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The Guidelines for Good Epidemiology Practices (GEPs) for Occupational and Environmental Epidemiologic Research address the conduct of studies generally undertaken to answer questions about human health in relationship to the work place or the environment. The GEPs propose minimum practices and procedures that should be considered to help ensure the quality and integrity of data used in epidemiologic research and to provide adequate documentation of the research methods. The GEPs address the process of conducting individual epidemiologic studies and do not prescribe specific research methods. The Guidelines for Good Epidemiology Practices propose minimum practices and procedures in the following areas: I. Organization and Personnel II. Facilities, Resource Commitment, and Contractors III. Protocol IV. Review and Approval V. Study Conduct VI. Communication VII. Archiving VIII. Quality Assurance Although the Guidelines for Good Epidemiology Practices will not guarantee good epidemiology, they do provide a useful framework for ensuring that all research issues are adequately addressed. This framework is proposed as a first step in improving epidemiologic research practices through adherence to sound scientific research principles. Appendices provide an overview of standard operating procedures, a glossary of terms used in the Guidelines, and suggested references on occupational epidemiology methods.
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In 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panel's best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee.
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OBJECTIVE: This paper aims to discuss the contribution of epidemiology to aspects of public policy that have either a direct influence on mental health and mental disorders, or an indirect effect by influencing environmental factors which influence mental health. Both kinds of public policy will need to be considered by governments wishing to protect, promote and improve the mental health of their populations. The paper draws on information from both relatively wealthy and low-income countries. METHOD: The paper defines epidemiology and mental health policy, sets out the range of government policies which may have an impact on mental health, and explores the ways in which epidemiology may contribute to mental health policy in relation to service inputs, processes and outcomes as well as to wider government policies. The paper also examines the advantages and disadvantages of different sources of data. RESULTS: There are a number of reasons to carry out large-scale surveys of psychiatric morbidity. First, effective policy should address the needs of the population, which can best be assessed by the epidemiology and the social and economic causes and consequences of psychiatric morbidity. Secondly, representative information in a defined geographic area can document the use of existing services and can estimate the extent of unmet needs and the services required meeting those needs. Thirdly, valid information on prevalence and associated risk factors of presumed causal importance allow aetiological hypotheses to be generated and tested and models developed for prevention. Finally, by repeating community surveys, it is possible to monitor the health of the population and trends. Epidemiological findings emphasize the importance of mental health policy addressing the key role of primary care, the social context and social consequences of disorder, the importance of addressing services for children, the need to reduce premature mortality from suicide and from physical illness. Epidemiological findings show that mental health and mental disorders are related to the environment both in its structural physical sense and in the sense of the social processes connected to and influenced by particular settings. Thus epidemiology can contribute to general policies on employment and unemployment, housing and homelessness, education and women's issues. CONCLUSION: Mental health policy is increasingly recognized as an essential area for countries wishing to enhance their economic, social and human capital. Epidemiological data are a basic prerequisite to informing such policies. Expert professional and epidemiological advice to ministries is essential if policy is to be rooted in the evidence for population needs, risk factors, effective treatments and services, and measurement of outcomes. It is therefore important to develop the capacity for policy work in the psychiatric profession by including public health, epidemiology and policy placements for young psychiatrists.
This paper aims to discuss the contribution of epidemiology to aspects of public policy that have either a direct influence on mental health and mental disorders, or an indirect effect by influencing environmental factors which influence mental health. Both kinds of public policy will need to be considered by governments wishing to protect, promote, and improve the mental health of their populations. The paper draws on information from both relatively wealthy and low-income countries. The paper defines epidemiology and mental health policy, sets out the range of government policies which may have an impact on mental health, and explores the ways in which epidemiology may contribute to mental health policy in relation to service inputs, processes and outcomes as well as to wider government policies. The paper also examines the advantages and disadvantages of different sources of data. There are a number of reasons to carry out large-scale surveys of psychiatric morbidity. First, effective policy should address the needs of the population, which can best be assessed by the epidemiology and the social and economic causes and consequences of psychiatric morbidity. Secondly, representative information in a defined geographic area can document the use of existing services and can estimate the extent of unmet needs and the services required meeting those needs. Thirdly, valid information on prevalence and associated risk factors of presumed causal importance allow aetiological hypotheses to be generated and tested and models developed for prevention. Finally, by repeating community surveys, it is possible to monitor the health of the population and trends. Epidemiological findings emphasize the importance of mental health policy addressing the key role of primary care, the social context and social consequences of disorder, the importance of addressing services for children, the need to reduce premature mortality from suicide and from physical illness. Epidemiological findings show that mental health and mental disorders are related to the environment both in its structural physical sense and in the sense of the social processes connected to and influenced by particular settings. Thus epidemiology can contribute to general policies on employment and unemployment, housing and homelessness, education, and women's issues. Mental health policy is increasingly recognized as an essential area for countries wishing to enhance their economic, social, and human capital. Epidemiological data are a basic prerequisite to informing such policies. Expert professional and epidemiological advice to ministries is essential if policy is to be rooted in the evidence for population needs, risk factors, effective treatments and services, and measurement of outcomes. It is therefore important to develop the capacity for policy work in the psychiatric profession by including public health, epidemiology, and policy placements for young psychiatrists.
STUDY OBJECTIVE: To determine the ways in which institutions devoted to international development influence epidemiological studies. DESIGN: This article takes a descriptive epidemiological study of El Salvador, Epidemiological Profile, conducted in 1994 by the US Agency for International Development, as a case study. The methods include discourse analysis in order to uncover the ideological basis of the report and its characteristics as a discourse of development. SETTING: El Salvador. RESULTS: The Epidemiological Profile theoretical basis, the epidemiological transition theory, embodies the ethnocentrism of a "colonizer's model of the world." This report follows the logic of a discourse of development by depoliticising development, creating abnormalities, and relying on the development consulting industry. The epidemiological transition theory serves as an ideology that legitimises and dissimulates the international order. CONCLUSIONS: Even descriptive epidemiological assessments or epidemiological profiles are imbued with theoretical assumptions shaped by the institutional setting under which epidemiological investigations are conducted.
OBJECTIVES: The Maternal and Child Health Epidemiology Program (MCHEP), jointly sponsored by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA), was evaluated in 1996-1997. As part of this evaluation, an effort was undertaken to identify components of effective MCH epidemiology, to examine their prevalence across participating states, and to assess differences with respect to these components between MCHEP and non-MCHEP states. METHODS: A case-study evaluation was undertaken in which nine states (five MCHEP and four non-MCHEP) rated themselves on a benchmark questionnaire and participated in interviews conducted during site visits. At the completion of the evaluation, 16 components of effective MCH epidemiology in state health agencies were identified. The nine states were rated by the evaluation team on each component. Ratings across all states and between MCHEP and non-MCHEP states were compared. RESULTS: There was a great deal of variability among the nine states with respect to the presence of the components of effective MCH epidemiology. Components on which the states appeared weakest overall were the presence of adequately trained personnel, the presence of adequate management information systems to support MCH programs, and whether the state health agency's epidemiologic unit understands the MCH planning cycle. States with an MCHEP assignee had a higher overall mean score than non-MCHEP states across all components. There were seven components on which the two groups of states differed. These include whether the MCH director is empowered in the state health agency, whether the state health agency has identified internal epidemiologic capacity building as a priority, and whether analytic leadership is available for MCH epidemiologic activities. CONCLUSIONS: Building and maintaining MCH epidemiologic capacity in state health agencies requires attention to a variety of factors. While the presence of an MCH epidemiologist is important, this is only one of many components that must be considered as both the federal and state governments seek to promote and institutionalize effective MCH epidemiology in state health agencies.
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OBJECTIVE: To describe the growth of developmental epidemiology in the past decade and to illustrate it with examples of recent studies. METHOD: A review of publications on developmental epidemiology in the past 10 years and a discussion of some key examples. RESULTS: The authors describe how the interaction between developmental psychopathology and psychiatric epidemiology has produced developmental epidemiology, the study of patterns of distribution of psychiatric disorders in time as well as in space. They give two examples of the kinds of questions that developmental epidemiology can help to answer: (1) Is the prevalence of autism increasing? Does the use of vaccines explain the increase? (2) Is there an epidemic of child and adolescent depression? Finally, they describe two areas of science that are beginning to inform developmental epidemiology: molecular genetics and the use of biological measures of stress. CONCLUSIONS: While child and adolescent psychiatric epidemiology continues, as described in the first of these reviews, to address questions of prevalence and burden, it has also expanded into new areas of research in the past decade. In the next decade, longitudinal epidemiological data sets with their rich descriptive data on psychopathology and environmental risk over time and the potential to add biological measures will provide valuable resources for research into gene-environment correlations and interactions.
The underrepresentation in epidemiology of members of racial/ethnic minority groups is greater than in medicine and health fields in general. Using printed recruitment materials, we evaluated the impression that epidemiology programs might make on prospective minority students. Mainstream recruitment materials were solicited from all identifiable U.S. epidemiology programs (n = 70) by requesting copies of typical mailings to prospective students. Of 51 respondents, 46 sent materials that could be analyzed by tabulating and evaluating minority-related content in text and pictures. Materials reflected a generally low-key approach to epidemiology student recruitment. Most minority-related text referred to affirmative action or financial aid and was at the school level rather than specific to the epidemiology programs. Few minority-related epidemiology course titles or research interests were identified. We recommend including more information about epidemiology and its relevance to minority health in mainstream recruitment materials as one possible strategy for increasing the number of minority applicants.
PURPOSE: African-, Hispanic-, and Native Americans are underrepresented in the field of epidemiology including degree programs. As part of the assessment component of its mandate, the American College of Epidemiology Committee on Minority Affairs conducted a survey of minority recruitment activities of U.S. epidemiology degree programs. METHODS: The survey, containing questions related to marketing activities, institution infrastructure, financial support, academic offerings, and receptive/supportive environment, was mailed to all programs identified in Episource as offering epidemiology degrees. Separate responses were requested concerning activities at the department and school levels. RESULTS: Fifty-two completed questionnaires were received (response rate of 79%). All but two institutions had at least one activity conducted by either the department or the school. However, all activities were more common at the school- than at the department-level. Indeed, some activities [a written minority student recruitment plan (6% of departments and 52% of schools), personnel with minority recruitment responsibilities (4% of departments and 73% of schools)] were almost exclusively school-sponsored. Although marketing-type activities were the most common minority recruitment tool used by departments, only 21% made visits to minority schools, 17% visited other colleges specifically to recruit minorities, and 12% produced materials targeted to ethnic/racial minorities. Six percent of the departments and 19% of the schools offered financial support (grants, fellowships, scholarships) to almost all underrepresented minority students. CONCLUSIONS: Even though individual epidemiology degree programs may not see a need for general recruitment activities in order to maintain the size of their applicant pool, minority-specific recruitment activities should be undertaken to enhance and diversify that pool. We recommend that epidemiology departments develop, adopt, and implement comprehensive written plans for the recruitment of underrepresented minority students into their programs.
The routine presentation of epidemiologic data by "race" has been challenged as impeding identification of modifiable risk factors and fostering an unsubstantiated belief in the biologic distinctness of the "races." This study examines the past and current uses of "race" in US epidemiologic research. The authors reviewed every paper published in the 1921, 1930, 1940, 1950, and 1960 volumes of the American Journal of Hygiene and in the 1965, 1970, 1975, 1980, 1985, and 1990 volumes of the American Journal of Epidemiology. Of the total of 1,200 papers published during the sample years, 558 reports of original epidemiologic research conducted in the United States were identified. The proportion of these papers containing a reference to "race" rose steadily from 1975. However, the proportion of papers reporting inclusion of "nonwhite" populations did not show a parallel increase. Exclusion of "nonwhite" subjects and description of predominantly "white" study populations increased instead. Recommendations for future epidemiologic practice include the following: 1) greater inclusion of "nonwhite" populations in epidemiologic research and 2) vigorous investigation of the root causes of observed "race"-associated differences.