is described for evaluating the effect of peak exposures in which peaks may be defined on a relative basis for each worker, or with respect to an absolute value, such as the permissible occupational exposure limit. The analytic strategy is illustrated with data from a case-control study of silicosis in relation to quantitative estimates of silica exposure. In this example, relative peak exposures and average non-peak exposures appear to be better predictors of silicosis risk than cumulative exposure.     

Molecular epidemiology,phylogeny and evolution of dermatophytes

Dermatophytes are fungi that invade and propagate in the keratinized skin of mammals, including humans, often causing contagious infections. The species of medical concern belong to the genera Microsporum, Trichophyton, Epidermophyton (in their anamorphic state) and Arthroderma (in their telomorphic state), which were traditionally identified based on their morphology and biochemical characters. Nonetheless, limitations linked to the differentiation of closely related agents at species and strains level have been recently overcome by molecular studies. Indeed, an accurate identification of dermatophytes is pivotal for the establishment of effective control and prevention programs as well as for determining the most appropriate and effective antifungal therapies to be applied. This article reviews the DNA techniques and the molecular markers used to identify and to characterize dermatophyte species, as well as aspects of their phylogeny and evolution. The applications of typing molecular strain to both basic and applied research (e.g., taxonomy, ecology, typing of infection, antifungal susceptibility) have also been discussed.     

Nosocomial aspergillosis: Environmental microbiology,hospital epidemiology,diagnosis and treatment

Epidemiology, diagnosis and treatment of nosocomial aspergillosis. Appropriate environmental control measures are important in preventing or arresting an outbreak of nosocomial aspergillosis. These include selective environmental microbiological surveillance and floor to ceiling barriers during construction or renovation. These is particularly important for the bone marrow transplant units and units with persistently granulocytopenic patients. We have summarized the point source and cited or formulated the environmental correction measures relating to 25 outbreaks of nosocomial aspergillosis involving a total of more than 100 patients. The most frequent settings of nosocomial invasive aspergillosis occurred in granulocytopenic patients following respiratory infection from an airborne source, associated with hospital construction or contaminated ventilation systems.     

丹东市人感染新型布尼亚病毒病例流行病学分析

目的分析人感染新型布尼亚病毒病的临床特点和流行病学特征,为制定预防控制措施提供依据。方法采用统一的诊断标准和流行病学个案调查表对病例进行调查。结果2010—2012年丹东市报告人感染新型布尼亚病毒病确诊病例52例,年平均发病率2.16/10万,病死率为7.69％。临床表现主要为发热(100%)、全身酸痛(82.7%)、头痛(75.0%)、乏力(71.2％)、恶心(76.9%);血常规检查有血小板计数(98.1%)和白细胞计数减少(92.3％);71.2%病例开始表现为感冒症状;病例多来自山区和丘陵地区农村,以男性、中老年、农民为主,发病时间6—10月;48.1%病例发病前有明确的蜱叮咬史,1例二代病例与首例病例为兄妹关系,有血液接触史。结论人感染新型布尼亚病毒病例发病初期临床症状多为感冒且症状不典型,发病有明显地域特征,散发病例多见,动物及媒介蜱在新型布尼亚病毒传染给人的过程中起着重要作用,但不排除人与人传播可能。     

社会流行病学及其应用

流行病学是"研究人群中疾病与健康状况的分布及其影响因素,并研究防制疾病及促进健康策略和措施的科学."[1].流行病学的研究内容包括疾病/健康结局及其影响因素,目的 是探索或明确导致疾病或促进健康的因素.根据研究侧重点不同,流行病学派生出很多分支.社会流行病学是一门新兴的侧重于研究"原因"的分支学科.本研究拟从历史、概念、理论、方法等方面简要介绍社会流行病学.     

Social epidemiology: Definition,history, and research examples

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.     

Genetic epidemiology of childhood brain tumors.

The study goal was to determine the genetic (heritable) contribution to childhood brain tumors (CBT) which cause nearly one quarter of all childhood cancer deaths. Their etiology remains unknown, but previous studies have suggested a proportion of CBT may be heritable. In this study we collected family histories of 243 confirmed CBT patients referred to The University of Texas M. D. Anderson Cancer Center between the years 1944 and 1983, diagnosed before age 15, and residents of the United States or Canada. Family histories were obtained for all the probands' first degree relatives (parents, siblings, and offspring) and extended to include selected second degree relatives (aunts, uncles, grandparents) using sequential sampling. To determine if these CBT families exhibited excess cancer, we compared their cancer experience to age-, race-, sex-, and calendar-year specific rates from the Connecticut Tumor Registry. No cancer excess was observed among 1,099 first and second degree relatives [39 cancers observed (O) and 44 expected (E) for a standardized incidence ratio (SIR) of 0.88]. For colon cancer, although small numbers, five cases were observed among the probands' first degree relatives with 1.6 expected, for a significant SIR of 3.10. Segregation analysis demonstrated that chance alone could not account for the observed cancer distribution with a multifactorial model providing the best overall explanation of the data. Overall, heredity played a role in the etiology of CBT in 4% of the study families: four (1.7%) due to known hereditary syndromes (nevoid basal cell carcinoma syndrome and von Recklinghausens neurofibromatosis--NF-1), four (1.7%) with multifactorial inheritance, and two additional families with cancers aggregating similar to the clinical criteria described for the Li-Fraumeni cancer family syndrome.     

云南3个边境州10个特有少数民族10岁以下儿童贫血流行病学调查研究

[目的]了解儿童贫血的分布规律和原因,寻找一种适应农村使用的简单、可行、可靠的鉴别诊断地中海盆血（thalassemia,简称地贫）和缺铁性贫血（iron deficient anemia,IDA）的方法,为该疾病的防治提供依据。[方法]采用整群分层随机球群的方法对云南省3个边境州的10个特有的少数民族10岁以下儿童进行流行病学调查,并进行血常规和血红蛋白电泳检测。[结果]云南省3个边境州10个特有少数民族10岁以下儿童贫血总体患病率为16．7％,其中德宏州为21．9％,西双版纳州为19．0％,怒江州为5．7％。民族方面：景颇族居首,占25．6％,其次为傣族23．3％-23．6％;多因素分析表明,县（市）和β-地贫是贫血的危险因素。MCV／RBC商值〈15以及MCV1和（或）RDWt鉴别诊断地贫和IDA以前者为优。[结论]地中海贫血发生率高的地区和民族其贫血发生率亦高,因此鉴别诊断地贫和IDA有非常重要的意义,MCV／RBC商值〈15是有效筛查地贫和IDA的可靠的指标。     

分子流行病学进展——机遇和挑战

分子流行病学是流行病学的分支,是流行病学和分子生物学的交叉学科。分子流行病学主要通过对生物标志的研究,在分子水平阐明疾病的分布、发生、发展规律及其影响因素。随着人类基因组学、精准医学、大数据等领域的快速发展,给分子流行病学提供了新的发展机遇和挑战。     

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables.

Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35–65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country.

For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the “Developed” World.

The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention.