bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of population data in spatial epidemiology
Authors: Arnold R. A. , Diamond I. D. , Wakefield J. C.
Published: September 2009

This chapter considers the use of population counts in spatial epidemiological studies. The chapter proceeds as follows. Section 3.2 reviews data available for estimating the populations of small areas. Section 3.3 describes a number of estimation methods. Section 3.4 considers the implications of inadequacies in population estimates under various models describing the relationship between ‘true’ and estimated counts. Section 3.5 presents an example that illustrates both the sensitivity of inference to the choice of counts and a method by which inter-censual counts may be estimated.
Socio-economic factors at areal level and their relationship with health
Authors: Carstairs V.
Published: September 2009

This chapter focuses on the development and application of area methods to examine socio-economic differentials and their effects on health in the UK. Individual socio-economic variables and deprivation indices at area level have proven their value in allowing a socio-economic dimension to emerge from a range of routine databases over the past two decades. However, as social climate changes, it is likely that the constituent variables in the indices will require review.
Mapping mortality data in the United States
Authors: Pickle L. W.
Published: September 2009

This chapter discusses the advantages of and disadvantages of mapping mortality data, methods used in producing mortality atlas, and recent research suggesting improvements in map design that can enhance the accurate communication of the underlying patterns. Experiences in mapping mortality data for the Atlas of United States Mortality is used to illustrate the general methods.
Geographical analysis of communicable disease data
Authors: Atkinson P. , Molesworth A.
Published: September 2009

This chapter presents methods to map and analyze communicable disease data. It discusses their limitations and proposes possible solutions or alternative approaches to minimize some of these problems. The discussion is based on experience of the surveillance of communicable diseases in England and Wales. It argues that the quality and availability of georeferenced information is improving, but the nature of surveillance systems designed to provide timely data to inform intervention means that complete data are unlikely to be achieved. Thus, geographical analysis of communicable disease data will require ongoing development of robust spatial analysis techniques that can cope with clustered patterns, minimize the impact of missing data, and incorporate mixed resolution data.
Geographical variations in childhood leukaemia incidence
Authors: Bithell J. F. , Vincent T. J.
Published: September 2009

This chapter examines geographical variations in the incidence of childhood leukaemia. It shows there is more variation of incidence at the international level than at smaller geographical scales of study. Geographical variations in childhood leukaemia incidence are generally not as great as is sometimes supposed, and that such as do occur may be due as much to genetic differences as to environmental ones.
Personal exposure monitoring in environmental epidemiology
Authors: Nieuwenhuijsen M.J.
Published: September 2009

The exposure to any pollutant is determined by the concentration of the pollutant in the environment, its specific character, and the duration and frequency of contact. Estimates of these characteristics can be obtained instrumentally (i.e., using a monitoring device), via questionnaires, through direct observation, or through the use of biomarkers. This chapter focuses on the measurement of personal exposure with instruments or biomarkers. Although personal monitoring is labour-intensive and expensive, it remain a valuable technique because it can dramatically improve exposure assessment in epidemiological studies, thus adding to the scientific credibility of the studies.
The role of geographical studies in risk assessment
Authors: Järup L.
Published: September 2009

This chapter evaluates the use of geographical information systems (GIS) in risk assessment. It shows that the use of GIS at all stages of the risk assessment process has both strengths and weaknesses. In the case of exposure assessment, one of its main advantages is the possibility of modelling exposure geographically so that individual exposure may be estimated without costly and cumbersome measurements. However, misuse of GIS for exposure estimation may lead to completely erroneous risk assessment.
Climate change and human health: mapping and modelling potential impacts
Authors: McMichael A. J. , Martens P. , Kovats R. S. , Lele S.
Published: September 2009

This chapter examines the methods used to describe and forecast the health impacts of climate change. It considers the research methods applicable to assessing the potential impacts of climate change, including empirical studies of climate/health relationships, predictive modelling, and general assessments of health consequences of complex demographic, social, and economic disruptions.
Established major coronary risk factors: historical overview
Authors: Stamler J.
Published: September 2009

This chapter presents a historical overview of research on the six established major risk factors for coronary heart disease: adverse diet, diet-related above-optimal levels of serum total cholesterol (TC), blood pressure (BP), overweight/obesity, diabetes mellitus (DM), and cigarette smoking. These have been shown to be centrally involved in the multifactorial causation of severe atherosclerotic disease, its complications, and its multiple clinical manifestations — first and foremost the epidemic of CHD in Western industrialized countries.
Trends in Asia
Authors: Ueshima H.
Published: September 2009

This chapter discusses trends in coronary heart disease (CHD) in Asia. Conventional risk factors for CHD in Asian countries are similar to those of Western countries. The major determinant of CHD mortality and morbidity among populations is the population level of serum TC, which is related to the levels of fat intake, Keys score, and BMI in populations. CHD mortality and morbidity have started to decline or have levelled off after the early phase of increase in Japan, Singapore, Hong Kong, Taiwan, and Korea due to declining trends in smoking and the prevalence of hypertension and/or blood pressure levels.
Coronary heart disease burden among persons of African origin
Authors: Cooper R. S.
Published: September 2009

This chapter focuses on the burden of cardiovascular disease for the US black population, while noting the contrasts with West Africa and the Caribbean. For all forms of heart disease, combined death rates are 50% higher in US blacks compared to whites. The risk factor pattern that underlies this differential has evolved over the course of the African diaspora and reflects the severe social and economic disadvantage currently experienced by US blacks. The classic finding of a positive association of CVD and economic development across countries, with a negative association between socio-economic strata and risk within industrialized countries, is apparent in this sample of populations.
Coronary heart disease mortality attributable to smoking: global and regional estimates for 2000
Authors: Ezzati M. , Lopez A. D.
Published: September 2009

This chapter employs the indirect smoking impact ratio method (Peto et al. 1992), which uses absolute lung cancer mortality in a population as a marker for accumulated hazards of smoking, to estimate the global impact of smoking on coronary heart disease (CHD) mortality. In 2000, an estimated 873,000 people died from CHD in the world due to smoking, accounting for 15% of global adult CHD mortality. This figure represents a significant proportion of the more than 4.8 million smoking-attributable deaths in 2000. Of these deaths, 359,000 were in developing countries, marking a transition to an era in which smoking kills a comparable number of people from CHD in developing countries as in industrialized nations.
Lipids and cholesterol
Authors: Law M. R. , Rodgers A.
Published: September 2009

This chapter discusses the role of lipids and cholesterol in coronary heart disease (CHD). The high levels of serum cholesterol found in Western populations are a major cause of the high mortality from CHD. Realistic dietary change in a community can lower serum cholesterol by 0.6 mmol/l (10%) and reduce heart disease mortality by approximately 25% among middle-aged individuals. Cholesterol-lowering drugs (statins) can lower cholesterol by 1.8 mmol/l (30%), and reduce the risk of heart disease death by approximately 60% from the third year onwards. Statins are inexpensive and safe, and their widespread use should be encouraged.
Antioxidants and cardiovascular disease
Authors: Miller III E. R. , Appel L. J.
Published: September 2009

Antioxidant vitamin supplements are regularly consumed by over one-third of all adults in the United States. While the health benefits of vitamin supplements are unproven, many lay persons and health professionals believe that pill supplementation with antioxidants is an effective strategy for the prevention and treatment of acute and chronic illnesses, including cardiovascular diseases (CVDs). Contrary to the commonly held beliefs, recent large-scale randomized clinical trials have repeatedly documented no benefit from antioxidant vitamin supplements. This chapter reviews evidence for biological plausibility; the major observational studies which linked antioxidant intake to reduced risk of cardiovascular and other chronic diseases. It reviews the large number of trials which, collectively, fail to show benefit of antioxidant vitamin supplement use in preventing CVD and mortality.
Serum homocysteine and coronary heart disease
Authors: Wald D. S. , Law M. R. , Wald N. J. , Morris J. K.
Published: September 2009

This chapter discusses the link between serum homocysteine and coronary heart disease (CHD). Genetic studies show a moderately higher risk of CHD for a moderately higher level of serum homocysteine. Prospective studies show a positive association between serum homocysteine and cardiovascular disease after allowance for confounding. Although these two types of study are susceptible to different sources of error, they show quantitatively similar associations, a result that is unlikely to have occurred through different potential sources of confounding acting independently. The homocystinurias cause high serum homocysteine levels and high risks of premature cardiovascular disease, and lowering serum homocysteine reduces this high risk. These observations provide a compelling case for a cause and effect relationship between homocysteine and CHD and, therefore, a protective role for folic acid on CHD prevention.
Fish consumption, n-3 fatty acids, and coronary heart disease
Authors: Kromhout D.
Published: September 2009

Essential fatty acids are polyunsaturated fatty acids from the n-6 family (i.e., linoleic acid and arachidonic acid) present in vegetable oils, and of the n-3 family (i.e., eicosapentaenoic acid and docosahexaenoic acid) present in seafood. These fatty acids may protect against coronary atherosclerosis and thrombosis. It is hypothesized that a balanced intake of n-6 and n-3 fatty acids is of great importance in relation to prevention of coronary heart disease (CHD). Research on n-3 fatty acids, fish consumption, and CHD was stimulated by the pioneering studies among the Inuit (Eskimos) in Greenland. This chapter begins by summarizing the results of the studies among the Inuit. The results on fish consumption and CHD mortality are then reviewed at the population and individual levels. Both observational epidemiology and experimental studies show that a small amount of fish protects against fatal CHD and sudden cardiac death. It is, therefore, recommended to eat fish (preferably fatty fish) once or twice a week.
Metabolic syndrome, diabetes, and coronary heart disease
Authors: Hu G. , Qiao Q. , Tuomilehto J.
Published: September 2009

This chapter discusses the association of metabolic syndrome, diabetes, and coronary heart disease (CHD). Topics covered include incidence of CHD and CVD in patients with diabetes, possible mechanisms linking metabolic factors to CHD, and prevention of CHD in people with abnormal glucose regulation.
Systematic review of prospective cohort studies of psychosocial factors in the aetiology and prognosis of coronary heart disease
Authors: Kuper H. , Marmot M. , Hemingway H.
Published: September 2009

This chapter assesses the relative strength of the epidemiological evidence for causal links between psychosocial factors and coronary heart disease (CHD) incidence among healthy populations and prognosis among CHD patients. Prospective studies published up until 2001 identified seventy reports of aetiological effects and ninety-two reports of prognostic effects by psychosocial factors. Based on prospective epidemiological data, there was indication for an association between depression, social support, and psychosocial work characteristics with CHD aetiology and prognosis. The randomized trials, to date, have been negative. Evidence for an effect of anxiety or type A behaviour was less consistent.
Coagulation, thrombosis, and coronary heart disease
Authors: Meade T. W. , MacCallum P. K.
Published: September 2009

This chapter reviews evidence on the contribution of the coagulation system to arterial thrombosis through fibrin formation. Epidemiological studies of the coagulation system in thrombosis and coronary heart disease (CHD) have demonstrated its involvement and implications for its management and prevention.
Gene–environment interaction in coronary artery disease: apolipoprotein E and smoking and the interleukin-6 gene and inflammation as examples
Authors: Humphries S. E.
Published: September 2009

This chapter discusses gene-environment interaction in coronary artery disease (CAD). Topics covered include risk factors for CAD, apolipoprotein E and effect on lipid levels and coronary heart disease risk, APOE genotype-smoking interaction, homeostasis and use of stressing the genotype to identify functional variants, and the role of inflammatory processes in atherogenesis.
Life course influences on coronary heart disease
Authors: Smith G. Davey , Lynch J.
Published: September 2009

This chapter outlines the concepts of life course epidemiology as applied to coronary heart disease (CHD), discusses evidence with regard to early life factors and CHD, and considers the recently debated issue as to whether there is any need to continue searching for additional CHD risk factors above the well-established adulthood factors. It examines how well CHD trends fit with life course approaches and concludes by reviewing some of the remaining important issues in CHD epidemiology from a life course perspective.
Emergence of risk factors in children
Authors: Labarthe D. R.
Published: September 2009

This chapter discusses the ‘emergence’ of risk factors for atherosclerotic and hypertensive diseases in children and adolescents. The emergence of cardiovascular risk factors in childhood and adolescence is characterized in general by (a) a progressive shift in risk factor distributions with increasing age toward undesirable levels; (b) a tendency for clustering of multiple factors within individual persons; (c) tracking of risk factor values at the higher-risk extreme; and (d) an association with the extent and severity of atherosclerotic lesions observed well before adulthood. Variation in the trajectories of change in mean values of specific risk factors — such as distinct components of blood lipids, blood pressure, or blood glucose and insulin concentrations — indicates some complexity in these patterns and suggests that they may differ in some important aspects of causation and prevention.
Risk factors in the elderly
Authors: van der Bom J. G. , Grobbee D. E.
Published: September 2009

This chapter discusses atherosclerosis and other risk factors for cardiovascular diseases in the elderly. It considers findings from studies on serum cholesterol, blood pressure, smoking, and type 2 diabetes mellitus. It also discusses some of the risk factors that are an expression of damage already present in the heart and arteries: electrocardiogram (ECG) deviations, left ventricular hypertrophy, and changes in the wall of the (carotid) arteries.
Contributions to change: major risk factors and the potential for prevention
Authors: Beaglehole R. , Dobson A.
Published: September 2009

This chapter assesses the impact of changes in the major coronary heart disease (CHD) risk factors to changes in CHD event and mortality rates. The major risk factors can account for large differences on CHD event rates observed between populations. This supports the argument that these major risk factors can account for most of the CHD epidemics seen in the second half of the 20th century. It follows that the priority targets for prevention are to reduce levels of smoking, blood pressure, and total cholesterol in whole populations.
Prevention of coronary heart disease: findings from the Nurses’ Health Study and Health Professionals’ Follow-up Study
Authors: Hu F. B. , Willett W. C.
Published: September 2009

This chapter discusses the contributions of the Nurses' Health Study (NHS) and Health Professionals' Follow-up Study (HPFS) to the nutritional epidemiology of coronary heart disease (CHD). Compelling evidence from these studies indicates that CHD is heavily influenced by dietary and lifestyle factors. Replacing saturated and trans fats with unsaturated fats, including sources of n-3 fatty acids, substituting whole grain forms of carbohydrate for refined grains and potatoes, consuming an abundance of fruits and vegetables, and controlling body weight will dramatically reduce the risk of CHD. The magnitude of benefit achievable through diet and lifestyle is large and substantially greater than that due to drug treatment of blood cholesterol or hypertension.
Risk scores for management and prevention of cardiovascular disease
Authors: Wood D. A. , Kotseva K.
Published: September 2009

This chapter discusses risk scores for cardiovascular disease. Topics covered include the concept of cardiovascular risk, CVD prevention strategies and absolute multifactorial risk, advantages and disadvantages of absolute risk prediction, calculation of CVD risk, comparison of risk prediction method, and application of absolute risk to management of blood pressure and lipids.
Non-invasive measures of preclinical coronary heart disease
Authors: Greenland P.
Published: September 2009

This chapter reviews four non-invasive tests for detection of preclinical coronary heart disease (CHD) and for prediction of future coronary events in asymptomatic people: (a) coronary artery calcium detection by ultrafast computed tomography; (b) ankle-brachial blood pressure index; (c) B-mode ultrasound of the carotid artery for measurement of intima-media thickness; and (d) exercise stress testing. Each of these modalities has been studied in large samples of asymptomatic people in whom considerable follow-up and multivariable adjustment are available to determine incremental predictive value beyond standard risk factor measures.
Screening for future coronary heart disease
Authors: Wald N. J. , Law M. R.
Published: September 2009

Measuring risk factors such as blood pressure and serum cholesterol as a means of screening to identify people who will develop coronary heart disease has entered medical practice largely because of the aetiological importance of these factors. It has been assumed that an aetiologically important risk factor must also be a good screening test. This chapter examines risk factors considered as screening tests in general, and then examines how effective coronary heart disease (CHD) risk factors are in distinguishing individuals who will develop clinical CHD from individuals who will not.
Environmental measurement and modelling: introduction and source dispersion modelling
Authors: Colvile Roy , Briggs David , Nieuwenhuijsen Mark J.
Published: September 2009

This chapter provides a general introduction to the measurement and modeling of environmental exposures for environmental epidemiological studies, focusing on source based modeling. It provides various examples and references.
Analysis and modelling of personal exposure
Authors: Burdorf Alex
Published: September 2009

This chapter provides a general introduction to the modeling of personal environmental exposures for occupational and environmental epidemiological studies. It discusses in detail the use of analyses of variance and regression analyses in these types of studies. It provides various examples and references.
Exposure measurement error: consequences and design issues
Authors: Armstrong Ben
Published: September 2009

This chapter provides a general introduction to exposure misclassification and measurement error in occupational and environmental epidemiological studies. It describes its original, methods to quantify it, and methods to correct for it. It provides various examples and references.
Applying process evaluation
Authors: Platt Stephen , Gnich Wendy , Rankin David , Ritchie Deborah , Truman Julie , Backett-Milbum Kathryn
Published: September 2009

This chapter introduces the purposes, focus, and methods of process evaluation and explores some issues in the application of process evaluation using examples from two research projects. These issues include the boundary between formative and process evaluation; the impact of ongoing change during implementation of an intervention; and the development of relationships at fieldwork sites.
Evaluating the ethics of health promotion
Authors: Marks Dalya
Published: September 2009

This chapter examines some of the ethical issues surrounding the notions of “informed consent” and informed decision-making. It highlights some of the broader ethical issues facing health promotion interventions.
Evaluating mass media approaches
Authors: Wellings Kaye , Macdowall Wendy
Published: September 2009

Broad spectrum interventions aimed at reaching the general population make use of mass communication approaches such as TV, radio, press, billboard posters, and leaflets. This chapter examines the difficulties inherent in evaluating mass media campaigns. Topics discussed include the scope of interventions, evaluation research, process evaluation, outcome evaluation, selection of indicators/outcome measures, and measuring unintended consequences.
Visual cortex reprogramming following retinal lesions or artificial scotomas
Authors: Burke W.
Published: September 2009

This chapter considers the consequences of retinal lesions and discusses the controversies surrounding retinal lesioning techniques. The perceptual consequences of these techniques are described including hallucinations and perceptual ‘filling-in’. It also discusses the mechanisms of neural circuitry generating these disturbances.
Remodeling of cortical connections and enhanced long-term potentiation after lesions of the visual cortex
Authors: Eysel Ulf T. , Mittmann Thomas
Published: September 2009

Long-term potentiation (LTP) was first described in the mammalian hippocampus and was also elicited in the visual cortex of rats. LTP is most strongly expressed during early postnatal development when synaptic plasticity is high. To test the hypothesis that lesion-induced reorganization in the visual cortex is associated with increased LTP, this chapter examines synaptic plasticity in slices of the lesioned rat visual cortex in vitro. Characteristic changes are in plasticity are observed in the surround of lesions, supporting the hypothesis of enhanced LTP being involved in reprogramming of the visual cortex in response to local damage in the adult visual cortex.
Central auditory plasticity in mouse models of progressive sensorineural hearing loss
Authors: Willott James F.
Published: September 2009

This chapter presents data from mice, expressing genes which cause cochlear lesions, indicating possible consequences for hearing loss-induced plasticity. It also discusses data indicating that an augmented acoustic environment can modulate hearing loss-induced plasticity.
Critical periods for human cortical development
Authors: Ponton Curtis W.
Published: September 2009

This chapter describes the effects that a period of auditory deprivation due to profound deafness, followed by restoration of sensation via a cochlear implant, has on the development of the human auditory central nervous system. Neurophysiological evidence of human central auditory system plasticity in profoundly deaf adults and children who use cochlear prostheses will be based on scalp-recorded electrophysiological activity evoked by activation of the cochlear implant. This activity measured from cochlear implant users is contrasted with that of normal-hearing adults and children to illustrate the similarities and differences in auditory cortical activity. These results are set in the context of what is known about the generators of the AEPs (auditory evoked potentials) as well as recent studies describing the maturational sequence of the neuroanatomical structures, particularly in cortex.
Reprogramming the motor cortex for functional recovery after neonatal or adult unilateral lesion of the corticospinal system in the macaque monkey
Authors: Rouiller E. M. , Wannier T. , Schmidlin E. , Liu Y.
Published: September 2009

This chapter describes the mechanisms underlying reprogramming of the motor cortex in order to rehabilitate some motor control after a lesion affecting the central nervous system, namely the cerebral cortex or the cervical spinal cord. The corticospinal projection was chosen as a model to address the issue of reprogramming the cerebral cortex following a lesion occurring either at early (neonatal) or late (adult) stages. Reprogramming the motor cortex is used to refer to the re-establishment of functional control on motoneurons deprived of cortical inputs as a result of cortical or cervical lesion.
Critical appraisal of a randomized trial of a preventive agent
Authors: Elwood J. Mark
Published: September 2009

This chapter presents an example of the application of the scheme for critical appraisal: a randomized clinical trial entitled ‘Prevention of neural tube defects: results of the Medical Research Council Vitamin Study’, published in The Lancetin 1991. This large individually randomized trial has produced a result which has extremely high internal validity, with observation bias and confounding being ruled out as alternative explanations.
The results obtained from studies of causation
Authors: Elwood J. Mark
Published: September 2009

The previous chapter presented a classification of study design which separated the criteria used to select the groups of individuals to be compared from the time relationships of the study. The logic of this system will appear clear in this chapter, which discusses the results obtained from these studies. The format of the results and therefore the appropriate methods of interpreting them depend on the groups being compared. The extent to which particular problems and biases occur depends largely on the time relationships. Self-test questions are provided at the end of the chapter.
Combining results from several studies: systematic review and meta-analysis
Authors: Elwood J. Mark
Published: September 2009

This chapter is divided into two parts. The first part discusses systematic reviews and the role of meta-analysis. The second part presents the most widely used statistical methods for meta-analysis and related issues such as exploring differences between studies. Self-test questions are provided at the end of the chapter.
The diagnosis of causation
Authors: Elwood J. Mark
Published: September 2009

This chapter presents a scheme for assessing causal relationships in human health. The approach is that the diagnosis of causation depends on the consideration of both causal and non-causal explanations for the association seen. A reasoned judgement must be reached as to the likelihood of the association seen being produced by causality rather than by any other mechanism. The conclusion as to whether a particular association reflects causation is not a simple yes or no, but requires reasoned and probabilistic judgements.
Critical appraisal of a randomized clinical trial
Authors: Elwood J. Mark
Published: September 2009

This chapter presents an example of the application of the scheme for critical appraisal: a randomized clinical trial entitled ‘Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomized double-blind placebo-controlled trial’, published in The Lancet in 2005. This study illustrates both the strengths and weaknesses of randomized trials. The strengths are that with reasonable confidence, confounding and observation bias can be excluded as explanations for the results seen. The main weakness is that despite the enormous effort involved, the study is still limited in terms of size, and the main results are close to the conventional 5% cut-off for statistical significance.
Critical appraisal of a prospective cohort study
Authors: Elwood J. Mark
Published: September 2009

This chapter presents an example of the application of the scheme for critical appraisal: a prospective cohort study entitled ‘Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study’, published in The Lancet, in 2002. Working through this, critical appraisal shows that this is a substantial and carefully performed prospective cohort study, in which the information on outcome, asthma at the age of nine years, is very clear, and the information on breastfeeding is almost equally clear.
Critical appraisal of a retrospective cohort study
Authors: Elwood J. Mark
Published: September 2009

This chapter presents an example of the application of the scheme for critical appraisal: a retrospective cohort study entitled ‘Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols’, published in The Lancet in 1991. Assessed on its own, this study has produced results which are consistent with causality, but are not convincing, as other explanations cannot be excluded. Taken with the background of several other studies which also suggest an increase in this rare condition with this particular exposure, the overall evidence becomes much more persuasive.
Critical appraisal of a large population-based case–control study
Authors: Elwood J. Mark
Published: September 2009

This chapter presents an example of the application of the scheme for critical appraisal: large population-based case-control study entitled ‘Risk of breast cancer in relation to lifetime alcohol consumption’, published in the Journal of the National Cancer Institute in 1995. This large case-control study has shown a regular positive association between recorded alcohol intake and breast cancer risk. The results are generally consistent with the results of other observational studies, most of which, however, would be open to the same limitations.
Introduction
Authors: Elwood J. Mark
Published: September 2009

This introductory chapter begins with a brief description of the purpose of the book, which is to present a system of critical appraisal to help with the evaluation of studies in the health and medical fields, and also with the carrying out of studies more effectively. The method emphasizes the central importance of cause and effect relationships. An overview of the subsequent chapters is presented.
Evidence for Population Health
Authors: Heller Richard
Published: September 2009

This book aims to show the value of developing and applying an evidence base to public health. The application of evidence to clinical practice is well established, and the field of evidence-based medicine accepted as a basic clinical science, not so for public health. The book examines the methods used for Evidence Based Medicine, and shows how these can be applied to public health. In the process, a number of new measures are necessary to extend clinical measures to the population. Population impact measures are described and their value in public health policy-making described and discussed. The book identifies evidence for population health as an appropriate field of study. The chapters are divided in three sections to follow the structure of the Population Health Evidence Cycle: Ask the question, Collect the evidence, and Understand and use the evidence.
The population or the individual in public health?
Authors: Heller Richard F.
Published: September 2009

This chapter explains that there are special influences on health from the “context” in which we live, beyond the genetic and behavioral make up of individuals. The prevention and treatment paradoxes are defined (many have to change for few to benefit, and benefits to individual patients may not translate into much population benefit). Thus, health policy should not take undue note of influences relating to individuals, and should consider the population impact in addition.
Shifting the distribution
Authors: Heller Richard F.
Published: September 2009

This chapter shows that shifting the distribution of a variable for the whole population is an important concept in the prevention of illness. A shift in the population distribution will reduce the numbers of individuals at high risk and hence eligible for treatment, producing a rationale for a population approach to prevention. Health policies aimed at reducing inequalities should also take note of the benefit of shifting the population distribution, as it will improve the health of those at the low end of the distribution.
Evaluating population-based risks and interventions
Authors: Heller Richard F.
Published: September 2009

This chapter discusses the appropriateness of “levels of evidence,” which place systematic reviews of randomized controlled trials as the highest level of evidence, and proposes a new “population evidence hierarchy.” This takes note of alternative study designs based on their credibility, completeness, transferability, and hence usefulness. It is important not to deny the use of evidence in policy making just because it has not come from a systematic review of randomized controlled trials.
Getting the outcome measure right
Authors: Heller Richard F.
Published: September 2009

This chapter considers the individual and the population approaches to assessing health outcomes. Death, hospitalization, quality of life, cost, disability, inequality, and health literacy are considered and compared as health outcomes. A scheme for the critical appraisal of outcome measures is presented. The importance of focusing on outcomes, rather than process, in assessing a health policy is stressed.
Perceptions of risk among policy-makers and the public
Authors: Heller Richard F.
Published: September 2009

This chapter discusses how risk may be understood by, and communicated to individuals, the “public,” and policy-makers. Using the methods of communicating risk to individuals may not be appropriate at the population level, where population health outcomes and values should be used.
Managing knowledge for population health
Authors: Heller Richard F.
Published: September 2009

This chapter looks at how we can turn information into knowledge that can be used to implement the collected evidence—turning evidence into action. Knowledge, which may be explicit (based on external sources) or tacit (based on experience), must be managed in order that it can be used to inform practice. Organizational issues that will facilitate this include leadership, use of information and communications technology, and the organizational culture and skills capacity of the workforce.
Applying evidence to inform public health practice and health policy decision-making
Authors: Heller Richard F.
Published: September 2009

This chapter discusses the tensions between the health evidence base and other factors in making prioritization decisions that will influence public health and its practice. It concludes with a challenge to develop better methods for incorporating evidence into health priority setting.
Moral and legal responsibility and the new neuroscience
Authors: Morse Stephen J.
Published: September 2009

This chapter argues that neuroscience is largely irrelevant if the concept of responsibility is properly understood and evaluated. It begins with a positive description of the dominant conception of personhood and responsibility in Western law and morality. It then considers and rejects the challenge to this conception that any materialist scientific understanding of behavior, including neuroscientific explanation, creates. It argues that unless brain science evolves to such a stage that it radically undermines current conceptions of personhood, the brain will largely be irrelevant to ascriptions of moral and legal responsibility. The chapter concludes by returning to Roper and suggesting the proper way that the case should be argued.
Brains, lies, and psychological explanations
Authors: Buller Tom
Published: September 2009

This chapter addresses the following question: If we adopt the view that it is the brain that feels, thinks, and decides, then how do we accommodate commonsense explanations of human behavior and the notion that we are intentional rational agents capable of voluntary action? It argues that there are limits to the coexistence of folk psychology (and the notion that we are intentional rational agents) and neuroscience. It explores how neuroethics must accommodate both science and ethics and, drawing on contemporary studies of deception, lies, and others, urges an awareness of the limitations of neuroscience in determining thought and defining responsibility for actions.
Being in the world: neuroscience and the ethical agent
Authors: Zoloth Laurie
Published: September 2009

This chapter summarizes several classic arguments about consciousness and the nature of the mind (Descartes, Russell, Parfit, Skinner, Armstrong, Nagel, Dewey, James, Searle, and Koch). It argues that a coherent view of consciousness will include a way to understand memory and rational action, and suggests areas for future research on ethics in a world in which traditional ideas about duty, covenant, ipsity, and relationality are rapidly being re-understood in biological terms. It contends that ethics depends on narrative structures that give meaning to norms. Hence, the way that minds (and brains, to be precise) structure story and rule is critical to how we know and discern. At the core of this is memory and motive, yet for the ethicist, it will be the publicity of the moral gesture, the play out in history and social space, that is the final criterion of what beings mean to one another.
Creativity, gratitude, and the enhancement debate
Authors: Parens Erik
Published: September 2009

This chapter describes two ethical frameworks out of which people seem to come to the academic debate about enhancement technologies. It argues that the impulse to creativity (or self-transformation) can be thought of as the organizing commitment for one framework, and that the impulse to gratitude (or letting things be) can be thought of as the organizing commitment of the other. It also describes some of the different sets of reasons that seem to cluster around each of those commitments. Different reasons seem most salient, depending on one's framework.
Ethical dilemmas in neurodegenerative disease: respecting patients at the twilight of agency
Authors: Jaworska Agnieszka
Published: September 2009

This chapter presents a case study that illustrates the interplay between ethical conceptual analysis and neuroscientific findings in the resolution of moral dilemmas that arise in Alzheimer's disease. It defends the philosophical view that the immediate interests of an individual cannot be overridden as long as the individual possesses the capacity to value. In the context of each particular neurodegenerative disease, this recommendation must be guided by a scientifically informed assessment of when in the course of the disease the capacity to value could possibly be lost, and when it is likely to be retained. In the case of Alzheimer's disease, neuroscientific evidence indicates that the capacity to value is slowly and gradually weakened, and in some cases may not be completely lost until relatively far along in the disease's progression. Similar neuroethical analyses must be carried out for other diseases and disorders, and will probably yield different results.
Facts, fictions and the future of neuroethics
Authors: Gazzaniga Michael S.
Published: September 2009

This chapter argues that cognitive neuroscience has three main issues with respect to the current field of neuroethics. First, cognitive neuroscience can help with some current ethical dilemmas such as whether the embryo has the moral status of a human being. Secondly, there are important ethical areas to which neuroscientists are being asked to contribute when, in fact, they should not be. For instance, neuroscience has nothing to say about concepts such as free will and personal responsibility, and it probably also has nothing to say about such things as antisocial thoughts. Finally, cognitive neuroscience is building an understanding of how brain research will instruct us on ideas like universal morals possessed by all members of our species. This fundamental development will find cognitive neuroscience becoming central to the modern world's view of ethical universals.
A picture is worth 1000 words, but which 1000?
Authors: Illes Judy , Racine Eric , Kirschen Matthew P.
Published: September 2009

This chapter provides a brief review of technological capabilities for imaging the brain with an emphasis on functional methods, and explores the range of applications for which they have been used. It then examines the epistemological issues associated with this research. It proposes a set of new dimensions for responsibility to accompany the still-emerging field as it realizes increasingly greater potential, continues to grapple with the technology, and faces unprecedented ethical and social challenges.
Clinicians, patients, and the brain
Authors: Klitzman Robert
Published: September 2009

This chapter focuses on where and how several key neuroethical issues converge and diverge in diagnosis and treatment. First, it examines the broad obstacles that exist to addressing neuroethical problems optimally in clinical settings. Secondly, it explores ways that these barriers manifest themselves specifically in diagnostic tests that use neuroimaging and neurogenomics, and other clinical scenarios that involve treatment interventions. It discusses several sets of predicaments that appear likely to emerge, although others will no doubt confront clinicians as neurotechnology continues to advance.
The social effects of advances in neuroscience: legal problems, legal perspectives
Authors: Greely Henry T.
Published: September 2009

The term ‘neuroethics’ has been given several kinds of meanings. One use of neuroethics describes ethical problems arising directly from research in neuroscience; for example, what should researchers doing brain imaging tell research subjects about unusual findings of no known clinical significance? The term is also used to describe neuroscience (usually imaging) research into how humans resolve ethical or moral issues; for example, what parts of the brain are activated when subjects are wrestling with moral dilemmas? This chapter discusses a third area of neuroethics: the implications of new discoveries in, and capabilities of, neuroscience for our society and their consequences for the legal system. It looks specifically at three different ways in which neuroscience seems likely to change society and law. The discussion focuses on the society and the legal system of the United States, but the same basic issues will be found in all technologically advanced societies.
Poverty, privilege, and brain development: empirical findings and ethical implications
Authors: Farah Martha J. , Noble Kimberly G. , Hurt Hallam
Published: September 2009

This chapter attempts to relate findings on socio-economic status (SES) and brain development. The ultimate goals are to inform practical decisions concerning child policy, and to reveal the neuroethical dimensions of the problem of childhood poverty. It shows that who we are is determined not only by genetically programmed development, neurodegenerative disease, and psychoactive drugs, but also by the socio-economic circumstances of our childhood in equivalently physical mechanistic ways. Neuroethicists have rightly called attention to the ethically complex ability of drugs to change who we are. It is metaphysically just as perplexing, and socially at least as distressing, that an impoverished and stressful childhood can diminish us by equally concrete physical mechanisms, such as the impact of early life stress on medial temporal memory ability through neuroendocrine mechanisms.
Afterword. Neuroethics: mapping a new interdiscipline
Authors: Kennedy Donald
Published: September 2009

This chapter, drawn from the first ever presidential address on the topic of neuroethics at the annual meeting of the Society for Neurosciences, takes a look back at the discipline and a look forward. In 2003, the author projected areas of major neuroethical concern — privacy was a particularly big one — and brought attention to their ethical significance and meaning for neuroscience. This chapter reflects further on these issues, especially as they are raised in this volume, and brings us closer to realizing how intimately inseparable our science and specifically identity are from our moral world.
Memory, Cognition, and Dreams
Authors: Stickgold Robert
Published: September 2009

This chapter reviews recent findings from studies on cognitive processing during sleep using two distinct approaches. It first describes a series of studies that used standard cognitive testing to determine how these basic cognitive processes are altered during various sleep stages. It then describes a second set of experiments which used actual dream reports to investigate the nature of cognitive processing during sleep. The chapter concludes with a model of dream construction that suggests the nature of the relationship between dreaming and off-line memory reprocessing.
Expression and Modulation of Memory Traces During Paradoxical Sleep
Authors: Hennevin Elizabeth
Published: September 2009

This chapter begins with a discussion of the ups and downs of the research on sleep and memory. It then reviews studies on the importance of post-learning paradoxical sleep, the modulation of memory during post-learning paradoxical sleep, and neuronal plasticity and expression of memory traces during paradoxical sleep.
Neuronal Plasticity During Sleep Oscillations in Corticothalamic Systems
Authors: Steriade Mircea , Timofeev Igor
Published: September 2009

This chapter argues that spontaneously occurring brain rhythms during slow wave sleep (SWS) produce plastic changes in thalamic and neocortical neurons. It discusses the role played by augmenting responses elicited by stimuli at 10 Hz, which are the experimental model of sleep spindles, in producing plastic changes in neuronal properties through the rhythmic repetition of spike-bursts and spike-trains fired by thalamic and cortical neurons.
Molecular Mechanisms of Memory Consolidation
Authors: Hellman Kevin M. , Abel Ted
Published: September 2009

This chapter describes how neuromodulators and electrophysiological phenomena in the hippocampus during NREM and REM sleep affect intracellular signaling pathways that are known to mediate memory consolidation. The hippocampus appears to be a locus for consolidation during sleep, because it is required for the consolidation of spatial learning and contextual fear conditioning and these tasks require sleep for consolidation. During this period of sleep, replay of activity occurs in the hippocampus in oscillations that have the ability to alter synaptic plasticity, perhaps via molecular cascades involved in LTP.