History of public health research in Estonia: A review

The University of Tartu (which was founded In 1632) and itsDepartment of Public Health (Hygiene) have been the centre ofpublic health research in Estonia. Environmental factors suchas living conditions, water, soil, air and food have been thetraditional topics. The study on blind people and people sufferingfrom eye diseases among the rural population of Livonia conductedby Professor Himmelstiern in 1856–1859 proved to be thefirst epidemlological study in Russia. Professor Körber,a supporter of a statistical approach in research, founded thelocal school of demographers in 1890s. Professor Khlopin's stayin Tartu (1895–1903) was a very fruitful period. He andhis students paid much attention to communal hygiene. ProfessorRammul, the head of the department in 1920–1940, initiatedand supervised an extensive medicogeographical study of overallEstonia. The Second World War and post-war years caused a standstillin research. A revival occurred in the end of 1950s when ProfessorKask returned to the department. After his death (1968), AssociateProfessor Ulbo and Professor Jannus continued his work. Theirmain study areas were concerned with public health aspects ofthe water supply, nutrition of pre-school children and theirprovision with vitamins, work conditions and health risks ofsome occupations. During resent years the area of research hasenlarged to comprise health risks due to lifestyle factors,health economics and health care management topics. After thewar special medical research institutes were established. Theyhave made a considerable contribution to public health researchin Estonia.     

Epidemiological applications: a case report of a village epidemic of gastroenteritis

This is a case report of an epidemic of gastroenteritis which was investigated and controlled by epidemiological methods only, before laboratory investigations could be done to confirm the original epidemiological conclusions--from contaminated home made ice-cubes. The case and process are reported in order to encourage similar uses of epidemiology by field public health practitioners, especially within the district or primary health care systems and particularly in places where laboratory support are difficult to avail. The case is used also to discuss the equipments and facilities that ought to be part of the support system for every modern field public health practitioner. These should include computers, modern communication facilities and epidemiological support systems, especially senior epidemiologists; as such senior personnel are available to junior colleagues in the other areas of specialist medical practice.     

Personal privacy and public health: potential impacts of privacy legislation on health research in Canada

Despite variation in Canadian privacy laws between provinces and territories, increasing legislative protection of personal privacy has imposed restrictions on health research across the country. The effects of these restrictions on patient recruitment include increased study costs, durations, and decreased participation rates. Low participation rates can jeopardize the validity of research findings and the accuracy of measures of association by introducing non-response, or participation bias. We constructed simulations to assess potential effects of non-response bias on the accuracy of measures of association in a hypothetical case-control study. Small biases that alter the probability of selecting an exposed case can lead to dramatic inflation or attrition of the odds ratio (OR) in case-control studies. ORs are more unstable and subject to error when the true probability of selecting an exposed case is greater, such that strong positive associations are subject to error even at low levels of bias. Well-powered, population-based epidemiological research is a cornerstone of public health. Therefore, when weighing the benefits of protecting personal privacy, the benefits of valid and robust health research must also be considered. Options might include special legislative treatment of health research, or the use of an "opt-out" (vs. the current "opt-in") construct for consent in confidential research.     

From health research to social research: privacy, methods, approaches

Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed.     

Abstinence-only programs as a violation of adolescents' reproductive rights.

For most young women and young men throughout the world, adolescence is a time for the discovery and expression of sexuality. The process of this essential human behavior often occurs without accurate information about normal development, physiological processes, and the potential physical, social, and psychological results of sexual exploration. Much of the insufficient information available to adolescents in the United States and elsewhere is not accidental, but can be directly attributed to U.S. government policies, some of which infringe upon the human and reproductive rights of adolescents. Established U.S. policy that promotes abstinence-only programming through selective funding is a violation of adolescent reproductive rights, both at home and abroad. The authors explore why receiving accurate and appropriate sex education is a basic human right for adolescents, and provide suggestions about effective ways to address violations of this right.     

一起霍乱病例流行病学调查与处理

2005年9月1日,咸宁市中心医院收治一例霍乱疑似患者．该市疾病预防控制中心接到报告后立即派人前往进行了流行病学调查处理,现将调查处理情况报告如下。     

The current privacy environment: implications for third-party research.

A privacy revolution is under way. Public opinion survey data indicate that public concern about information privacy has reached all-time highs in recent years and shows little, if any, sign of abating. Public concern is the result of many factors, including evolving attitudes toward information, distrust of institutions, concerns about technology, and fear of harm, to name a few. Privacy also receives increasing amounts of media attention, often with adverse results for those organizations engaging in the scrutinized information practices. This public concern (and media attention) has prompted considerable legislative and regulatory activity at both the federal and state levels. New health information privacy rules promulgated by the Department of Health and Human Services pursuant to implement the Health Insurance Portability and Accountability Act of 1996, once implemented, for example, will affect large segments of the health care industry. Many types of medical research will be affected, possibly including some third-party research. This article begins with a brief overview, including a definition of privacy and an examination of the role of privacy in the American tradition. The article examines the current privacy environment as reflected through public opinion surveys about privacy, both broadly and in the medical research context specifically. Finally, the article examines recent and pending regulatory activity regarding health information privacy and the prospects for additional legislation or regulation.     

Using research results as a health promotion strategy: a five-year case study in Canada

Researchers in the field of health tend to share the resultsof their studies with colleagues by presenting papers and publishingin professional Journals. This practice is no longer adequateto promote major changes, as the infhiencers or agents of changesuch as senior administrators, elected officials and even thevoting public remain ignorant of the studies and their results.This article presents a case study of an effective, practicalhealth promotion strategy aimed at these agents of change. Itdescribes the planned, systematic dissemination of the resultsof two national surveys of the health knowledge, attitudes andbehaviour of schoolchildren in Canada. As a result, major influencesand changes have been documented in the development of programmes,resources and policies relevant to improved health educationin schools across Canada.     

食品加工违规处罚案例的分析

2005年春节前，接群众举报某农贸市场一个体食品摊贩用化学药品加工鸡爪。卫生监督员立即赶赴该摊贩加工点展开调查。在该加工点现场检查发现双氧水40kg、甲醛500ml、工业用碱1．5kg及2桶共约30kg正浸泡在水状液体中的鸡爪。卫生监督员当即制定了《现场检查笔录》和《询问笔录》，现场采集液泡鸡爪（连同浸泡液）送实验室进行甲醛和双氧水的定性检验，并对其加工现场及案件调查过程录像，将双氧水、甲醛、工业碱及鸡爪等异地保全。     

Learning from experience: privacy and the secondary use of data in health research

Health services research must continually address the question: Under what conditions may data not collected specifically for research, such as primary medical data, be re-used for research without compromising the privacy of the data-subjects? For secondary use of data in research there are basically three options. Option A: Use personal data with consent or other assent from the data-subjects. To make this both fairer and more practical, in many circumstances broader construals of consent, or permission or approval, need to be explored and instituted. Option B: Anonymise the data, then use them. For many studies, this is the most practical and desirable option. The craft of anonymisation, including reversible anonymisation, or key-coding, needs to be developed and more fully supported under law. Option C: Use personal data without explicit consent, under a public interest mandate. Whether and how the data should be anonymised will depend on the situation. Public health mandates and protections deserve to be clarified, strengthened and extended for a variety of surveillance, registration, clinical audit, health services research and other types of investigation. Safeguards are an integral part of the research promise to the public, offer crucial reassurance and should be emphasised. For health services research, databases are core resources, and their stewardship must be cultivated.     

达州市1起布鲁氏菌病的流行病学调查

摘要:目的　调查达州市布鲁氏菌病的传染来源和传播的危险因素,为制定有效的防控措施提供依据。方法　对个案流行病学调查资料、实验室检测结果和患者就诊记录进行描述性流行病学分析。结果　本次布鲁氏菌疫情确诊病例1名,4名密切接触者经实验室检验确诊携带者2名。结论　根据临床症状、实验室结果及流行病学接触史综合判断,这起布病疫情为1起密切接触羊群引起的布病疫情。建议今后加强畜牧检验检疫监管,提高人群防护,达到遏制布病疫情上升的目的。     

Individual privacy versus public good: protecting confidentiality in health research

Health and medical data are increasingly being generated, collected, and stored in electronic form in healthcare facilities and administrative agencies. Such data hold a wealth of information vital to effective health policy development and evaluation, as well as to enhanced clinical care through evidence‐based practice and safety and quality monitoring. These initiatives are aimed at improving individuals' health and well‐being. Nevertheless, analyses of health data archives must be conducted in such a way that individuals' privacy is not compromised. One important aspect of protecting individuals' privacy is protecting the confidentiality of their data. It is the purpose of this paper to provide a review of a number of approaches to reducing disclosure risk when making data available for research, and to present a taxonomy for such approaches. Some of these methods are widely used, whereas others are still in development. It is important to have a range of methods available because there is also a range of data‐use scenarios, and it is important to be able to choose between methods suited to differing scenarios. In practice, it is necessary to find a balance between allowing the use of health and medical data for research and protecting confidentiality. This balance is often presented as a trade‐off between disclosure risk and data utility, because methods that reduce disclosure risk, in general, also reduce data utility. Copyright © 2015 John Wiley & Sons, Ltd.     

一起水型感染性腹泻的流行病学调查

2006年8月31至9月6日,孝昌县卫店镇某村饶家岗发生一起不明原因腹泻。9月5日17∶00接到疫情报告后,孝昌县疾病预防控制中心立即组织专业人员赶赴现场,进行流行病学调查处理。从现场流行病学、病原学、临床学调查结果表明,该次腹泻病是1起水源污染致细菌性腹泻。现将调查结果分析如下。1流行病学特征1.1基本情况该自然村属丘陵地区,有36户,总人口147人,中青年人多在县城区务工,早出晚归。全村有80人共用1座国家饮水工程项目支助建造的水塔水,其余67人饮用自备小水井水。该水塔中的水取自村前水塘,无过滤及消毒设施,水塘的水质较差,有臭味。村…     

一起副溶血性弧菌食物中毒的流行病学调查

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Combining case study research and systems theory as a heuristic model

The combined use of case study and systems theory is not often seen in the literature. The use of both approaches enables the specifics of the case to consider the influence of broader systems and external environments, offering in-depth exploration as well as comparative analysis between cases in the context of the system. Health care has obvious systems operating that may have developed from organizational hierarchies, funding mechanisms, or traditional service delivery of health care. Systems theory is ideally suited to examine health care and health promotion sites, such as hospitals or universities. Sites can use the principles of systems theory to explore innovation, change, and complexity of service delivery in the context of a case study approach. This article discusses how the combination of the two can act as a heuristic model, offering its application to emergency department physiotherapy as an example, to further bolster the evidence base for using such a methodology.     

Nutrition-related health indicators and their major determinants in the new member states: case of Estonia

The process of transition towards market economy has had a great impact on population health in several countries of the former Soviet Union, including the Baltic countries. This paper gives an overview on existing health indicators and trend data for the republic of Estonia during the years of economic and political transition and compares them with the respective European average. By using this approach, the main health-related problems are outlined that cause concern from a public-health perspective.     

Communicating clinical research to reduce cancer risk through diet: Walnuts as a case example

Inflammation is one mechanism through which cancer is initiated and progresses, and is implicated in the etiology of other conditions that affect cancer risk and prognosis, such as type 2 diabetes, cardiovascular disease, and visceral obesity. Emerging human evidence, primarily epidemiological, suggests that walnuts impact risk of these chronic diseases via inflammation. The published literature documents associations between walnut consumption and reduced risk of cancer, and mortality from cancer, diabetes, and cardiovascular disease, particularly within the context of the Mediterranean Diet. While encouraging, follow-up in human intervention trials is needed to better elucidate any potential cancer prevention effect of walnuts, per se. In humans, the far-reaching positive effects of a plant-based diet that includes walnuts may be the most critical message for the public. Indeed, appropriate translation of nutrition research is essential for facilitating healthful consumer dietary behavior. This paper will explore the translation and application of human evidence regarding connections with cancer and biomarkers of inflammation to the development of dietary guidance for the public and individualized dietary advice. Strategies for encouraging dietary patterns that may reduce cancer risk will be explored.