bluuebunny/crossref_metadata_2025 huggingface dataset:
The Arc of Epidemiology
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter focuses on the evolution of causal research in epidemiology and how it influenced and was influenced by studies of psychiatric disorders. It discusses the three broad eras comprising the past evolution of epidemiology, spanning the period from the beginning of the 19th to the close of the 20th century (Sanitary Era, Infectious Disease Era, and Risk Factor Era). Each era lasted about fifty–seventy-five years and introduced a distinctive way of thinking about the causes of disease. The transition from one era to the next brought a powerful new strategy for finding causes and improving public health, but also led to the neglect of approaches developed in the previous eras, so that the field took ‘three steps forward and one step back.’ A fourth era is emerging, although its shape is not yet clear.
Study Designs
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter describes different risk factor study designs. Study designs can be viewed as techniques for organizing observations in ways that can reveal the causes of disease. The risk factor study designs attempt to do this by mimicking the counterfactual, which is the true test of causal effects. When the mimicry is successful, studies isolate the effects of the exposure on the disease. In regard to this mimicry, the randomized controlled trial is the simplest and most direct, but practical for only a small number of exposures. The cohort study is much more widely applicable, but selection into exposure is not random. The case-control study is more complex and indirect but often the most useful. Although the specific techniques differ among designs, the underlying strategy is the same—the examination of fully comparable groups of exposed and unexposed individuals to isolate the effects of specific risk factors. The chapter illustrates how each study was used to investigate the causal effect of low prenatal folate intake on neural tube defects (NTDs).
Relationships among Causes
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

Over the past fifty years, epidemiologists have refined the methods for isolating risk factors and put them to extremely good use. By examining one risk factor at a time, however, we cannot fully understand the etiology of a disease. Causes interact with one another and change one another in a dynamic process. This chapter presents and illustrates an elementary framework for translating ideas about disease causation into a set of predicted relationships among several variables in the web of causation, rather than merely into a predicted relationship between the exposure and the disease.
Diversity of Cohort Studies
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

The previous chapter described a prospective population cohort study as a prototype. By modifying one or another element of this prototype, this chapter constructs natural experiments, historical cohorts, and special exposure cohorts. To these three major variants a fourth is added—the clinical cohort—the purpose of which is to discover the determinants of the course and outcome of a disorder. This variant, close kin to the etiologic cohort, has been prominent in psychiatric epidemiology. The chapter gives an account of a cohort study that has evolved over a period of more than fifty years. Finally, it introduces a data set, the Prenatal Determinants of Schizophrenia Example (PDSE) study, for illustration in this and other parts of the book.
Causal Inference: A Thought Experiment
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

A cohort study is always a kind of ‘thought experiment’. One needs to imagine what results ‘would have been’ if the exposed and the unexposed groups had in fact been fully comparable. This chapter sets up a framework for conducting this thought experiment in a systematic way. The exposed and unexposed may differ on (1) other causes of the disease (confounding); (2) the length of time over which they are observed (unequal attrition); and (3) the accuracy with which cases are ascertained (differential misclassification). Each of these factors may account for part, or even all, of an apparent association between the exposure and the disease. They can also suppress an association or reverse it. The process of causal inference depends upon the identification and evaluation of these alternative explanations for results. This chapter shows how confounding, unequal attrition, and differential misclassification can produce an association between exposure and disease.
Confounding: What It Is and What Can Be Done
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

The first part of this chapter discusses the conditions under which a factor can confound the association between exposure and disease, and the conditions under which this cannot occur. It also differentiates confounders from antecedents or mediators. The next part discusses methods devised to neutralize the effects of confounders. Two standard methods are presented: matching to prevent confounding in the data by equalizing the exposed and the unexposed on a potential confounder, and statistical adjustment to compensate for confounding in the data by separating the effects of the exposure from the effects of the confounder.
Unequal Attrition under Different Types of Follow-Up
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter provides a framework for the prevention and control of bias due to unequal attrition in cohort studies. Like the effects of third-variable confounding, the effects of unequal attrition can be limited by the design, as well as the analysis, of a cohort study. The most problematic kind of attrition is differential. This kind of attrition causes a bias that may not be remediable. The chapter uses sensitivity analysis to gauge the potential bias.
Differential Misclassification
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter addresses misclassification of the disease that is linked to the exposure, that is, misclassification of disease that is unequal for the exposed and the unexposed groups. This is the type of misclassification most relevant to cohort studies. It begins by describing common scenarios of differential misclassification in psychiatric research. It then considers the resulting bias and how this can be limited. The chapter also discusses two special cases: third-variable effects and dependent nondifferential misclassification.
Logic of the Case-Control Design
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter explains the logic of the case-control strategy. It shows how to conceptualize a case-control study as a condensed version of a cohort study. This relationship between the two designs is well established in epidemiology. It is not familiar, however, to many researchers in other fields.
Applications of the Case-Control Study
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

Implementing a case-control study presents three central challenges. The first is to select cases and controls from the same source population. The investigator attempts to visualize the population that gave rise to the cases, and to select the controls appropriately from this population. The second is to establish the temporal order of exposure and disease. As opposed to the cohort study, in the case-control study the antecedence of the exposure to the disease is not established by design. The third is to obtain an unbiased measure of the exposure with information retrieved retrospectively, after the outcome is already known. The retrospective measurement presents the problem that misclassification of the exposure can be linked to the disease status. This chapter illustrates how case-control studies of psychiatric disorders have attempted to meet these challenges.
Biologic Studies in Psychiatry
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

Although epidemiologic and biologic researchers share the common goal of finding causes of psychiatric disorders, they approach the task from different vantage points. As a result, they sometimes advocate conflicting approaches to the design of studies. This chapter first takes the perspective of a biologic researcher. It points out the challenge of measuring the brain and how it sets the stage for research designs. It then takes the perspective of an epidemiologist, suggesting that biologic studies can be directly linked to epidemiology through consideration of the biologic factors being investigated within the same framework as other potential causes or risk factors for disease. The chapter shows how two classic biologic studies can be conceptualized as case-control studies.
Choosing Controls in Biologic Psychiatry
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

One of the most difficult and intellectually intriguing tasks of a biologic case-control study is the selection of the control group. An inappropriate control group can mask the presence of a true association or create the illusion of an association when one does not exist. Choosing a control group depends on thinking through the implications of many other features of the study: the types of cases being selected, the biologic process being examined, and most critically, the specific hypothesis being tested. No criteria can be advanced to define the perfect control group, because there is no control group that is appropriate for all or even most case-control studies. Nonetheless, it is possible to approach the task systematically. The previous chapters derived a practical guideline for making the best choice of a control group in an ordinary case-control study. This chapter demonstrates how it can be applied to biologic studies of causes. It takes up a central question, applies the guideline, and arrives at an answer that has important implications for biologic research.
Assessing Heterogeneity of Effects
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter introduces methods frequently used in epidemiology to assess statistical heterogeneity of effect in the studied sample. As in the case of confounding, the main analytic methods include stratification and statistical modeling. It first defines additive and multiplicative interaction. It then describes methods based on stratification: comparing homogeneity across strata of the effect modifier, comparing the expected and observed joint effect of two factors, or using graphical representation of interaction. It also briefly indicates methods that allow the testing of the statistical significance of apparently heterogeneous effects. Finally, the chapter introduces statistical modeling of interaction by logistic regression.
Integrating Epidemiology with Genetics
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter discusses the integration of research on genetic and environmental causes. It argues that finding genetic causes of mental disorders will also provide a key to finding nongenetic causes. An environmental cause would more likely be detected if researchers studied the individuals whose genetic makeup renders them vulnerable to its effects. The converse is also true. Researchers would more likely find a genetic cause if they could study the individuals who have the environmental exposure required for this genetic vulnerability to lead to a disease.
Genetic Association Studies
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter focuses on genetic association studies. The goal of genetic association studies is to investigate the effects of genotypic variation on disease risk. These designs are built on a concept of a genetic cause that closely resembles the concept of a risk factor in epidemiology. Moreover, they correspond well to designs previously articulated by risk factor epidemiologists. Thus, the concepts and methods of risk factor epidemiology are particularly useful in this context.
Twin Studies of Heritability
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

This chapter focuses on the methodological issues arising from the discrepancy between the results of heritability studies and epidemiologic designs. It focuses on the basic principles of the heritability design. The discussion is limited to heritability studies of twins, which is used as a prototype. The discussion is also limited to a categorical disease outcome. The chapter begins by describing the twin study, a type of natural experiment, and explains how it can estimate the contributions of genetic and environmental causes of a disorder. It then compares the twin studies to risk factor designs. It proposes a reason that these approaches can yield different results for the effect of shared family environment.
Designs for the Genomic Era
Authors: Susser Ezra , Schwartz Sharon , Morabia Alfredo , Bromet Evelyn J.
Published: September 2009

Genomics offers to genetics and to epidemiology powerful analytic tools and information unprecedented in medical research. Searches for genetic causes now exploit this richness. Traditional designs are modified to achieve their goals more directly, and new designs are possible. Because the designs are still evolving, often by trial and error, any description of the present state may soon be outdated. This chapter focuses on a limited number of themes that should have enduring import. It describes some of the key challenges presented by the use of genomic information and then suggests a strategy to help address these challenges.
Introduction
Authors: Ford, Jr. Lacy K.
Published: September 2009

This introductory chapter begins with a discussion of the differences in the ideas and interests surrounding slavery in the upper South and lower South. It then explains the structure and argument of the book. An overview of the seven parts of the book is presented.
Chapter Two Rebellion and Reaction
Authors: Ford, Jr. Lacy K.
Published: September 2009

This chapter explores the impact of Gabriel's insurrection plot on the upper South's consideration of slavery's future. White authorities in Virginia brutally suppressed the rumored rebellion in peremptory fashion and enacted strong measures to protect white safety. But the longer-term impact of the Gabriel insurrection scare intensified discussion of ways to facilitate colonization, encourage gradual emancipation (through the presumed success of colonization), and, most of all, stimulate the diffusion of slaves to the new cotton lands of the Southwest through the domestic slave trade.
Chapter Five Paternalism Emerges
Authors: Ford, Jr. Lacy K.
Published: September 2009

The emergence of the paternalist movement from its humble late-18th-century origins became a potent insurgency in the lower South. Paternalism's advocates faced twin challenges: they had to both persuade slaves to accept Christianity and convince whites that paternalism was an effective method of slave control. This chapter charts paternalism's rise during the Second Great Awakening and its emergence initially in areas such as the Carolina and Georgia Lowcountry, which had a network of well-established churches.
Chapter Six Paternalism Contested
Authors: Ford, Jr. Lacy K.
Published: September 2009

This chapter examines the actions of those lower South whites who countered that paternalism was not an effective means of slave control. The massive migration of whites and the concomitant forced migration of slaves to the fresh cotton lands of western Georgia, Alabama, Mississippi, and Louisiana generated a need for strict slave discipline in rapidly developing areas that played against the paternalist message of familial treatment of slaves. The constant tension punctuated by open conflict between the whites who settled the lower South and the Native American population that had long called the region home also encouraged whites to see military and paramilitary force as essential to their survival. Open warfare with Great Britain and the increased fear of slave insurrection that accompanied it also worked against the thrust of paternalist ideology by generating a popular taste for force and coercion.
Chapter Eleven Rumors and Insurrection
Authors: Ford, Jr. Lacy K.
Published: September 2009

This chapter examines the immediate reaction of upper South whites to the publication of David Walker's Appeal and Nat Turner's slave revolt in Virginia. The deep fear and persistent anxiety that the Turner insurrection aroused among upper South whites, and white Virginians especially, is discussed as background to a growing popular interest in accelerating the demographic reconfiguration of slavery in the region.
Chapter Thirteen Tennessee Debates Slavery
Authors: Ford, Jr. Lacy K.
Published: September 2009

This chapter examines Tennessee's debates on slavery. In the middle South, the Turner crisis raised questions about the future of slavery and the position of free blacks in a slaveholding society. These issues were debated not in the aftermath of a divisive state constitutional convention, as was the case in Virginia, but as Tennessee and North Carolina moved haltingly but inexorably toward state constitutional conventions of their own. These constitutional reform movements were driven by the pressure from white egalitarians eager to democratize state politics as thoroughly as possible despite entrenched conservative opposition. Thus, in the middle South, the debates over slavery and free blacks occurred within the cauldron of a white egalitarian crusade for constitutional revision.
Models for Disease
Authors: Holford Theodore R.
Published: September 2009

This chapter discusses the concept of a model for the disease process, emphasizing simple and very general models that can be used to study a variety of diseases. Quantities that are used to describe this fundamental model are the hazard function, the survival function, and the failure time density function. Each of these quantities can be derived from one of the others, so that they are really different expressions of the same underlying concept. Two forms are often used for the hazard: a constant hazard and a Weibull hazard. In many applications, however, it is not feasible to describe adequately the hazard by a simple mathematical function, which is one reason for the availability of non-parametric or semiparametric methods.
Analysis of Time to Failure
Authors: Holford Theodore R.
Published: September 2009

This chapter considers nonparametric methods for summarizing the occurrence of failures over time. The survival curve is the most commonly used summary, and actuarial, piecewise constant, and product limit estimators are discussed. Another use for estimates of survival curves is to validate assumptions about the distribution of times to failure that may underlie a parametric analysis. For this type of analysis plots of the log and the log-log of the survival curve are considered, which provide a diagnostic tool for evaluating the validity of assumed exponential, or Weibull, distributions. Finally, tests for comparing two survival curves are considered, which are best used when the proportional hazards assumption applies. Exercises are provided at the end of the chapter.
Parametric Models for Hazard Functions
Authors: Holford Theodore R.
Published: September 2009

This chapter considers several approaches to using regression models when a mathematical expression that describes the way in which the hazard varies with time is known. The simplest of these is the constant hazard model, which does not vary with time. Applications of the Poisson regression model are described. The Weibull distribution is also considered, which provides very useful generalizations to the constant hazard assumption. Exercises are provided at the end of the chapter.
Analysis of Matched Studies
Authors: Holford Theodore R.
Published: September 2009

This chapter discusses methods of analysis for studies that employed matching in order to adjust for potential confounding of the disease exposure association of interest. It distinguishes between a general strategy of stratification to achieve balance for an important covariate, which can subsequently be included in the analysis; and rigorous matching in which one or two unique controls are identified for a study subject. The first methods considered made use of score statistics. These methods were then extended to model fitting, which can be accomplished using either logistic regression or proportional hazards software. Exercises are provided at the end of the chapter.
Power and Sample Size Requirements
Authors: Holford Theodore R.
Published: September 2009

This chapter considers the sample size and power aspects of study design. It considers sample size from the perspective of estimation, in which the confidence interval indicated the level of precision desired for the study. It then discusses two-group hypothesis tests and general hypothesis tests.
Extending Regression Models
Authors: Holford Theodore R.
Published: September 2009

This chapter considers some new directions that are emerging as important tools for the analysis of epidemiological data and which offer extensions to the approaches used in earlier chapters of this text. Some of these methods have been better developed than others, but they are active areas of research that should ultimately provide essential tools to the analytic epidemiologist.
The multidisciplinary nature of public health genetics in research and education
Authors: Austin Melisa A. , Peyser Patricia A.
Published: September 2009

This chapter presents an overview of areas of research that provide information important to genetics in public health. It discusses education in public health genetics. It also presents in-depth descriptions of two emerging graduate programs at the universities of Michigan and Washington and describes other educational opportunities. The chapter concludes with a summary of future needs for research and education in public health genetics.
Surveillance for birth defects and genetic diseases
Authors: Botto Lorenzo D. , Mastroiacovo Pierpaolo
Published: September 2009

This chapter describes some surveillance issues that will likely be increasingly relevant as birth-defects surveillance moves into the future, and that provide instructive similarities and contrast with the emerging field of genetic disease surveillance. In the discussion of genetic-disease surveillance, emphasis is placed on high-penetrance, single-gene conditions that usually manifest in the pediatric age group.
Surveillance for hemophilia and inherited hematologic disorders
Authors: Soucie J. Michael , Rickles Frederick R. , Evatt Bruce L.
Published: September 2009

This chapter discusses public health surveillance of hemophilia and inherited hematologic disorders. Topics covered include the importance of data in establishing and maintaining good health care delivery systems, considerations for data collection in the hemophilia population, selection of data collection system and content, and surveillance programs for hemophilia in the United States.
Public health assessment of genetic susceptibility to infectious diseases: malaria, tuberculosis, and HIV
Authors: McNicholl Janet M , Downer Marie V. , Aidoo Michael , Hodge Thomas , Udhayakumar Venkatachalam
Published: September 2009

The understanding of the host genetic factors that influence susceptibility to and the course of infectious diseases is growing rapidly. Even for the most common pathogens, however, there is an incomplete understanding of all the important genes. As sequencing of the more than 100,000 human genes continues and as technologies advance, new discoveries about host genes and their role in infectious diseases are made almost daily. Translating this knowledge into public health actions, particularly those aimed at combating and controlling infectious diseases, is a major challenge. This chapter focuses on this downstream phase of genetics, particularly on how new knowledge can be integrated into existing public health programs and strategies.
Newborn screening quality assurance
Authors: Hannon W. Harry , Henderson L. Omar , Bell Carol J.
Published: September 2009

This chapter discusses quality assurance (QA) for newborn screening programs. It describes the Newborn Screening Quality Assurance Program (NSQAP) at the CDC in Atlanta, Georgia, which provides services for laboratories that use specimens of dried-blood spots (DBSs) to perform newborn screening tests. The mission of this program is to improve interlaboratory comparability and to work toward interlaboratory standardization.
Community genetics in the Netherlands
Authors: Ten Kate Leo P.
Published: September 2009

This chapter reviews the current situation in the Netherlands, starting with some background information on health insurance schemes, followed by a description of clinical genetics services, and a survey of community genetics services. It then considers the prevailing climate of fear and uneasiness regarding genetics in Dutch society at large and among politicians in particular. Finally, the chapter describes the activities of a small band of people who are trying to get community genetics “on the agenda”.
Lessons learned from newborn screening for phenylketonuria
Authors: Pass Kenneth A.
Published: September 2009

This chapter discusses the lessons learned from newborn screening for phenylketonuria (PKU) in the U.S. Newborn screening is, conceptually, a simple public health program with well-defined goals. The implementation of a successful program requires many components outside the testing laboratory, extensive expertise in areas ranging from phlebotomy to genetic counseling, attention to innumerable details, and, above all, dedication by all staff involved. In terms of public health impact, newborn screening touches more lives daily than perhaps any other public health program, and its influence now extends far beyond the perinatal period.
Applying genetic strategies to prevent atherosclerosis
Authors: Williams Roger R. , Hopkins Paul N. , Wu Lily L. , Hunt Steven C.
Published: September 2009

Atherosclerotic disease of coronary and cerebral arteries accounts for almost half of all deaths in the United States each year. Heart attacks and strokes are often attributable to inherited predisposition, especially when they occur at a relatively early age. Researchers are accumulating information regarding the role of genetics in influencing the risk factors for atherosclerosis in several major categories, including lipids and lipoproteins (LDL HDL and VLDL cholesterol; Lp(a); triglycerides; apo ALAII, and B; apo E genotypes); glucose and insulin metabolism (diabetes, glucose intolerance, and insulin resistance); prothrombotic factors (fibrinogen, plasminogen activator inhibitor-1, factor VII coagulant activity, homocysteine); and hypertension. This chapter discusses the basic approaches for evaluating and addressing heritable factors for atherosclerosis.
Genetics, public health, and the law
Authors: Clayton Ellen Wright
Published: September 2009

This chapter discusses the legally defined scope of the government's powers to use genetic information to improve the public health. It begins by discussing public health law more generally before turning to the particular challenges raised by genetics.
Genetics and public health: informed consent beyond the clinical encounter
Authors: Press Nancy , Clayton Ellen Wright
Published: September 2009

This chapter begins with a discussion of the barriers to adequate informed consent. It then presents examples that show how public health and genetics might come together, either in research or in clinical programs. The examples cover prenatal genetic screening, newborn screening programs, and the ways in which all genetics research inevitably involves families. It is argued that in designing modes of obtaining informed consent, explicit consideration must be given to the structural forces that may make truly informed consent difficult in each particular situation. Moreover, it must be realized that these structural forces have the potential to increase in importance and impact when coupled with any program that purports to have the public's health at stake.
Public health surveillance of genetic information: Ethical and legal responses to social risk
Authors: Burris Scott , Gostin Lawrence O. , Tress Deborah
Published: September 2009

The practice of public health begins with effective surveillance of physical characteristics, diseases, behavior, and environmental conditions that significantly influence a population's well-being. Although surveillance of genetic information will significantly advance the public's health, it also entails some real and perceived risks. The social objective is to achieve the public good that comes from genetic information without unreasonable or unethical interference with the civil liberties of individuals. But even when individual interests are well protected by law, perceptions of risk to social status, employment, or other relationships can persist and confound useful public health data collection. This chapter explores the problem that such “social risk” poses to public health collection of genetic data. It discusses the capacities and limitations of law as an antidote to social risk, and presents ethical principles for understanding and assessing the benefits and risks of population-based genetics. It concludes with recommendations for surveillance policy and research.
Study Design, Measures of Effect, and Sources of Bias
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter addresses the principles of research study design. It provides an in-depth description of commonly used study designs to address research objectives. It presents information about study designs for descriptive epidemiology (i.e., studies of disease incidence, prevalence, and mortality rates) and analytic epidemiology (i.e., randomized trials, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case-control studies). It describes the measures of effect that reflect the associations between health predictors and neurologic outcomes (odds ratios, relative risks). The second part of the chapter describes common study biases that can adversely affect study validity (sampling error, selection bias, confounding) and how to avoid these biases in the design and conduct of clinical and epidemiological studies.
Alzheimer’s Disease and Vascular Dementia
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter explores the frequency with which dementing illnesses occur in populations, their distributions by personal characteristics, and what is known about their causes and potential protective factors. The primary focus is on the most common forms of dementia: Alzheimer's disease and vascular dementia. The chapter summarizes clinical and pathologic features of Alzheimer's disease and vascular dementia, and highlights recent theories of how risk factors affect brain reserve. With the evolution of the epidemiology of dementia from case-control studies to prospective cohort studies has come a new set of methodological challenges. These include identification of representative populations, enhancing subject participation and retention in studies, the need to include institutionalized as well as community-dwelling populations, the non-standardized use of cognitive tests to screen for dementia, and the complexities of the diagnostic process itself. Finally, the chapter summarizes risk and protective factors for disease expression, including cardiovascular risk factors, lifestyle factors, and factors that affect brain reserve.
Movement Disorders
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter covers five movement disorders: Parkinson's disease, dystonia, tic disorders, Huntington's disease, and essential tremor. These disorders demonstrate many of the most common challenges encountered in the epidemiologic investigation of movement disorders. Each section includes a description of the disease, followed by a review of descriptive studies (disease incidence, prevalence, and mortality studies), and discussion of genetic and environmental risk factors for the disorder. At the end of each section, directions for future studies are discussed.
Amyotrophic Lateral Sclerosis
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter focuses on amyotrophic lateral sclerosis (ALS), the most common motor neuron disease. It discusses the three major forms of ALS: sporadic ALS, the familial or hereditary form of ALS, and the western Pacific (Mariana Islands) form. Considerable progress has been made in recent years on identifying genetic loci responsible for Mendelian forms of ALS; this evidence is summarized. The potential importance of geographic clusters is discussed, with particular emphasis on the western Pacific form of ALS because it often occurs in association with a parkinsonism and/or dementia complex (PDC). The incidence of Western Pacific ALS peaked and then declined in the mid-20th century, which strongly implicated an environmental cause. The chapter also presents detailed information regarding putative risk factors for sporadic ALS, which includes environmental toxicants, skeletal trauma, cigarette smoking, diet, and vigorous physical activity.
Multiple Sclerosis
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter provides information on the epidemiology of multiple sclerosis (MS), the most common disabling neurological disease in young adults. It describes the clinical and pathologic features of MS and how these features pose challenges for clinical diagnosis and case definition criteria. Information is provided regarding the descriptive epidemiology of MS, including studies of incidence, prevalence, and temporal trends in MS frequency. Also included is a discussion of the interesting geographical features of the MS distribution, including MS disease clusters, the latitude gradient in disease risk, and migrant studies of individuals who move from high-risk to low-risk regions. Other sections of the chapter cover evidence regarding the infectious etiology of MS, including the important role that Epstein-Barr virus appears to play in disease susceptibility. The role of lifestyle factors is receiving increasing emphasis in MS epidemiologic studies, and evidence is summarized regarding the potential role of cigarette smoking, diet, and hormonal factors.
Brain and Spinal Cord Injury
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

Up to 50% of all trauma deaths in the United States involve significant injury to the brain or spinal cord. This chapter highlights the public health significance of traumatic brain and spinal cord injury and examines methodological issues in studies of the epidemiology of these injuries. It addresses methodological challenges in epidemiologic and clinical studies of brain and spinal cord injury, including difficulties in case ascertainment, differing approaches to brain injury classification, and measurement issues in brain injury severity and outcome scales. The chapter summarizes scientific literature addressing demographic and lifestyle risk factors for brain injury including age, sex, and alcohol consumption. External causes of traumatic brain and spinal cord injury are also discussed, including transportation-related injuries and increasingly recognized sports-related brain injuries.
Peripheral Neuropathy
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter focuses on peripheral neuropathy, which is the third or fourth most common neurologic disorder, even among the elderly. It begins with a description of the classification system for peripheral neuropathies. Because the underlying etiology or precipitating events of peripheral neuropathy are identifiable for the majority of affected individuals, epidemiologic research has largely focused on descriptive studies of disease frequency or on identifying the factors that modify the influence of the already existing risk factors. Three of the most common neuropathies are covered in detail: diabetic neuropathy, carpal tunnel syndrome, and Guillain–Barré syndrome. Each of these conditions is discussed in terms of distribution and risk factors, and is concluded with a discussion of future research directions to address unanswered questions. The chapter emphasizes methodologic approaches that that could be employed to improve the rigor of studies of these conditions.
Epilepsy
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter begins with a discussion of the taxonomy of seizure disorders and the clinical features of epilepsy that pose methodological challenges in clinical and epidemiologic studies. Descriptive studies of incidence and prevalence are described for the following seizure types: partial, generalized tonic-clonic, myoclonic, and absence seizures. Risk factors for epilepsy are discussed in the context of case-control and cohort designs, and evidence is summarized regarding the role of non-genetic risk factors (traumatic brain injury, infections, cerebrovascular disease, brain tumors, degenerative CNS diseases, and developmental deficits). The chapter discusses factors associated with prognosis and mortality of epilepsy, as well as common causes of death in epilepsy patients. The final section addresses evidence for familial aggregation and genetic causes of seizures.
Health Services Research in Neurology
Authors: Nelson Lorene M. , Tanner Caroline M. , Van Den Eeden Stephen K. , McGuire Valerie M.
Published: September 2009

This chapter covers the principles of health services research, which is critical for understanding and reducing the burden of neurological disease across populations. The goal of neurologic health services research is to create a scientific basis for measurably improving the care that is provided to patients with both chronic and acute neurological conditions. It is multi-disciplinary research that draws on the expertise of neurologists trained in clinical research methods, economists, biostatisticians, epidemiologists, sociologists, and other social scientists. Typical sources of data for health services research studies are surveys and interviews, medical records, and administrative data sets. Most health services researchers employ a combination of quantitative and qualitative research methods, and they work in collaboration with health care administrators and organizations in which health care is provided in the US. The chapter encompasses the design and execution of studies of access to care, quality of care and outcomes research, effectiveness, and cost-effectiveness.
The Quantitative Assessment of Neighborhood Social Environments
Authors: Raudenbush Stephen W.
Published: September 2009

As interest in the social sciences and public health increasingly turns to the integration of individual, family, and neighborhood processes, a potential mismatch arises in the quality of measures. Standing behind individual measurement are decades of research, producing measures that often have excellent statistical properties. In contrast, much less is known about measures of ecological settings such as neighborhoods, and the methodology needed to evaluate these measures is in its infancy. This chapter aims to adapt tools from psychometrics to improve the quality of ecometric measures. An extension to the approach sketched in the chapter would take into account spatial autocorrelation. Neighborhood clusters have been treated as independent. Ongoing work will build spatial associations into the models presented here.
Geocoding and Measurement of Neighborhood Socioeconomic Position: A U.S. Perspective
Authors: Krieger Nancy , Zierler Sally , Hogan Joseph W. , Waterman Pamela , Chen Jarvis , Lemieux Kerry , Gjelsvik Annie
Published: September 2009

This chapter focuses on conceptual and methodologic issues germane to public health monitoring in the United States. Many of the concepts, methods, and questions, however, are likely to be relevant to other countries as well as to etiologic studies of neighborhood effects on health and other aspects of well-being. It argues that data on the socioeconomic characteristics of neighborhoods—whether compositional or contextual—can be useful for describing and monitoring social inequalities in health.
Neighborhoods and Infectious Diseases
Authors: Fullilove Mindy Thompson
Published: September 2009

This chapter focuses on a series of neighborhood-level social/structural processes that have influenced the spread of HIV, syphilis, gonorrhea, and tuberculosis in the United States. Through the lens offered by three highly social processes, it examines the ways in which fundamental causes of disease, in the sense proposed by Link and Phelan (1995), contribute to the propagation of infectious disease agents and cases of infection. The chapter focuses on the local construction of sex and drug scenes, disruption in neighborhood cohesion, and the “redlining” of epidemics that are concentrated in marginalized communities.
Residential Segregation and Health
Authors: Acevedo-Garcia Dolores , Lochner Kimberly A.
Published: September 2009

This chapter examines research on racial segregation and health. It argues that both theoretically and empirically, research on neighborhood effects needs to relate neighborhood characteristics to broader social processes such as class segregation, racial/ethnic segregation, and residential mobility. So far, U.S. research on segregation and health has not addressed this type of question. Multilevel studies that assume that neighborhoods do not occur in isolation but are influenced by their metropolitan area may enrich the research on neighborhoods and health.
Neighborhoods and Networks: The Construction of Safe Places and Bridges
Authors: Berkman Lisa F. , Clark Cheryl
Published: September 2009

This chapter examines the role of neighborhoods in the structure and functioning of networks. It also aims to classify communities as lost, saved, or liberated based on the structure and function of networks and the extent to which these networks are geographically bounded. It considers two very different communities: gay and lesbian communities in cities and inner-city African-American communities. Men and women living in urban communities today normally have ties within their neighborhoods and across the city. Networks are both local and nonlocal. In this way, gay men and lesbians and African Americans are much like other urban dwellers. Both groups, however, invest a great deal in nurturing local relationships and sharing a common space, perhaps more so than many other urban groups.
Neighborhoods, Aging, and Functional Limitations
Authors: Glass Thomas A. , Balfour Jennifer L.
Published: September 2009

This chapter makes a case for the importance of studying neighborhood effects on functional limitations in late life. It reviews existing literature and proposes a theoretical model to guide future research on the health effects of neighborhoods on older persons. Public policy implications are discussed.
Control of Infectious Diseases: A Twentieth-Century Public Health Achievement
Authors: Levitt Alexandra M. , Drotman D. Peter , Ostroff Stephen
Published: September 2009

The marked decline in infectious-disease-associated mortality that took place in the United States during the first half of the 20th century contributed to the sharp drop in infant and child mortality and the more than thirty-year average increase in life expectancy over the past 100 years. The 19th-century discovery that microorganisms are the cause of many diseases led to substantial improvements in sanitation and hygiene, formulations of vaccinations, development of diagnostic tests, and the introduction of antibiotics. Despite this overall progress, devastating pandemics of infectious diseases occurred during the 20th century including the influenza in 1918 and human immunodeficiency virus first recognized in 1981. This chapter reviews major 20th-century achievements in the control of infectious diseases in the United States and ends with a discussion of challenges for the 21st century.
Advances in Food Safety to Prevent Foodborne Diseases in the United States
Authors: Tauxe Robert V. , Esteban Emilio J.
Published: September 2009

In the United States, the current food supply is broader and far safer than it was 100 years ago. At the start of the 20th century, contaminated foods frequently caused botulism, typhoid fever, septic sore throat, and trichinosis, diseases that now rarely occur. Along with drinking water treatment, sewage sanitation, and pasteurization, food-safety measures have become routine; these measures have been developed and initiated in response to specific public health threats and are continually evolving. The shift of the U.S. food supplies from small local farms to huge global agribusinesses has opened new niches for pathogens, as well as the potential for more systematic disease prevention. The methods public health authorities use to detect, investigate, and understand these public health threats have also advanced over the last century. This chapter, which addresses the progress achieved in the field of food safety, serves to support the continuing effort to make food safer.
A Shot at Protection: Immunizations Against Infectious Disease
Authors: Hinman Alan R. , Orenstein Walter A.
Published: September 2009

Edward Jenner, an 18th century English physician, observed that milkmaids who had recovered from cowpox, did not have the facial scars of smallpox. In 1796, he demonstrated that inoculation of a susceptible individual with material from a cowpox lesion protected against smallpox. The next vaccination (against rabies) was introduced 100 years later. The pace of vaccine introduction then increased with a marked acceleration in the introduction of new vaccines in the last years of the 20th century. The widespread use of vaccines has had a dramatic impact on the occurrence of infectious diseases in the United States. This chapter describes the progress made as a result of immunization as well as the challenges remaining to realize the full current and future potential of immunizations. It focuses on smallpox, poliomyelitis, and measles, and briefly addresses other vaccine-preventable diseases of childhood.