Issues in conducting epidemiologic research among elders: lessons from the MOBILIZE Boston Study

Conducting research in elderly populations is important, but challenging. In this paper, the authors describe specific challenges that have arisen and solutions that have been used in carrying out The MOBILIZE Boston Study, a community-based, prospective cohort study in Massachusetts focusing on falls among 765 participants aged 70 years or older enrolled during 2005-2007. To recruit older individuals, face-to-face interactions are more effective than less personal approaches. Use of a board of community leaders facilitated community acceptance of the research. Establishing eligibility for potential participants required several interactions, so resources must be anticipated in advance. Assuring a safe and warm environment for elderly participants and offering a positive experience are a vital priority. Adequate funding, planning, and monitoring are required to provide transportation and a fully accessible environment in which to conduct study procedures as well as to select personnel highly skilled in interacting with elders. It is hoped that this paper will encourage and inform future epidemiologic research in this important segment of the population.     

Reproducible epidemiologic research

The replication of important findings by multiple independent investigators is fundamental to the accumulation of scientific evidence. Researchers in the biologic and physical sciences expect results to be replicated by independent data, analytical methods, laboratories, and instruments. Epidemiologic studies are commonly used to quantify small health effects of important, but subtle, risk factors, and replication is of critical importance where results can inform substantial policy decisions. However, because of the time, expense, and opportunism of many current epidemiologic studies, it is often impossible to fully replicate their findings. An attainable minimum standard is "reproducibility," which calls for data sets and software to be made available for verifying published findings and conducting alternative analyses. The authors outline a standard for reproducibility and evaluate the reproducibility of current epidemiologic research. They also propose methods for reproducible research and implement them by use of a case study in air pollution and health.     

Biological markers in epidemiologic research

This paper identifies some of the issues relevant to the use of biological markers in epidemiologic research. Foremost among these are clarity of definitions and marker classification. Illustrations of markers in the categories of internal dose, biological effective dose, biological response, disease, and susceptibility are presented with a theoretical model for the interrelationship among these. Issues faced by epidemiologists in selecting markers for specific studies concern exposure complexity, marker specificity, marker persistence, time to appearance, and the use of target vs. surrogate biological media. Feasibility issues concern sample collection, transport, storage, and characteristics of the laboratory assay. The rationale for biological markers in epidemiologic research is strong in that markers have the potential for (1.) improving the accuracy of our "exposure variables," (2.) permitting the identification of preclinical disease and providing opportunities for prevention, (3.) allowing for more homogeneous and etiologically relevant classifications of disease, and (4.) enhancing our understanding of the biological processes leading to disease occurrence, thereby strengthening the interpretation of epidemiologic data and the theoretical framework from which we formulate research questions.     

Georeferenced data in epidemiologic research

This paper reviews some conceptual and practical issues regarding the application of georeferenced data in epidemiologic research. Starting with the disease mapping tradition of geographical medicine, topics such as types of georeferenced data, implications for data analysis, spatial autocorrelation and main analytical approaches are heuristically discussed, relying on examples from the epidemiologic literature, most of them concerning mapping disease distribution, detection of disease spatial clustering, evaluation of exposure in environmental health investigation and ecological correlation studies. As for concluding remarks, special topics that deserve further development, including the misuses of the concept of space in epidemiologic research, issues related to data quality and confidentiality, the role of epidemiologic designs for spatial research, sensitivity analysis and spatiotemporal modeling, are presented.     

The emerging importance of genetics in epidemiologic research II. Issues in study design and gene mapping

PURPOSE: To provide a synthesis of current approaches to the discovery of genes associated with complex human diseases by examining the joint potential of traditional epidemiologic methods and current molecular techniques for gene discovery. METHODS: A discussion of optimal approaches for defining complex disease phenotypes in genetic epidemiology, ascertainment strategies for estimating genetic influences on disease risk, genomic approaches for localizing complex-disease-susceptibility genes, and the potential synergistic effects of integrating genetic and traditional epidemiologic expertise is provided in the second part of a three-part series on the importance of genetics in epidemiologic research. RESULTS: The ability to quantify genetic influences on disease risk appears highly dependent on the measurement of specific risk factor traits, ascertainment strategies for recruiting study subjects, and a variety of genomic approaches that are rapidly facilitating our ability to identify genes influencing inherited human diseases and to quantify genetic influences on disease risk. CONCLUSIONS: Integrating population-based methods of assessing disease risk with human genetics and genome technology is critical for identifying genetic polymorphisms that influence risk of disease and for defining genetic effects on complex disease etiology.     

产科病房健康教育实施体会

健康教育是整体护理中的重要内容，做好这项工作对促进产后健康恢复，预防疾病，改善护患关系具有积极作用。我院在实施整体护理过程中，对住院分娩的孕产妇实行健康教育，收到较好的效果，现将具体做法与体会报告如下。１制定健康教育计划 为了保证教育工作切实落实，提高教育质量，我们将教育项目和内容制定成标准护理计划。见附表。２教育方法２．１小组式教育：病房每周一、三、五下午召集能下床的产妇及产妇家属集中到宣教室，由病房护士利用播放录像带和拟好的健康教育知识进行讲课，课后发放试卷给每位产妇及家属予以效果评估。２．…     

以农村学校为基地进行农村健康教育的做法与体会

20世纪 70年代以来 ,许多发展中国家都采取了以农村学校为“中心力量”推动农村社区经济、文化等方面发展的“中心战术”。 80年代后 ,我国政府也要求实施“农科教统筹”战略 ,强调农村教育为当地建设服务的教育方针。当前 ,随着农村经济的发展与农民生活水平的提高 ,我国农村居民对卫生保健知识的需求也在不断增长。而农村地区由于缺乏健康教育力量与资源 ,广大农民的这一需求不能及时、有效地得到满足。为此 ,我们进行了以农村学校为基地、以学生为中介进行农民健康教育工作的尝试。1　以农村学校为基地进行农村健康教育的做法1. 1　在卫…     

实施健康教育中值得重视的几个问题

随着国家改革的不断深入,人民生活水平,卫生水平和科学文化水平的提高,人口结构疾病的构成,医学模式,健康概念,卫 生保健需求的变化,健康教育在各级医院已深入开展,护士已从被动的向病人做好解释工作,转向主动向病人做好健康教育,护患之间建立了相互信任与合作关系,普遍受到社会好评。 然而,在实施健康教育中还存在一些问题,影响制约着健康教育的深入,至此,笔者总结了1年来健康教育实施经过,提出以下问题,与同仁们共同探讨。     

新时期实施农村初级卫生保健的思考

中国共产党十七大报告提出了“确保到2020年全面建成小康社会”的奋斗总目标，同时提出“人人享有基本医疗卫生服务”的卫生工作新目标，这一目标实质就是要实现人人享有卫生保健。安徽省是农业大省，近70％的人口在农村，要实现这一目标，重点在农村要加快发展初级卫生保健。2007年11月，卫生部与世界卫生组织在北京召开中国农村初级卫生保健发展国际研讨会，卫生部代表中国政府发出“北京倡议”，把健康放在首位，以行动应对挑战。本人从安徽实际出发，就新时期发展初级卫生保健，实现人人享有卫生保健战略目标，浅谈一点认识，与大家共同探讨。