Epidemiologists

流行病学家
  • 文章类型: Editorial
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  • 文章类型: Journal Article
    当前乌克兰和加沙的人道主义危机,伴随着长期的危机,以及与气候有关的灾害,暴露了人道主义系统的局限性。在这些背景下,人道主义组织经常与收集斗争,分析,口译,利用健康数据,由于具有挑战性的经营环境和资金限制。正是在这些背景下,现场流行病学起着至关重要的作用,但往往被忽视的作用。现场流行病学家面临着独特的挑战,包括快速变化的条件,质量差的数据,和偏见。尽管有这些困难,准确的流行病学数据对于需求评估至关重要,干预指导,和宣传。常规方法通常需要适应危机环境,在测量方面仍然存在差距。本文讨论了流行病学在这种情况下的作用,注意到缺乏训练有素的“人道主义流行病学家”和专门培训是主要问题。为了满足这些需求,意大利流行病学协会于2024年初组织了一个课程,以提高在人道主义危机中工作的工作人员的流行病学技能,并向传统流行病学家介绍危机特定的挑战。该课程涵盖了现场流行病学的关键概念和方法,强调使用二级健康数据。它的积极接待强调了对这种专业培训的需求。改善人道主义危机中的公共卫生信息收集和使用是道德和实践上的必要条件。的确,投资于现场流行病学并认识到其重要性可以加强人道主义干预,更好地为弱势群体服务。
    The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained \'humanitarian epidemiologists\' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.
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  • 文章类型: Historical Article
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    M-估计是一种统计程序,对某些彗星流行病学分析特别有利,包括估计调整后的边际风险对比(即逆概率加权和g计算)和数据融合的方法。在这样的设置中,最大似然方差估计是不一致的。因此,流行病学家经常使用bootstrap来估计方差。相比之下,M估计允许在这些设置中一致的方差估计,而不需要引导的计算复杂性。在本文中,我们介绍了M估计,并提供了四个说明性的实现示例以及多种语言的软件代码。M估计是一种灵活且计算效率高的估计程序,是流行病学家工具箱的有力补充。
    M-estimation is a statistical procedure that is particularly advantageous for some comon epidemiological analyses, including approaches to estimate an adjusted marginal risk contrast (i.e. inverse probability weighting and g-computation) and data fusion. In such settings, maximum likelihood variance estimates are not consistent. Thus, epidemiologists often resort to bootstrap to estimate the variance. In contrast, M-estimation allows for consistent variance estimates in these settings without requiring the computational complexity of the bootstrap. In this paper, we introduce M-estimation and provide four illustrative examples of implementation along with software code in multiple languages. M-estimation is a flexible and computationally efficient estimation procedure that is a powerful addition to the epidemiologist\'s toolbox.
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  • 文章类型: Journal Article
    在马萨诸塞州(MA),对于新的艾滋病毒和传染性梅毒病例,通常会提供伴侣通知,但是没有针对淋病和衣原体的正式合作伙伴通知服务。电子合作伙伴通知(ePN)这允许患者匿名通知他们的伴侣性传播感染暴露,可以填补这个空白。我们评估了马萨诸塞州全州ePN服务的可接受性和理想特征。我们在波士顿地区的性健康诊所对患者进行了半结构化访谈,并与临床医生和马萨诸塞州公共卫生部现场流行病学家(FEs)进行了焦点小组。我们开发了一个码本,并对访谈和焦点小组数据进行了主题分析;25%的访谈是双重编码的。我们从我们的数据中确定了六个主要主题:(1)合作伙伴通知是一个关系过程,(2)合作伙伴通知取决于情况。有效的ePN系统有三对挑战和核心价值:(3)污名化与包容性,(4)信任与不信任,(5)隐私与有用的信息共享。因此,(6)全州范围的ePN平台必须在每个可能的步骤是可定制的。尽管ePN在所有三组中都是可以接受的,个人使用的可能性是基于患者的社会文化背景,人际关系,对平台和卫生当局的信任,希望避免污名化,隐私需要。这些因素最好由适应用户偏好和需求的平台来容纳。ePN提供了将有淋病或衣原体风险的合作伙伴与临床护理联系起来的机会,这是对更劳动密集型FE角色的补充。
    In Massachusetts (MA), partner notification is routinely offered for new HIV and infectious syphilis cases, but there are no formal partner notification services for gonorrhea and chlamydia. Electronic partner notification (ePN), which allows patients to anonymously notify their partners of sexually transmitted infection exposure, could fill this gap. We evaluated the acceptability of and ideal characteristics for a statewide ePN service in MA. We performed semistructured interviews with patients at a Boston area sexual health clinic and conducted focus groups with clinicians and Massachusetts Department of Public Health Field Epidemiologists (FEs). We developed a codebook and thematically analyzed interview and focus group data; 25% of interviews were double coded. We identified six main themes from our data: (1) partner notification is a relational process and (2) partner notification is situation dependent. There are three pairs of challenges and core values for an effective ePN system: (3) stigmatization versus inclusivity, (4) trust versus mistrust, and (5) privacy versus helpful information sharing. Therefore, (6) a statewide ePN platform must be customizable at each possible step. Although ePN was acceptable across all three groups, the likelihood of individual use was grounded in a patient\'s sociocultural context, interpersonal relationships, trust in the platform and health authorities, desire to avoid stigmatization, and privacy needs. These factors are best accommodated by a platform that adapts to users\' preferences and needs. ePN presents an opportunity to link partners at risk for gonorrhea or chlamydia to clinical care that is complementary to the more labor-intensive FE role.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:COVID-19强调了现场流行病学培训计划(FETPs)的重要性,因为各国面临压倒性的需求。专家们呼吁更多的现场流行病学家接受更好的培训。自1951年以来,FETP一直在全球范围内建立公共卫生能力,然而,缺乏对这些课程学习的探索。这项定性研究将(1)描述培训FETP现场流行病学家的方法;(2)描述FETP学员学习现场流行病学的策略;(3)解释使培训方法与FETP学习策略保持一致的原则和实践。
    方法:研究设计,实施和解释是与FETP培训师的协作努力。数据收集将包括对FETP培训人员和受训人员的访谈,以及参与者对西太平洋区域四个FETP培训和学习活动的观察。数据分析将分三个阶段进行:(1)我们将在开放编码过程中使用Charmaz的扎根理论的恒定比较方法来识别和优先考虑数据中的类别和属性;(2)在集中编码过程中,我们将使用不断的比较和波尔金霍恩的叙事分析,比较优先类别的故事,填写这些类别的属性和(3)我们将使用Polkinghorne的叙事分析来构建反映感兴趣领域的叙事,确定卡尔和凯米斯的做法之间的对应关系,理解和情况,以解释FETP中的学习原理和过程。
    背景:我们已经获得了在澳大利亚国立大学(2021/771)和台湾卫生与福利部(112206)进行这项研究所需的伦理批准。数据将不会公开,但是匿名的发现将与FETP共享以进行协作解释。最终,研究结果和解释将出现在同行评审的期刊和会议上。
    COVID-19 underscored the importance of field epidemiology training programmes (FETPs) as countries struggled with overwhelming demands. Experts are calling for more field epidemiologists with better training. Since 1951, FETPs have been building public health capacities across the globe, yet explorations of learning in these programmes are lacking. This qualitative study will (1) describe approaches to training field epidemiologists in FETP; (2) describe strategies for learning field epidemiology among FETP trainees and (3) explain the principles and practices aligning training approaches with learning strategies in FETP.
    The research design, implementation and interpretation are collaborative efforts with FETP trainers. Data collection will include interviews with FETP trainers and trainees and participant observations of FETP training and learning events in four FETP in the Western Pacific Region. Data analysis will occur in three phases: (1) we will use the constant comparison method of Charmaz\'s grounded theory during open coding to identify and prioritise categories and properties in the data; (2) during focused coding, we will use constant comparison and Polkinghorne\'s analysis of narratives, comparing stories of prioritised categories, to fill out properties of those categories and (3) we will use Polkinghorne\'s narrative analysis to construct narratives that reflect domains of interest, identifying correspondence among Carr and Kemmis\'s practices, understandings and situations to explain principles and processes of learning in FETP.
    We have obtained the required ethics approvals to conduct this research at The Australian National University (2021/771) and Taiwan\'s Ministry of Health and Welfare (112206). Data will not be available publicly, but anonymised findings will be shared with FETP for collaborative interpretation. Ultimately, findings and interpretations will appear in peer-reviewed journals and conferences.
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  • 文章类型: Editorial
    在1980年代初期,癌症生物学和流行病学方法都在发生变化。1984年,著名的癌症流行病学家理查德·皮托,在1981年,发表了具有里程碑意义的癌症的原因与理查德娃娃-写了一个简短的章节“需要无知的癌症研究”,流行病学和投机性达尔文生物学的世界相遇。他对进化理论如何与癌症相关的思考被称为“皮托悖论”,而他对“黑盒流行病学”的阐述提供了随后在该领域实践的逻辑。我们在本期《欧洲流行病学杂志》上转载了这个闪闪发光的,有先见之明的生物知情流行病学理论的例子,连同四个评论,专注于其丰富内容的不同方面。这里提供了1984章的一些背景背景,以及我们对癌症流行病学中各种悖论的猜测。我们认为,在过去40年中,在识别新的可改变的癌症原因方面相对缺乏进展的一个原因可能反映了这种暴露在环境中无处不在。并讨论由此得出的流行病学教训。
    During the early 1980s both cancer biology and epidemiological methods were being transformed. In 1984 the leading cancer epidemiologist Richard Peto - who, in 1981, had published the landmark Causes of Cancer with Richard Doll - wrote a short chapter on \"The need for ignorance in cancer research\", in which the worlds of epidemiology and speculative Darwinian biology met. His reflections on how evolutionary theory related to cancer have become known as \"Peto\'s paradox\", whilst his articulation of \"black box epidemiology\" provided the logic of subsequent practice in the field. We reprint this sparkling and prescient example of biologically-informed epidemiological theorising at its best in this issue of the European Journal of Epidemiology, together with four commentaries that focus on different aspects of its rich content. Here were provide some contextual background to the 1984 chapter, and our own speculations regarding various paradoxes in cancer epidemiology. We suggest that one reason for the relative lack of progress in indentifying novel modifiable causes of cancer over the last 40 years may reflect such exposures being ubiquitous within environments, and discuss the lessons for epidemiology that would follow from this.
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  • 文章类型: Journal Article
    新冠肺炎大流行暴露了围绕科学专业知识的紧张关系,这对卫生系统的有效性具有重大影响。与这种紧张的关键接触,然而,在紧急情况发生后巩固的课程和计划中很大程度上缺失了。缺乏讨论紧张关系的良好框架,模糊的术语“公众信任”已经扩散成为一个流行词,代表着更清晰的讨论。专家和公众之间的紧张关系并不新鲜,however.回顾1930年代是很有用的,当健康专家被认定为“新流行病学家”时,他设想了一种新的现代流行病学,有些人相信,将解决公共合作中明显的失败。这些年对流行病学知识的生产和使用的不同方法的历史分析揭示了关于流行病学核心力量的辩论,以及讨论围绕公共卫生流行病学专业知识的紧张关系的关键框架。
    The Covid-19 pandemic has laid bare a tension around scientific expertise that has major implications for the effectiveness of health systems. Critical engagement with this tension, however, is largely missing from the lessons and programs consolidating in the wake of the emergency. Lacking good frameworks for discussing the tension, the vague term \"public trust\" has proliferated into a buzzword that stands in for more articulate discussion. The tension between experts and the public is not new, however. It is useful to look back to the 1930s, when health experts identifying as \"new epidemiologists\" imagined a new modern science of epidemiology that, some believed, would resolve evident failures in public cooperation. Historical analysis of different approaches to the production and use of epidemiological knowledge in these years reveals a debate about power at the heart of epidemiology, and a critical framework for discussing the tension around epidemiological expertise in public health.
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